Survey of Protective Measures and H5N1-Seroprevalence Among Bird Collectors During An Avian Influenza A/H5N1 Outbreak on Ruegen, Germany, February-March 2006

Abstract

Background: Despite the availability of measles vaccines since 1959, measles still remains an important public health problem. Particularly, high case fatality rates up to 33% have been reported in displaced populations after a disaster. Objectives: This study defies the epidemiological risk factors of potential measles outbreak among displaced populations after a disaster. Methods: A systematic literature review was conducted and a total of 64 literatures that met the criteria were selected from Pub-Med and Medline. The reports and guidelines fromWorld Health Organization and Center for Diseases Control and Prevention were also reviewed. Findings: Low vaccination coverage among displaced children in camps and surrounding communities and the lack of periodic vaccination were a main risk factor for measles outbreaks. Refugees’ movement and high density has contributed to measles transmission while malnutrition was associated with high case fatality. Moreover, intervention for measles control were often disrupted by ongoing conflict (Sudan 2004), or limited road access (Afghanistan 2001). Accessibility to health care may be limited due to the destruction of health infrastructures (Mexico 1985). Surveillance for measles outbreak detection was often weak due to the rapid alternation of the national surveillance system; specifically when the disaster occurred in countries with limited laboratory capacities and/or lack of trained health staff for surveillance. No adequate surveillance system has been documented specifically for disasters and refugee settings, but syndromic surveillance together with active cases findings were often performed. Conclusion: Morbidity and mortality from measles was often increased after a disaster under circumstances including population movement, malnutrition and low vaccination coverage in addition to the disruption of the health system. Measles is a significant infectious disease in displaced population. More systematic measures should be taken to reduce a risk of measles in such population.