Abstract
IntroductionIn October 4th, 2018, a measles outbreak was declared in Madagascar. This study describes the epidemiology of the outbreak and determines public health implications for measles elimination in Madagascar.MethodsData have been collected using line list developed for the outbreak. Serum samples were collected within 30 days of rash onset for laboratory testing; confirmation was made by detection of measles immunoglobulin M (IgM) antibody.ResultsA total of 2,930 samples were analysed in the laboratory among which 1,086 (37%) were laboratory confirmed. Measles cases age ranged from a minimum of 1 month to a maximum of 88 years. The median and the mean were 7 years and 9 years respectively. Children between 1 to 9 years accounted for 50.6% of measles cases. Attack rate (39,014 per 1,000,000 inhabitants) and case fatality rate (1.2%) were highest among children aged 9-11 months. A total of 67.2% cases were unvaccinated. As of March 14th, 2019, all the 22 regions and 105 (92%) health districts out of 114 were affected by the measles outbreak in Madagascar.ConclusionMeasles outbreak in Madagascar showed that the country is not on the track to achieve the goal of measles elimination by 2020.
Highlights
IntroductionMeasles is one of the most contagious diseases of humans [1, 2] with a basic reproductive number (the average number of secondary cases produced by a primary case in a completely susceptible population) of 12-18 [3]
Measles is one of the most contagious diseases of humans [1, 2] with a basic reproductive number of 12-18 [3]
This study describes the epidemiology of the outbreak, and determines public health implications for measles elimination in Madagascar
Summary
Measles is one of the most contagious diseases of humans [1, 2] with a basic reproductive number (the average number of secondary cases produced by a primary case in a completely susceptible population) of 12-18 [3]. Measles occurs as a seasonal disease in endemic areas. Patients are usually contagious from about 4 days before occurrence of the rash until 4 days after eruption, when the levels of measles virus in the respiratory tract are highest. Patients improve by the third day after rash onset, and have fully recovered 7-10 days after onset of disease. Most cases of measles occur during the dry season, whereas in temperate zones, incidence peaks during late winter and early spring [1]. On October 4th, 2018, a measles outbreak was confirmed by the National Reference Laboratory. This outbreak started in the capital city, Antananarivo, and extended to all the 22 regions of the Madagascar [9, 10]. This study describes the epidemiology of the outbreak, and determines public health implications for measles elimination in Madagascar
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