Women and children wait to be treated at a Medecins Sans Frontieres (MSF) support clinic in Thaker, Southern Unity, South Sudan March 20, 2017. Picture taken March 20, 2017.

Siegfried Modola / Reuters</s>NAMORUNYANG, South Sudan — In a remote village in South Sudan, 15 children died from severe toxicity caused by contaminated measles vaccines, government health investigators said Thursday. The National Adverse Events Following Immunization Committee, supported by the World Health Organization, and UNICEF vaccine safety experts examined the cases and those of 32 other children who suffered fever, vomiting and diarrhea.

About 300 people had received inoculations against measles in the village of Nachodokopele during a recent four-day vaccination campaign. The village is in Namorunyang state, which borders Ethiopia and is part of South Sudan’s Equatoria region.

Evidence gathered by the investigators indicates that vaccination team members, who were neither qualified nor properly trained, did not adhere to immunization safety standards approved by the WHO.

A single syringe was reused during the campaign instead of being discarded after a single use. The investigators say that reuse caused a syringe to become contaminated, and this contaminated the measles vaccine vials, which then infected the children.

Measles is a highly contagious, serious disease caused by a virus, yet a safe and cost-effective vaccine is available.

“Measles vaccine is supplied as a freeze-dried product. It’s like a powder in a vial,” said Dr. William Schaffner, an infectious disease specialist and professor of preventive medicine at Vanderbilt University. This powder must be mixed with an approved diluent — or diluting liquid — that comes in another vial, and once combined, “you have an active vaccine that can be used.”

The process requires “good aseptic technique,” an approved health care method to prevent contamination, said Schaffner, who is also a spokesman for the Infectious Diseases Society of America. Aseptic technique would include not reusing a syringe.

The vaccination team also failed to follow temperature range recommendations to preserve the quality of the inoculations. Instead, they stored the vaccines in facilities that lacked proper temperature control for four days, the investigation found.

“The measles vaccine is a live virus vaccine,” Schaffner said, which has been weakened, so it provides protection without making people sick.

“It’s also heat-sensitive, so if you reconstitute it and then leave it around — lying around in hot temperatures — if you delay administering it, then the vaccine’s effectiveness diminishes,” he said.

If you somehow contaminate the vaccine, an improper temperature “gives an opportunity for the bad germs that have been introduced into the vaccine to multiply. It’s like putting them into an incubator. So then the bad germs can actually grow up, and then when you do administer the vaccine, you’re administering a much larger dose of the germ itself.”

This is much more likely to lead to a serious infection, such as sepsis.

The South Sudan Ministry of Health has commissioned an administrative committee to review the report and offer suggestions for actions to improve vaccine delivery going forward, according to the WHO.

The Ministry of Health could not be reached for comment for this report.

A country in east-central Africa, South Sudan borders Sudan, Ethiopia, Kenya, Uganda, Democratic Republic of the Congo and the Central African Republic. In 2011, South Sudan gained its independence from Sudan, yet it has struggled with governance, according to the CIA World Factbook. Though a peace agreement was signed by warring parties in 2015, fighting broke out between the two principal parties that signed the agreement, and the country re-entered conflict in July.

As of July, the total population of South Sudan was 12.5 million. In February, the UN announced a formal declaration of famine in parts of Unity state, where 4.9 million are in need of help.

Risk of measles and other preventable diseases is extremely high in South Sudan due to a backlog of unvaccinated children in areas of insecurity. The country has experienced significant measles outbreaks.

“In 2013, there were 145,700 measles deaths globally,” the WHO said. “In refugee settings, the death rate from measles may be as high as 30%.”

Worldwide, more than 2 billion children have been protected against measles by the vaccine.

“The vaccine is extraordinarily effective in preventing these infections. We’d like to give it to every child in the world,” Schaffner said. In use since the late 1960s, the vaccine offers children lifelong protection against the measles virus.

“It’s likely there were a whole series of errors in the administration of the vaccine (in Nachodokopele) for something this tragic to occur,” he said. “It’s, fortunately, enormously rare.”</s>A Botched Vaccine Campaign For Measles Killed 15 Children in South Sudan

In a tragic turn in South Sudan, an effort to protect 15 children ended up killing them.

The children, all under age 5, died of severe sepsis and toxicity due to a botched vaccination campaign, according to a joint statement issued Thursday by UNICEF and the World Health Organization.

The vaccine had been left unrefrigerated. One syringe was reused over the course of four days.

The campaign, which took place in early May in the rural town of Kapoeta, was part of an effort by the South Sudan government to vaccinate 2 million children against measles. The vaccines were provided by UNICEF. The World Health Organization provided some training on how to administer the vaccines.

How could something like this happen?

We talked to William Moss — a professor of epidemiology and immunology at the Johns Hopkins Bloomberg School of Public Health and the head of epidemiology at the International Vaccine Access Center — about what went wrong.

This interview has been edited for length and clarity.

This is a tragedy on so many levels. How could this have happened?

South Sudan has been plagued by a civil war, conflict, famine and other outbreaks for three years. Measles vaccination campaigns are complex operations with logistical challenges — and this is a place with poor health infrastructure. That's not an excuse, but it provides some context in understanding how such a thing could have happened.

In addition to the deaths, 32 children were sickened from the 300-person vaccination campaign in South Sudan. What went wrong, exactly?

Untrained people were administering the vaccine. The measles vaccine needs to be diluted. One has to take a liquid and mix it with the dry form, and that's where the error occurred. The [WHO and UNICEF] report says they used the same syringe to reconstitute the vaccine [instead of discarding it after single use]. If that vaccine vial gets contaminated with a toxin or bacteria, then gets injected into a child, that's what causes disease and death.

Some reports are saying children as young as 12 years old were administering the vaccine.

I have never heard of children being used in a vaccination campaign before, so this would be highly, highly unusual. Measles is administered with a needle and syringe. In measles vaccination campaigns, it's trained health care workers who deliver the vaccine. For polio vaccines where it's oral, you can have trained lay people administer the vaccine, but not children. If in fact children were administering the vaccine, that's inexcusable.

Does this show that there was pressure to rush this measles campaign in South Sudan? In 2016, there were 2,294 suspected measles cases.

Measles is a public health problem [in South Sudan]. A measles outbreak can be devastating with high death rates in part because of the undernutrition of the population and the lack of access to health care services. You have the urgent need to get the population vaccinated — but in this village where [this vaccination campaign] occurred, there was improper staffing in terms of administering the vaccines.

Do you anticipate this will slow down vaccination campaigns around the world?

That's obviously a big concern. This is a tragedy on multiple levels, primarily for the children and families who were involved in this. When an event like this happens, there's a lot of concern that this will decrease the willingness of parents to have their children vaccinated against measles.

What people need to know is that this is a rare event. The problem is not the measles vaccine, which is very safe. This is a failure of the health system.

According to the Red Cross in South Sudan, some mothers are angry and are unconvinced they should take their children to get vaccinated. What will groups need to do to reassure these mothers that vaccines are safe?

The organizations involved in the campaign, such as WHO and UNICEF, need to ensure that anyone administering the measles vaccine in South Sudan is trained and qualified to do so. The government of South Sudan needs to ensure that this doesn't happen again.

Oftentimes in these types of settings, it comes down to community leaders. Groups like the Red Cross and [aid groups] on the ground would need to engage with those leaders to point out the value and importance of measles vaccinations, particularly in these communities at high risk of measles outbreaks and deaths. If not, it might be extremely difficult to turn this around.

Given the anti-vaccine movement in the West and skepticism about vaccines in many poorer nations, how much of a setback is this for vaccine efforts around the world?

The anti-vaccine movement is complicated. But my understanding is that the argument against vaccines is not based on this type of event. They raise different issues, but not around the possibility of a vaccine vial getting contaminated with bacteria or people dying from toxins.

Still, events like these generate a lot of negative publicity around vaccines. Anytime there's an event like this, it's a major setback for the global vaccine efforts. It takes a long time to establish trust.

What else should we know about the measles vaccine?

We have to remember that the introduction of the measles vaccine saves millions of children's lives each year. Prior to the introduction of the measles vaccine in the 1960s, millions of children died each year from measles. Now slightly over 100,000 people are estimated to die each year. This is an enormous public health success story.

This is why the measles vaccine campaign continued in South Sudan after this tragedy. This wasn't a problem with the vaccine. This was a problem unique to that village.</s>South Sudan's government said 15 young children have died in a botched measles vaccination campaign which saw people as young as 12 years old administering the vaccines.

The health ministry on Friday blamed the deaths on human error. One syringe was used for all the children, and the vaccine was not stored properly.

The government said all of the children who died were under the age of five. It is setting up a commission to determine who is responsible and whether victims' families will be compensated.

The measles vaccination campaign is targeting more than two million children across the country.

The World Health Organisation provides some training to South Sudan's health officials and the UN children's agency provides the vaccines to the government.</s>Nairobi: Fifteen young children have died in a botched measles vaccination campaign that saw people as young as 12 years old administering the vaccines, South Sudan's government announced on Friday.

The health ministry blamed the deaths on human error. One syringe was used for all the children, and the vaccine was not stored properly.

Measles is yet another challenge facing the desperately poor country that has already been devastated by more tha three years of civil war and a recently declared famine, a well as a cholera outbreak.

The government said all of the children who died were under the age of five. It is setting up a commission to determine who is responsible and whether victims' families will be compensated.

The measles vaccination campaign is targeting more than millions of children across the country. About 300 children were targeted in the area where the children's deaths occurred.

The children died in the town of Kapoeta in early May and other children have become gravely ill after the vaccination campaign.

Abdulmumini Usman, the South Sudan country director for the World Health Organisation, told The Associated Pres earlier this week that even after the organisation became aware of the deaths, the measles campaign continued across the country except in Kapoeta.

"This campaign is lifesaving," Usman said.

WHO provides some training to South Sudan's health officials and the UN children's agency provides the vaccine to the government. It was not immediately clear whether any UN officials were present at the time of the botched vaccinations.

Dr Samson Baba, an immunisation official in the ministry of health, refused to comment on the deaths earlier this week and instead demanded the source of the information. South Sudan's government on Friday said vaccinations are no being denied to any part of the country, including those held by opposition forces.

The civil war has killed tens of thousands and sent more than 1.8 million people fleeing the country, creating the world's fastest-growing refugee crisis.

In 2016, South Sudan had at least 2,294 measles cases and 28 people died, according to UN data.</s>Botched measles vaccines claimed the lives of 15 South Sudanese children near the Kenyan border, health officials said on Friday.

“An investigation into the cause of the death of 15 children in the rural and remote Nachodopele village. has concluded that the severe sepsis/toxicity resulting from the administration of a contaminated vaccine caused the event”, Health Minister Riek Gai Kok told reporters.

The same syringe was used, without sterilisation, on 300 children during a four-day vaccination campaign.

In a joint statement, the World Health Organization and UNICEF said another 32 children suffered fever, vomiting and diarrhoea but recovered.

The campaign came amid a measles outbreak that has killed 70 children this year, the latest tragedy to strike the world’s youngest nation, which has been gripped by civil war for over three years – affecting its ability to deliver decent healthcare. The nation is also dealing with severe starvation and a cholera outbreak.

According to the government, the same syringe was used for all the children last month and the vaccine was not stored properly.

Measles is caused by a virus and can be serious and potentially deadly, especially for babies and young children. There are also protocols for the cold-chain storage of vaccines, and these were not followed. The Ministry of Health has commissioned a multiagency administrative committee to review the AEFI report and make appropriate recommendations for better vaccine administration.

South Sudan’s health ministry blamed the deaths on human error. The vaccine is supposed to be kept in the dark at between 2°C and 8°C.

South Sudan has been embroiled in a bloody civil war for three years now, which has led to the deaths of tens of thousand of people and created the fastest-growing refugee crisis in the world, where almost two million South Sudanese have fled the country.

The organisation provides some training to South Sudan’s health officials, while the United Nations children’s agency provides the vaccines.

Do you ever have any question about anything you wish to ask and get answer?

Do you something awesome to share with the world?</s>JUBA, South Sudan (AP) — Fifteen young children have died in a botched measles vaccination campaign that saw people as young as 12 years old administering the vaccines, South Sudan’s government announced Friday.

The United Nations said the children died of “severe sepsis/toxicity” from the contaminated vaccine, and the health ministry blamed the deaths on human error. One syringe was used for all the children during the four-day campaign, and the vaccine was stored without refrigeration the entire time.

Measles is yet another challenge facing the desperately poor East African country that already has been devastated by more than three years of civil war and a recently declared famine, as well as a cholera outbreak.

The government said all of the children who died were under the age of 5. It is setting up a commission to determine who is responsible and whether victims’ families will be compensated.

The measles vaccination campaign is targeting more than 2 million children across the country. About 300 children were targeted in the area where the children’s deaths occurred.

The children died in the rural town of Kapoeta in early May. Another 32 children suffered fever, vomiting and diarrhea but recovered, a joint statement by the World Health Organization and the U.N. children’s agency UNICEF said.

Abdulmumini Usman, the South Sudan country director for the World Health Organization, told The Associated Press earlier this week that even after the organization became aware of the deaths, the measles campaign continued across the country except in Kapoeta.

“This campaign is lifesaving,” Usman said.

WHO provides some training to South Sudan’s health officials and the U.N. children’s agency provides the vaccines to the government. It was not immediately clear whether any U.N. officials were present at the time of the botched vaccinations.

The joint statement by WHO and UNICEF said the vaccination team involved in the deaths was “neither qualified nor trained.” It called the deaths a “tragic event.”

Dr. Samson Baba, an immunization official in the ministry of health, refused to comment on the deaths earlier this week, instead demanding the source of the information.

South Sudan’s government on Friday also said vaccinations are not being denied to any part of the country, including those held by opposition forces.

The civil war has killed tens of thousands and sent more than 1.8 million people fleeing the country, creating the world’s fastest-growing refugee crisis.

In 2016, South Sudan had at least 2,294 measles cases and 28 people died, according to U.N. data. So far this year, at least one person has died and 665 people have been infected.

Friday’s U.N. statement said the risk of measles in the country remains “extremely high.”</s>used 1 syringe for all children//left the vaccine out//was not refrigerated//made it contaminated//no excuse for it</s>Fifteen children died in South Sudan after receiving contaminated measles vaccines that had not been properly refrigerated, and were mixed using the same syringe for four days.

In addition to the blunders handling the vaccine, Health Minister Riek Gai Kok said that two children, aged 12 and 13, had been recruited to administer it.

An investigation showed that local officials failed to follow immunisation guidelines during a four-day campaign to vaccinate around 300 people in the southeastern state of Kapoeta in May, Kok said.

"The team that vaccinated the children in this tragic event were neither qualified not trained for the immunisation," he added.

The campaign came amid a measles outbreak that has killed 70 children this year, the latest tragedy to strike the world's youngest nation, which has been gripped by civil war for over three years -- affecting its ability to deliver decent healthcare.

The country has also been affected by repeated bouts of cholera.

"A single reconstitution syringe was used for multiple vaccine vials for the entire four days of the campaign instead of being discarded after single use," Kok said, referring to the device used to mix vaccines before injecting them with a separate syringe.

"The reuse of the reconstitution syringe causes it to become contaminated which in turn contaminates the measles vaccine vials and infects the vaccinated children."

"The vaccines were stored in a building with no cold chain facilities for four days," said Kok.

He did not expand on the use of children to administer the vaccines, saying only: "Recruiting children of twelve and thirteen that is unacceptable but we are going to find out how did it happen."

The investigation, supported by the World Health Organisation (WHO) and the UN children's agency UNICEF, determined that the children in the remote village of Nachodepele died from "the administration of a contaminated vaccine".

Another 32 children suffered similar symptoms of fever, vomiting and diarrhoea but recovered.

According to the WHO, measles vaccines are freeze-dried and need to be reconstituted with a diluting agent just before being administered. The vaccine is supposed to be kept in the dark at between 2°C and 8°C.

"This year alone we have received 70 children (who have died) of measles .... Vaccines are safe if (officials) follow the guidelines," said WHO country director Abdulmumin Usman.

Nearly two million people have fled South Sudan, which is also suffering a famine induced by the conflict. Tens of thousands of people have been killed in fighting.</s>NAIROBI, Kenya (AP) — South Sudan says 15 young children die in botched measles vaccination campaign.
Fifteen young children die of "severe sepsis/toxicity" from contaminated vaccine during South Sudan's measles vaccination campaign. In one instance, a syringe containing vaccine stored without refrigeration was used for all the children over four days.