Factors contributing to measles transmission during an outbreak in Kamwenge District Western Uganda April to August 2015.

Friday, 12th of January 2018 Print

BMC Infect Dis. 2018 Jan 8;18(1):21. doi: 10.1186/s12879-017-2941-4.

Factors contributing to measles transmission during an outbreak in Kamwenge District Western Uganda April to August 2015.

Nsubuga F1 Bulage L2 Ampeire I3 Matovu JKB4 Kasasa S4 Tanifum P5 Riolexus AA2 Zhu BP5.

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Abstract

BACKGROUND:

In April 2015 Kamwenge District western Uganda reported a measles outbreak. We investigated the outbreak to identify potential exposures that facilitated measles transmission assess vaccine effectiveness (VE) and vaccination coverage (VC) and recommend prevention and control measures.

METHODS:

For this investigation a probable case was defined as onset of fever and generalized maculopapular rash plus ≥1 of the following symptoms: Coryza conjunctivitis or cough. A confirmed case was defined as a probable case plus identification of measles-specific IgM in serum. For case-finding we reviewed patients medical records and conducted in-home patient examination. In a case-control study we compared exposures of case-patients and controls matched by age and village of residence. For children aged 9 m-5y we estimated VC using the percent of children among the controls who had been vaccinated against measles and calculated VE using the formula VE = 1 - ORM-H where ORM-H was the Mantel-Haenszel odds ratio associated with having a measles vaccination history.

RESULTS:

We identified 213 probable cases with onset between April and August 2015. Of 23 blood specimens collected 78% were positive for measles-specific IgM. Measles attack rate was highest in the youngest age-group 0-5y (13/10000) and decreased as age increased. The epidemic curve indicated sustained propagation in the community. Of the 50 case-patients and 200 controls 42% of case-patients and 12% of controls visited health centers during their likely exposure period (ORM-H = 6.1; 95% CI = 2.7-14). Among children aged 9 m-5y VE was estimated at 70% (95% CI: 24-88%) and VC at 75% (95% CI: 67-83%). Excessive crowding was observed at all health centers; no patient triage-system existed.

CONCLUSIONS:

The spread of measles during this outbreak was facilitated by patient mixing at crowded health centers suboptimal VE and inadequate VC. We recommended emergency immunization campaign targeting children <5y in the affected sub-counties as well as triaging and isolation of febrile or rash patients visiting health centers.

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