Measles outbreak investigation in an urban slum of Kaduna Metropolis, Kaduna State, Nigeria, March 2015.

Obafemi Joseph Babalola,Adebola Olayinka,Patrick Nguku,Aisha Abubakar,Saheed Gidado,Ibrahim Usman Kusfa,Ismaila Nda Ibrahim

doi:10.11604/pamj.2019.32.150.15764

Abstract

IntroductionDespite availability of an effective vaccine, the measles epidemic continue to occur in Nigeria. In February 2015, we investigated a suspected measles outbreak in an urban slum in Rigasa, Kaduna State, Nigeria. The study was to confirm the outbreak, determine the risk factors and implement appropriate control measures.MethodsWe identified cases through active search and health record review. We conducted an unmatched case-control (1:1) study involving 75 under-5 cases who were randomly sampled, and 75 neighborhood controls. We interviewed caregivers of these children using structured questionnaire to collect information on sociodemographic characteristics and vaccination status of children. We collected 15 blood samples for measles IgM using Enzyme Linked Immunosorbent Assay. Descriptive, bivariate and logistic regression analyses were performed using Epi-info software. Confidence interval was set at 95%.ResultsWe recorded 159 cases with two deaths {case fatality rate = 1.3%}. 50.3% (80) of the cases were male. Of the 15 serum samples, 11(73.3%) were confirmed IgM positive for measles. Compared to the controls, the cases were more likely to have had no or incomplete routine immunization (RI) [adjusted odds ratio (AOR) (95% confidence interval (CI)]: 28.3 (2.1, 392.0), contact with measles cases [AOR (95% CI)]: 7.5 (2.9, 19.7), and having a caregiver younger than 20 years [AOR (95% CI)]: 5.2 (1.2, 22.5). Measles serum IgM was positive in 11 samples.ConclusionWe identified low RI uptake and contact with measles cases as predictors of measles outbreak in Rigasa, Kaduna State. We recommended strengthening of RI and education of care-givers' on completing RI schedule.

Highlights

IntroductionHighly contagious vaccine preventable viral disease which usually affects younger children
Measles is an acute, highly contagious vaccine preventable viral disease which usually affects younger children
The index case for this outbreak was a 10 months old female child that had maculopapular rash on 5th January, 2015. She was unvaccinated for measles and never had any immunization for vaccine preventable diseases according to Expanded Programme on Immunization (EPI) schedule

Summary

Introduction

Highly contagious vaccine preventable viral disease which usually affects younger children. Being unvaccinated against measles is a risk factor for contracting the disease [3]. Other factors responsible for measles outbreak and transmissions in developing countries are; lack of parental awareness of vaccination importance and compliance with routine immunization schedule, household overcrowding with easy contact with someone with measles, acquired or inherited immunodeficiency states and malnutrition [4,5,6]. Measles case fatality rate (CFR) in developing countries are normally estimated to be 3-5%, but may reach 10-30% compared with 0.1% reported from industrialized countries [2]. Nigeria is second to India among ten countries with large number of unvaccinated children for measles, and has 2.7 million of the 21.5 million children globally that have zero dose for measles containing vaccine (MCV1) in 2013 [9]. In 2012, 2,553 measles cases were reported in Nigeria, an increase from 390 cases reported in 2006 [10]

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Discussion

Conclusion