Investigation and control of measles outbreak in Puli-Khumri and Baghlan-Markazi Districts, Baghlan province, Afghanistan: a teaching case-study

Abstract

Measles is a highly contagious viral disease that remains a significant cause of death among young children globally despite the availability of a safe and effective vaccine. Measles is transmitted via droplets from the nose, mouth, or throat of infected persons, and initial symptoms include a high fever, runny nose, bloodshot eyes, and tiny white spots on the inside of the mouth. Several days later, a rash develops, starting on the face and upper neck and gradually spreading downwards. Routine measles vaccination for children, combined with mass immunization campaigns in countries with low routine coverage, are key public health strategies to reduce global measles deaths. In Afghanistan, 25,000 cases were reported in 2017 of which 85% were among children under the age of 10. These cases span over 20 of the 34 provinces across Afghanistan, with the worst affected provinces being Kabul, Paktika, Kunar, Badghis and Ghor. The majority of outbreaks are reported, investigated, and responded to throughout recent years in the country. This current outbreak of measles with an almost two-year duration is investigated and reported from Baghlan province. The goal of this case study is to develop competencies and consolidate understanding of participants to investigate and control outbreaks. This case study stimulates the students to investigate and control a measles outbreak and critically appraise an epidemic report. The case study is designed for training novice field epidemiology trainees. The case study can be administered in 3-4 hours. Used as adjunct training material, the case study provides the trainees with competencies in investigating outbreaks and identifying factors affecting outbreaks.