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. 2019 May 29;33(Suppl 2):7.
doi: 10.11604/pamj.supp.2019.33.2.17172. eCollection 2019.

Lessons learned from detecting and responding to recurrent measles outbreak in Liberia post Ebola-Epidemic 2016-2017

Thomas Nagbe  1 , George Sie Williams  2 , Julius Monday Rude  2 , Sumor Flomo  1 , Trokon Yeabah  1 , Mosoka Fallah  1 , Laura Skrip  1 , Chukwuemeka Agbo  2 , Nuha Mahmoud  2 , Joseph Chukwudi Okeibunor  3 , Kwuakuan Yealue  2 , Ambrose Talisuna  3 , Ali Ahmed Yahaya  3 , Soatiana Rajatonirina  3 , Adolphus Clarke  4 , Esther Hamblion  3 , Tolbert Nyenswah  1 , Bernice Dahn  4 , Alex Gasasira  2 , Ibrahima Socé Fall  3
Affiliations

Lessons learned from detecting and responding to recurrent measles outbreak in Liberia post Ebola-Epidemic 2016-2017

Thomas Nagbe et al. Pan Afr Med J. .

Abstract

Introduction: Measles is an acute viral disease that remains endemic in much of sub-Sahara Africa, including Liberia. The 2014 Ebola epidemic disrupted an already fragile health system contributing to low uptake of immunization services, population immunity remained low thus facilitating recurrent outbreaks of measles in Liberia. We describe lessons learnt from detecting and responding to recurrent outbreaks of measles two years post the 2014 Ebola epidemic in Liberia.

Methods: We conducted a descriptive study using the findings from Integrated Diseases Surveillance and Response (IDSR) 15 counties, National Public Health Institute of Liberia (NPHIL), National Public Health Reference Laboratory (NPHRL) and District Health Information Software (DIHS2) data conducted from October to December, 2017. We perused the outbreaks line lists and other key documents submitted by the counties to the national level from January 2016 to December 2017.

Results: From January 2016 to December 2017, 2,954 suspected cases of measles were reported through IDSR. Four hundred sixty-seven (467) were laboratory confirmed (IgM-positive), 776 epidemiologically linked, 574 clinically confirmed, and 1,137 discarded (IgM-negative). Nine deaths out of 1817 cases were reported, a case fatality rate of 0.5%; 49% were children below the age of 5 years. Twenty-two percent (405/1817) of the confirmed cases were vaccinated while the vaccination status of 55% (994/1817) was unknown.

Conclusion: Revitalization of IDSR contributed to increased detection and reporting of suspected cases of measles thus facilitating early identification and response to outbreaks. Priority needs to be given to increasing the uptake of routine immunization services, introducing a second dose of measles vaccine in the routine immunization program and conducting a high-quality supplementary measles immunization campaign for age group 1 to 10 years to provide protection for a huge cohort of susceptible.

Keywords: Integrated disease surveillance and response; alert and epidemic thresholds; immunization; measles; outbreak.

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Conflict of interest statement

The authors declare no competing interest.

Figures

Figure 1
Figure 1
Laboratory confirmed measles cases 2016 and 2017
Figure 2
Figure 2
Measles Epi-Linked cases 2016 and 2017
Figure 3
Figure 3
Clinically compatible measles cases 2016 and 2017
Figure 4
Figure 4
Discarded measles cases 2016 and 2017
Figure 5
Figure 5
Measles attack rate in Liberia 2016 and 2017
Figure 6
Figure 6
Comparison of geographical distribution of confirmed cases of measles in Liberia, 2016 and 2017
See this image and copyright information in PMC

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