Did the Ebola outbreak disrupt immunisation services? A case study from Liberia

Abstract

All health facilities providing routine immunisation services in Liberia. To compare the number of routine facility-based and outreach immunisations and measles cases before, during and after the Ebola outbreak. A descriptive cross-sectional study. Immunisation coverage for fully immunised children before the Ebola outbreak was 73%. Immunisation coverage for all antigens declined by half compared to baseline during the outbreak. These findings were similar in facility-based and outreach immunisations. During the outbreak, the proportion of fully immunised children dropped by respectively 58%, 33% and 39% in the most, moderately and least Ebola-affected counties. Immunisation rate of recovery in the post-Ebola period was respectively 82%, 21% and 9% in the most, moderately and least affected counties compared to the Ebola-outbreak period. Outreach immunisation recovered slowly compared to facility-based immunisation. The mean number of measles cases reported per month was 12 pre-Ebola, 16 Ebola and 60 post-Ebola. This study provides insights into the possible impact of an Ebola outbreak on countrywide immunisation. The outbreak weakened a struggling national immunisation programme, and post-outbreak recovery took significant time, which likely contributed to the measles epidemic. Recommendations for the improvement of immunisation services that could limit further preventable epidemics in Liberia and similar contexts at risk for Ebola are provided.

Impact of Eastern Congo Ebola Outbreak on Child Health Services Delivery: Decline of Routine Child Immunization and Need for Vaccine Supplementation

“…There was a signi cant decrease in the number of vaccine doses administered monthly for all antigens received during the Ebola outbreak (August-October 2018) as compared with the pre Ebola period (May-July 2018). Our results corroborate those found in several other countries affected by EVD [11,16].…”

The 2014–2015 Ebola virus disease outbreak and primary healthcare delivery in Liberia: Time-series analyses for 2010–2016

“…Analyses using routine health information system (RHIS) data originating from Guinea and Sierra Leone have recently chronicled the effect of the EVD epidemic on the delivery of public-sector care for maternal, child, and reproductive health services, showing dramatic decreases during the Ebola outbreak (on the order of 50% declines) and sustained low levels not suggesting recovery [ 3 – 5 ]. Previous descriptive studies using RHIS data from Liberia have shown decreases in maternal and child health (MCH) indicators [ 6 , 7 ], malaria treatment [ 8 ], HIV testing [ 9 ], and tuberculosis diagnoses [ 10 ] during the EVD outbreak. Others have estimated that EVD-related disruptions in treating malaria alone will contribute to significantly more excess deaths than direct EVD-related mortality [ 11 ].…”

What was the effect of the West African Ebola outbreak on health programme performance, and did programmes recover?

“…For example, in Liberia the already struggling immunisation programme was further weakened during the outbreak and took significant time to recover post-Ebola. 19 Nevertheless, most programmes showed rapid recovery post-Ebola, while in others performance was sustained during the outbreak. This is illustrated by studies of the HIV programmes in both countries.…”

“…6 Sixteen studies were conducted, and are assembled here for this special issue. [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] Through the study of routine data the performance of a wide range of programmes was assessed before, during and after the outbreak. These studies present data from mother and child health care services, the human immunodeficiency virus (HIV), tuberculosis, vaccination, malaria, malnutrition and non-communicable diseases programmes.…”