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Background. A measles outbreak in Pohnpei State, Federated States of Micronesia in 2014 affected many persons who had received ≥1 dose of measles-containing vaccine (MCV). A mass vaccination campaign targeted persons aged 6 months to 49 years, regardless of prior vaccination.Methods. We evaluated vaccine effectiveness (VE) of MCV by comparing secondary attack rates among vaccinated and unvaccinated contacts after household exposure to measles.Results. Among 318 contacts, VE for precampaign MCV was 23.1% (95% confidence interval [CI], −425 to 87.3) for 1 dose, 63.4% (95% CI, −103 to 90.6) for 2 doses, and 95.9% (95% CI, 45.0 to 100) for 3 doses. Vaccine effectiveness was 78.7% (95% CI, 10.1 to 97.7) for campaign doses received ≥5 days before rash onset in the primary case and 50.4% (95% CI, −52.1 to 87.9) for doses received 4 days before to 3 days after rash onset in the primary case. Vaccine effectiveness for most recent doses received before 2010 ranged from 51% to 57%, but it increased to 84% for second doses received in 2010 or later.Conclusions. Low VE was a major source of measles susceptibility in this outbreak; potential reasons include historical cold chain inadequacies or waning of immunity. Vaccine effectiveness of campaign doses supports rapid implementation of vaccination campaigns in outbreak settings.

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Pohnpei State’s Division of Primary Health Care implemented enhanced surveillance for early warning and detection of disease to support the 8th Micronesian Games (the Games) in July 2014.The surveillance comprised 11 point-of-care sentinel sites around Pohnpei, Federated States of Micronesia, collecting data daily for eight syndromes using standard case definitions. Each sentinel site reported total acute care encounters, total syndrome cases and the total for each syndrome. A public health response, including epidemiological investigation and laboratory testing, followed when syndrome counts reached predetermined threshold levels.The surveillance was implemented using the web-based Suite for Automated Global Electronic bioSurveillance Open-ESSENCE (SAGES-OE) application that was customized for the Games. Data were summarized in daily situation reports (SitReps) issued to key stakeholders and posted on PacNet, a Pacific public health e-mail network.Influenza-like illness (ILI) was the most common syndrome reported (55%, n = 225). Most syndrome cases (75%) were among people from Pohnpei. Only 30 cases out of a total of 408 syndrome cases (7%) presented with acute fever and rash, despite the large and ongoing measles outbreak at the time. No new infectious disease outbreak was recorded during the Games. Peaks in diarrhoeal and ILI cases were followed up and did not result in widespread transmission.The technology was a key feature of the enhanced surveillance. The introduction of the web-based tool greatly improved the timeliness of data entry, analysis and SitRep dissemination, providing assurance to the Games organizers that communicable diseases would not adversely impact the Games.

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BackgroundHuman leptospirosis is an emerging infectious disease of global significance, and is endemic to several countries in the Pacific. Zoonotic transmission dynamics combined with diagnostic challenges lead to difficulties in prevention and identification of cases. The Federated States of Micronesia (FSM) lacks surveillance data for human leptospirosis. This hospital-based serologic survey sought to estimate the burden of leptospirosis, collect information relating to associated factors, and assess the leptospirosis point-of-care rapid diagnostic test (RDT) commonly used in FSM.MethodsA four-month hospital-based survey was conducted in Pohnpei State, FSM in 2011. Patients with undifferentiated fevers presenting to hospital were referred for enrolment by physicians. Consenting participants provided paired blood specimens 10–30 days apart, and responded to interview questions regarding demographics, clinical symptoms, exposure to animals, and environmental exposure. Blood samples were subjected to immunochromatographic RDT and confirmed by microscopic agglutination test (MAT).ResultsOf 54 participants tested by MAT, 20.4% (95% confidence interval [CI] 10.1–30.6%) showed serologic evidence of acute infection. Occupation student (odds ratio [OR], 17.5; 95% CI: 1.9–161.1) and recreational gardening (OR, 8.6; 95% CI: 1.0-73.8), identified by univariate logistic regression, were associated with infection. The local rapid diagnostic test (RDT) performed with a sensitivity of 69.2 (42.3-89.3 CI) and specificity of 90.0 (81.6-95.6 CI) compared to MAT.ConclusionsThis study demonstrated a high burden of leptospirosis in Pohnpei. Further work is warranted to identify additional risk factors and opportunities to control leptospirosis in Pohnpei and other Pacific settings.

Antimicrobial stewardship (AMS) has emerged as a systematic approach to optimize antimicrobial use and reduce antimicrobial resistance. To support the implementation of AMS programs, the World Health Organization developed a draft toolkit for health care facility AMS programs in low- and middle-income countries. A feasibility study was conducted in Bhutan, the Federated States of Micronesia, Malawi, and Nepal to obtain local input on toolkit content and implementation of AMS programs. This descriptive qualitative study included semi-structured interviews with national- and facility-level stakeholders. Respondents identified AMS as a priority and perceived the draft toolkit as a much-needed document to further AMS program implementation. Facilitators for implementing AMS included strong national and facility leadership and clinical staff engagement. Barriers included lack of human and financial resources, inadequate regulations for prescription antibiotic sales, and insufficient AMS training. Action items for AMS implementation included improved laboratory surveillance, establishment of a stepwise approach for implementation, and mechanisms for reporting and feedback. Recommendations to improve the AMS toolkit’s content included additional guidance on defining the responsibilities of the committees and how to prioritize AMS programming based on local context. The AMS toolkit was perceived to be an important asset as countries and health care facilities move forward to implement AMS programs.