Details:

Alternative Title:
BMC Infect Dis
Personal Author:
Nsubuga, Fred ; Bulage, Lilian ; Ampeire, Immaculate ; Matovu, Joseph K. B. ; Kasasa, Simon ; ... More +
Nsubuga, Fred ; Bulage, Lilian ; Ampeire, Immaculate ; Matovu, Joseph K. B. ; Kasasa, Simon ; Tanifum, Patricia ; Riolexus, Alex Ario ; Zhu, Bao-Ping Less -
Description:
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 (13/10,000), 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.


Subject:
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Case-control Study
Global Health Security
Measles
Research Article
Vaccine Effectiveness
Vaccine Failure

Source:
BMC Infect Dis. 18.
Pubmed ID:
29310585
Pubmed Central ID:
PMC5759285
Document Type:
Journal Article
Funding:
grant number 5U2GGH000817-03)/CC/CDC HHS/United States
Collection(s):
CDC Public Access
Main Document Checksum:
[+]
urn:sha256:6bc80bd74501f2de3d75b9d38028b165fb653cf1d43e22e0ee138abb10b874c6
File Type:

Supporting Files

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