A measles outbreak propagated by children congregating at water collection points: Mayuge District, Eastern Uganda, October 2016

Atuhairwe²,

Bulage³

et al. 2020

Preprint

Self Cite

Background: Measles is a highly infectious viral disease. In August 2017, Lyantonde District, Uganda reported a measles outbreak to Uganda Ministry of Health. We investigated the outbreak to assess the scope, factors facilitating transmission, and recommend control measures.Methods: We defined a probable case as sudden onset of fever and generalized rash in a resident of Lyantonde, Lwengo, or Rakai Districts from 1 June-30 September 2017, plus ≥1 of the following: coryza, conjunctivitis, or cough. A confirmed case was a probable case with serum positivity of measles-specific IgM. We conducted a neighborhood- and age-matched case-control study to identified exposure factors, and used conditional logistic regression to analyze the data. We estimated vaccine effectiveness and vaccination coverage.Results: We identified 81 cases (75 probable, 6 confirmed); 4 patients (4.9%) died. In the case-control study, 47% of case-patients and 2.3% of controls were hospitalized at Lyantonde Hospital pediatric department for non-measles conditions 7-21 days before case-patient’s onset (ORadj=34, 95%CI: 5.1-225). Estimated vaccine effectiveness was 95% (95%CI: 75-99%) and vaccination coverage was 76% (95%CI: 68-82%). During the outbreak, an “isolation” ward was established inside the general pediatric ward where there was mixing of both measles and non-measles patients. Conclusions: This outbreak was amplified by nosocomial transmission and facilitated by low vaccination coverage. We recommended moving the isolation ward outside of the building, supplemental vaccination, and vaccinating pediatric patients during measles outbreaks.

Section: Discussioncontrasting

confidence: 87%

Measles Outbreak Amplified in a Pediatric Ward: Lyantonde District, Uganda, August 2017

Atuhairwe²,

Bulage³

et al. 2020

Preprint

Self Cite

“…The estimated VE for the one-dose vaccination during this investigation (95%) was higher than previous estimates of 64% (14) 75% (23) and 77% (24) ; however, the confidence interval for the current estimate (80-100%) overlaps with those of the previous estimates [17-85% (14) and 25-92% (23), respectively]. Observed VE in the field varies and is influenced by many factors, such as number of doses administered, vaccine quality, cold-chain failure, and host factors (25).…”

Section: Discussioncontrasting

confidence: 87%

“…Outbreaks have been recently reported in various parts of the country, and this outbreak is likely linked to one of more of those recent outbreaks, several of which have also been linked to exposure in healthcare settings (14). In another outbreak, measles was associated with congregation of children at water-collection points (23). In this outbreak, though, visiting watercollection points was protective.…”

Section: Discussionmentioning

confidence: 77%

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Measles Outbreak Amplified in a Pediatric Ward: Lyantonde District, Uganda, August 2017

Atuhairwe²,

Bulage³

et al. 2019

Preprint

Self Cite

Background: Measles is a highly infectious viral disease. In August 2017, Lyantonde District, Uganda reported a measles outbreak to Uganda Ministry of Health. We investigated to assess the outbreak scope, factors facilitating transmission, and recommend control measures. Methods: We defined a probable case as sudden onset of fever and generalized rash in a resident of Lyantonde, Lwengo, or Rakai Districts from 1 June-30 September 2017, plus ≥1 of the following: coryza, conjunctivitis, or cough. A confirmed case was a probable case with serum positivity of measles-specific IgM. We conducted a neighborhood- and age-matched case-control study to identified exposure factors, and used conditional logistic regression to analyze the data. We estimated vaccine effectiveness and vaccination coverage. Findings: We identified 81 cases (75 probable, 6 confirmed); 4 patients (4.9%) died. In the case-control study, 47% of case-patients and 2.3% of controls were hospitalized at Lyantonde Hospital pediatric department for non-measles conditions 7-21 days before case-patient’s onset (ORadj=34, 95%CI: 5.1-225). Estimated vaccine effectiveness was 95% (95%CI: 75-99%) and vaccination coverage was 76% (95%CI: 68-82%). During the outbreak, an “isolation” ward was established inside the pediatric ward. Measles and non-measles patients were mixed in regular pediatric wards. Conclusion:This outbreak was amplified by nosocomial transmission and facilitated by low vaccination coverage. We recommended moving the isolation ward outside of the building, supplemental vaccination, and vaccinating pediatric patients during measles outbreaks.

“…Outbreaks have been recently reported in various parts of the country, and this outbreak is likely linked to one of more of those recent outbreaks, several of which have also been linked to exposure in healthcare settings (14). In another outbreak, measles was associated with congregation of children at water-collection points (24). In this outbreak, visiting water-collection points was protective.…”

Section: Discussionmentioning

confidence: 79%

Measles Outbreak Amplified in a Pediatric Ward: Lyantonde District, Uganda, August 2017

Atuhairwe²,

Bulage³

et al. 2020

Preprint

Self Cite

Background: Measles is a highly infectious viral disease. In August 2017, Lyantonde District, Uganda reported a measles outbreak to Uganda Ministry of Health. We investigated the outbreak to assess the scope, factors facilitating transmission, and recommend control measures. Methods: We defined a probable case as sudden onset of fever and generalized rash in a resident of Lyantonde, Lwengo, or Rakai Districts from 1 June-30 September 2017, plus ≥1 of the following: coryza, conjunctivitis, or cough. A confirmed case was a probable case with serum positivity of measles-specific IgM. We conducted a neighborhood- and age-matched case-control study to identified exposure factors, and used conditional logistic regression to analyze the data. We estimated vaccine effectiveness and vaccination coverage. Findings: We identified 81 cases (75 probable, 6 confirmed); 4 patients (4.9%) died. In the case-control study, 47% of case-patients and 2.3% of controls were hospitalized at Lyantonde Hospital pediatric department for non-measles conditions 7-21 days before case-patient’s onset (OR adj =34, 95%CI: 5.1-225). Estimated vaccine effectiveness was 95% (95%CI: 75-99%) and vaccination coverage was 76% (95%CI: 68-82%). During the outbreak, an “isolation” ward was established inside the general pediatric ward where there was mixing of both measles and non-measles patients. Conclusions This outbreak was amplified by nosocomial transmission and facilitated by low vaccination coverage. We recommended moving the isolation ward outside of the building, supplemental vaccination, and vaccinating pediatric patients during measles outbreaks.