Lessons learned from detecting and responding to recurrent measles outbreak in Liberia post Ebola-Epidemic 2016-2017.

Thomas Nagbe,Bernice Dahn,Laura Skrip,Chukwuemeka Agbo,Tolbert Nyenswah,Sumor Flomo,Mosoka Fallah,Ambrose Talisuna,Nuha Mahmoud,Julius Monday Rude,Trokon Yeabah,Soatiana Rajatonirina,Alex Gasasira,Ali Ahmed Yahaya,Ibrahima Socé Fall,Kwuakuan Yealue,Esther Hamblion ,Adolphus T Clarke ,George S.b Williams ,Joseph Okeibunor

doi:10.11604/pamj.supp.2019.33.2.17172

Abstract

IntroductionMeasles is an acute viral disease that remains endemic in much of sub-Sahara Africa, including Liberia. The 2014 Ebola epidemic disrupted an already fragile health system contributing to low uptake of immunization services, population immunity remained low thus facilitating recurrent outbreaks of measles in Liberia. We describe lessons learnt from detecting and responding to recurrent outbreaks of measles two years post the 2014 Ebola epidemic in Liberia.MethodsWe conducted a descriptive study using the findings from Integrated Diseases Surveillance and Response (IDSR) 15 counties, National Public Health Institute of Liberia (NPHIL), National Public Health Reference Laboratory (NPHRL) and District Health Information Software (DIHS2) data conducted from October to December, 2017. We perused the outbreaks line lists and other key documents submitted by the counties to the national level from January 2016 to December 2017.ResultsFrom January 2016 to December 2017, 2,954 suspected cases of measles were reported through IDSR. Four hundred sixty-seven (467) were laboratory confirmed (IgM-positive), 776 epidemiologically linked, 574 clinically confirmed, and 1,137 discarded (IgM-negative). Nine deaths out of 1817 cases were reported, a case fatality rate of 0.5%; 49% were children below the age of 5 years. Twenty-two percent (405/1817) of the confirmed cases were vaccinated while the vaccination status of 55% (994/1817) was unknown.ConclusionRevitalization of IDSR contributed to increased detection and reporting of suspected cases of measles thus facilitating early identification and response to outbreaks. Priority needs to be given to increasing the uptake of routine immunization services, introducing a second dose of measles vaccine in the routine immunization program and conducting a high-quality supplementary measles immunization campaign for age group 1 to 10 years to provide protection for a huge cohort of susceptible.

Highlights

Measles is an acute viral infectious disease caused by a virus in the paramyxovirus family and an important cause of childhood morbidity and mortality [1]
In September 1998, the World Health OrganizationRegional Committee for Africa (WHO/AFRO) adopted the Integrated Disease Surveillance and Response (IDSR) strategy for priority diseases, conditions and events as one of the key aspects of disease control in the WHO African Region that leads to early detection, appropriate investigation, laboratory confirmation and timely response to public health conditions and events [4,5,6]
As a lesson learnt from EVD outbreak in Liberia [7], the strengthened IDSR has led to increased reporting of suspected cases, laboratory confirmation as well as linkage of epidemiological and laboratory data for detection and response to measles outbreaks throughout the country

Summary

Introduction

Measles is an acute viral infectious disease caused by a virus in the paramyxovirus family and an important cause of childhood morbidity and mortality [1]. In September 1998, the World Health OrganizationRegional Committee for Africa (WHO/AFRO) adopted the Integrated Disease Surveillance and Response (IDSR) strategy for priority diseases, conditions and events as one of the key aspects of disease control in the WHO African Region that leads to early detection, appropriate investigation, laboratory confirmation and timely response to public health conditions and events [4,5,6]. The Liberia Ministry of Health (MOH) adapted the second edition of the generic integrated disease surveillance and response technical guideline in 2014 supported by World Health Organization-Regional Office for Africa (AFRO) in collaboration with the United States Centers for Disease Control and Prevention (CDC) in Atlanta. The guidelines aimed at contributing to reduction of mortality, morbidity and disability from diseases, public health events and conditions through timely, accurate, complete reporting and analysis of data for public health action. These lessons and recommendations will contribute to the quality of measles surveillance and response as well as the global measles elimination efforts

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