Factors contributing to measles transmission during an outbreak in Kamwenge District, Western Uganda, April to August 2015.

Autor: Nsubuga F; Uganda Public Health Fellowship Program - Field Epidemiology Track, Makerere University School of Public Health, P.O. Box 7072, Kampala, Uganda. fred.nsubuga@musph.ac.ug., Bulage L; Uganda Public Health Fellowship Program - Field Epidemiology Track, Makerere University School of Public Health, P.O. Box 7072, Kampala, Uganda., Ampeire I; Uganda National Expanded Program on Immunization, Ministry of Health, Kampala, Uganda., Matovu JKB; Makerere University School of Public Health, Kampala, Uganda., Kasasa S; Makerere University School of Public Health, Kampala, Uganda., Tanifum P; Division of Public Health Protection, Center for Global Health, US Centers for Disease Control and Prevention, Kampala, Uganda., Riolexus AA; Uganda Public Health Fellowship Program - Field Epidemiology Track, Makerere University School of Public Health, P.O. Box 7072, Kampala, Uganda., Zhu BP; Division of Public Health Protection, Center for Global Health, US Centers for Disease Control and Prevention, Kampala, Uganda.
Jazyk: angličtina
Zdroj: BMC infectious diseases [BMC Infect Dis] 2018 Jan 08; Vol. 18 (1), pp. 21. Date of Electronic Publication: 2018 Jan 08.
DOI: 10.1186/s12879-017-2941-4
Abstrakt: Background: In April 2015, Kamwenge District, western Uganda reported a measles outbreak. We investigated the outbreak to identify potential exposures that facilitated measles transmission, assess vaccine effectiveness (VE) and vaccination coverage (VC), and recommend prevention and control measures.
Methods: For this investigation, a probable case was defined as onset of fever and generalized maculopapular rash, plus ≥1 of the following symptoms: Coryza, conjunctivitis, or cough. A confirmed case was defined as a probable case plus identification of measles-specific IgM in serum. For case-finding, we reviewed patients' medical records and conducted in-home patient examination. In a case-control study, we compared exposures of case-patients and controls matched by age and village of residence. For children aged 9 m-5y, we estimated VC using the percent of children among the controls who had been vaccinated against measles, and calculated VE using the formula, VE = 1 - OR M-H , where OR M-H was the Mantel-Haenszel odds ratio associated with having a measles vaccination history.
Results: We identified 213 probable cases with onset between April and August, 2015. Of 23 blood specimens collected, 78% were positive for measles-specific IgM. Measles attack rate was highest in the youngest age-group, 0-5y (13/10,000), and decreased as age increased. The epidemic curve indicated sustained propagation in the community. Of the 50 case-patients and 200 controls, 42% of case-patients and 12% of controls visited health centers during their likely exposure period (OR M-H  = 6.1; 95% CI = 2.7-14). Among children aged 9 m-5y, VE was estimated at 70% (95% CI: 24-88%), and VC at 75% (95% CI: 67-83%). Excessive crowding was observed at all health centers; no patient triage-system existed.
Conclusions: The spread of measles during this outbreak was facilitated by patient mixing at crowded health centers, suboptimal VE and inadequate VC. We recommended emergency immunization campaign targeting children <5y in the affected sub-counties, as well as triaging and isolation of febrile or rash patients visiting health centers.
Databáze: MEDLINE
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