Pan Afr Med J. 2017 Jun 9;27(Suppl 2):9. doi: 10.11604/pamj.supp.2017.27.2.10705. eCollection 2017.
Measles outbreak investigation in Guji zone of Oromia Region Ethiopia.
Belda K1 Tegegne AA2 Mersha AM2 Bayenessagne MG3 Hussein I1 Bezabeh B2.
Despite the increase of immunization coverage (administrative) of measles in the country there are widespread outbreaks of measles. In this respect we investigated one of the outbreaks that occurred in hard to reach kebeles of Guji Zone Oromia region to identify the contributing factors that lead to the protracted outbreak of measles.
We used a cross-sectional study design to investigate a measles outbreak in Guji zone Oromia region. Data entry and analysis was performed using EPI-Info version 22.214.171.124 and MS-Microsoft Excel.
In three months time a total of 1059 suspected cases and two deaths were reported from 9 woredas affected by a measles outbreak in Guji zone. The cumulative attack rate of 81/100000 population and case fatality ratio of 0.2% was recorded. Of these 821 (77.5%) cases were < 15 years of age and 742 (70%) were zero doses of measles vaccine. Although all age groups were affected under five years old were more affected 495 (48%) than any other age groups. In response to the outbreak an outbreak response immunization was organized at the 11th week of the epidemic when the epidemic curve started to decline. 6 months to14 years old were targeted for outbreak response immunization and the overall coverage was 97 % (range: 90-103%). Case management with vitamin A supplementation active case search and health education was some of the activities carried out to curb the outbreak.
We conclude that low routine immunization coverage in conjunction with low access to routine immunization in hard to reach areas low community awareness in utilization of immunization service inadequate cold chain management and delivery of a potent vaccine in hard to reach woredas/kebeles were likely contributed to the outbreak thats triggered a broad spread epidemic affecting mostly children without any vaccination. We also figured that the case-based surveillance lacks sensitivity and timely confirmation of the outbreak which as a result outbreak response immunization were delayed. We recommend establishing reaching every child (REC) strategy in Guji zone with particular emphasis too hard reach areas to enhance the current immunization service and furthermore to conduct data quality self-assessment or cluster coverage survey to verify the reported high vaccination coverage in some kebeles. We also recommend conducting the second opportunity as a form of supplemental immunization activities in 2-3 year interval or consider the national second dose introduction in the routine immunization system to improve population immunity. We further recommend that there is a need to boost the sensitivity of case-based surveillance system to be able to early detect confirm and react to future epidemics.