Nicolas Peyraud

An epidemic of dystonic reactions in central Africa

www.thelancet.com/lancetgh Vol 5 February 2017 e137 bought in a pharmacy or procured at a government health centre. The evidence suggests that this large outbreak of dystonic reactions, in a remote area of central Africa, was caused by the consumption of tablets labelled as diazepam but which in fact contained undeclared haloperidol. No alternative explanation was found to explain the clinical features observed. It is most likely that these were falsifi ed medicines, deliberately and fraudulently mislabelled. This case emphasises the importance of investi gating atypical clinical presentations and the need for multidisciplinary approaches. Meningitis was a reasonable working diagnosis, in a remote community, by primary health-care workers unfamiliar with dystonia. Further investigations revealed that, in this area of DRC, patients frequently receive diazepam over the counter to treat a wide range of illnesses for which diazepam should not have been used according to rational prescribing. Although dystonic reactions are rarely life-threatening, they often cause distress, panic, and shame for patients and their families. Local public perceptions of the outbreak were not linked to the consumption of medication, but rather to meningitis or “evil spells/spirits”. Joint action led to the posting of an international WHO alert about the circulation of falsifi ed diazepam in sub-Saharan Africa. Two types of falsifi ed diazepam have been identifi ed to date. Both products have tablets that are embossed with the mark “AGOG”: falsifi ed diazepam sold in bottles marked “Centaur Solina An epidemic of dystonic reactions in central Africa

The new WHO decision-making framework on vaccine use in acute humanitarian emergencies: MSF experience in Minkaman, South Sudan

IntroductionThe main causes of death during population movements can be prevented by addressing the population’s basic needs. In 2013, the World Health Organization (WHO) issued a framework for decision making to help prioritize vaccinations in acute humanitarian emergencies. This article describes MSF’s experience of applying this framework in addition to addressing key population needs in a displacement setting in Minkaman, South Sudan.Case descriptionMilitary clashes broke out in South Sudan in December 2013. By May 2014, Minkaman, a village in the Lakes State, hosted some 85,000 displaced people. MSF arrived in Minkaman on 28 December 2013 and immediately provided interventions to address the key humanitarian needs (health care, access to drinking water, measles vaccination). The WHO framework was used to identify priority vaccines: those preventing outbreaks (measles, polio, oral cholera vaccine, and vaccine against meningococcal meningitis A (MenAfrivac®)) and those reducing childhood morbidity and mortality (pentavalent vaccine that combines diphtheria, tetanus, whooping cough, hepatitis B, and Haemophilus influenzae type B; pneumococcal vaccine; and rotavirus vaccine). By mid-March, access to primary and secondary health care was ensured, including community health activities and the provision of safe water. Mass vaccination campaigns against measles, polio, cholera, and meningitis had been organized. Vaccination campaigns against the main deadly childhood diseases, however, were not in place owing to lack of authorization by the Ministry of Health (MoH).ConclusionsThe first field use of the new WHO framework for prioritizing vaccines in acute emergencies is described. Although MSF was unable to implement the full package of priority vaccines because authorization could not be obtained from the MoH, a series of mass vaccination campaigns against key epidemic-prone diseases was successfully implemented within a complex emergency context. Together with covering the population’s basic needs, this might have contributed to reducing mortality levels below the emergency threshold and to the absence of epidemics. For the WHO framework to be used to its full potential it must not only be adapted for field use but, most importantly, national decision makers should be briefed on the framework and its practical implementation.

MSFeCARE: an electronic algorithm to improve antibiotic prescription in the management of childhood illness in primary health care

INTRODUCTION: MSFeCARE is an electronic clinical decision support system designed to improve quality of care and rational use of antibiotics for childhood illnesses in children 50% reduction in antibiotic prescriptions and provided valuable information to guide clinical supervision. The tool holds immense potential to improve the quality of care and reduce irrational antibiotic prescription. Plans are underway for further implementation and continued monitoring.