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

Area of Science:

• Public Health
• Epidemiology
• Global Health

Background:

• Routine immunisation services are critical for child health.
• The 2014-2016 Ebola virus disease (EVD) outbreak in West Africa disrupted essential health services, including immunisation.
• Liberia's national immunisation programme faced challenges prior to the EVD outbreak.

Purpose of the Study:

• To compare routine immunisation coverage and measles incidence before, during, and after the Ebola outbreak in Liberia.
• To assess the impact of the Ebola outbreak on facility-based and outreach immunisation services.
• To evaluate the recovery of immunisation services in different Ebola-affected regions.

Main Methods:

• A descriptive cross-sectional study design was employed.
• Data on routine immunisation services and measles cases were collected from health facilities in Liberia.
• Analysis compared pre-outbreak, during-outbreak, and post-outbreak periods, stratified by county-level Ebola impact.

Main Results:

• Routine immunisation coverage for fully immunised children dropped by 50% during the Ebola outbreak.
• Coverage declines varied by county, with the most affected counties experiencing a 58% drop.
• Post-outbreak recovery was slow, particularly for outreach immunisation, and measles cases significantly increased (12 pre-Ebola to 60 post-Ebola per month).

Conclusions:

• The Ebola outbreak significantly weakened Liberia's national immunisation programme.
• The disruption and slow recovery of immunisation services likely contributed to a subsequent measles epidemic.
• Recommendations are provided to strengthen immunisation services and prevent future epidemics in Ebola-affected regions.