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. 2019 Feb 15;19(1):201.
doi: 10.1186/s12889-019-6511-0.

Epidemiological characteristics and trends of a Nationwide measles outbreak in Mongolia, 2015-2016

Oyunchimeg Orsoo  1   2 , Yu Mon Saw  3   4 , Enkhbold Sereenen  1   5 , Buyanjargal Yadamsuren  2 , Ariunsanaa Byambaa  6 , Tetsuyoshi Kariya  1   7 , Eiko Yamamoto  1 , Nobuyuki Hamajima  1
Affiliations

Epidemiological characteristics and trends of a Nationwide measles outbreak in Mongolia, 2015-2016

Oyunchimeg Orsoo et al. BMC Public Health. .

Abstract

Background: Mongolia was one of the four countries that received a measles-elimination certificate from the World Health Organization Regional Office for the Western Pacific in 2014. Following the outbreaks in many countries including China, a large measles outbreak occurred in Mongolia in 2015. This study reports 2015-2016 measles outbreak incidence, mortality, and complications, according to time, geographical distribution, and host characteristics.

Methods: The epidemiological characteristics and trends of measles outbreak were analyzed using the Mongolian national surveillance data reported to the Center for Health Development, Ministry of Health, from January 2015 to December 2016.

Results: In total, 23,464 cases of measles including eight deaths were reported in 2015, and 30,273 cases of measles including 132 deaths were reported in 2016, which peaked in June 2015 and March 2016, respectively. Majority of the cases were reported from Ulaanbaatar (35,397, 65.9%). The highest attack rates were 241 per 10,000 population in Darkhan-Uul aimag, and 263 per 10,000 population in Ulaanbaatar. Measles-related death, nosocomial infection, and complications were most frequent among children aged < 1 year.

Conclusions: Following no reports of measles since 2011, a large nationwide outbreak occurred in Mongolia, despite the high vaccination coverage in the past. The highest incidence rate was reported in Ulaanbaatar city, and Umnugovi aimag in 2015 and Darkhan-Uul aimag in 2016. The most affected age group were aged < 1 year and those aged 15-24 years. Mortality cases were prominent among children aged < 1 year who were not eligible for vaccination. A systematic vaccination strategy is required to prevent another measles outbreak.

Keywords: Elimination; Measles; Mongolia; Outbreak; Reported cases; Vaccination.

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Conflict of interest statement

Ethics approval and consent to participate

The study protocol was approved by the Bio Medical Science Ethical Inspection Committee of Ministry of Health, Mongolia (Ref. no: 01/2017). The permission to use official statistical data of measles reported cases from national surveillance database was obtained from the Center for Health Development, Ministry of Health, Mongolia (Ref. no: 02/2017). Individuals’ information such as name, health insurance card number, and address were applied de-identification procedure to maintain confidentiality of respondents. This procedure was applied at all stage of data analysis.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Map of Mongolia. Mongolia consists of 21 aimags and Ulaanbaatar city
Fig. 2
Fig. 2
The incidence of measles in Mongolia, from March 2015 to December 2016. The incidence of all reported measles cases in the crude number is shown according to the date of rash onset, from March 2015 to December 2016. The number of death cases is shown on the right axis according to the date of death. SIA: Supplementary immunization activity
Fig. 3
Fig. 3
Geographical distribution of measles in Mongolia, from March 2015 to December 2016, The attack rate per 10,000 population in each aimag is categorized into 0, 0.1–10, 10–20, 20–40, 40–80, > 80, from March 2015 to December 2016
Fig. 4
Fig. 4
Age distribution of measles in Mongolia, from March 2015 to December 2016
Fig. 5
Fig. 5
Geographical distribution of death cases due to measles in Mongolia, from March 2015 to December 2016. The mortality rate per 10,000 population in each aimag is shown, from March 2015 to December 2016
Fig. 6
Fig. 6
Complications of death cases (n = 140). Complications of measles-related death cases are categorized into five groups: encephalitis, B05.0; encephalitis + pneumonia, B05.0 and B05.2, J18.0 or J18.8; pneumonia, B05.2; meningitis, B05.8; and others, B05.8. The number of death cases with pneumonia (encephalitis + pneumonia, pneumonia) are significantly higher in children aged 0–6 months than those in the other age groups (P < 0.05; OR, 2.4; 95% CI, 1.9–5.3)
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