Measles Outbreaks in the Mozambican Refugee Camps in Malawi: The Continued Need for an Effective Vaccine

Porter, John D.; Gastellu-Etchegorry, M.; Navarre, Isabelle; Lungu, G; Moren, Alain

doi:10.1093/ije/19.4.1072

Cited by 34 publications

(30 citation statements)

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“…Clinical diagnosis of measles from a number of conditions that present with fever and rash symptoms [7] is difficult without laboratory confirmation, mostly for dark-skinned people. Therefore, laboratory testing should be an essential component of surveillance to confirm measles infection in order to establish the appropriate intervention, including vaccination.…”

Section: Discussionmentioning

confidence: 99%

“…The World Health Organization (WHO) recognizes refugees as one of the high-risk groups for measles outbreaks. Several outbreaks have been reported among refugees and other emergency settings [7-9] due to their characteristic massive population displacements, overcrowding, high population densities and low vaccination coverage [10,11]. Overcrowding is associated with the transmission of higher infectious doses of measles virus, resulting in more severe cases of clinical disease [12], which makes measles more often the leading cause of mortality among children in refugee populations.…”

Section: Introductionmentioning

confidence: 99%

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Measles outbreaks in displaced populations: a review of transmission, morbidity and mortality associated factors

Kouadio

Kamigaki

Oshitani

2010

BMC Int Health Hum Rights

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BackgroundMeasles is a highly contagious infectious disease with a significant public health impact especially among displaced populations due to their characteristic mass population displacement, high population density in camps and low measles vaccination coverage among children. While the fatality rate in stable populations is generally around 2%, evidence shows that it is usually high among populations displaced by disasters. In recent years, refugees and internally displaced persons have been increasing. Our study aims to define the epidemiological characteristics and risk factors associated with measles outbreaks in displaced populations.MethodsWe reviewed literature in the PubMed database, and selected articles for our analysis that quantitatively described measles outbreaks.ResultsA total of nine articles describing 11 measles outbreak studies were selected. The outbreaks occurred between 1979 and 2005 in Asia and Africa, mostly during post-conflict situations. Seven of eight outbreaks were associated with poor vaccination status (vaccination coverage; 17-57%), while one was predominantly due to one-dose vaccine coverage. The age of cases ranged from 1 month to 39 years. Children aged 6 months to 5 years were the most common target group for vaccination; however, 1622 cases (51.0% of the total cases) were older than 5 years of age. Higher case-fatality rates (>5%) were reported for five outbreaks. Consistent factors associated with measles transmission, morbidity and mortality were vaccination status, living conditions, movements of refugees, nutritional status and effectiveness of control measures including vaccination campaigns, surveillance and security situations in affected zones. No fatalities were reported in two outbreaks during which a combination of active and passive surveillance was employed.ConclusionMeasles patterns have varied over time among populations displaced by natural and man-made disasters. Appropriate risk assessment and surveillance strategies are essential approaches for reducing morbidity and mortality due to measles. Learning from past experiences of measles outbreaks in displaced populations is important for designing future strategies for measles control in such situations.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Measles outbreaks in displaced populations: a review of transmission, morbidity and mortality associated factors

Kouadio

Kamigaki

Oshitani

2010

BMC Int Health Hum Rights

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“…Measles case-fatality ratios in children in complex emergencies have been as high as 20-30%. 18,19 During a famine in Ethiopia, measles alone or in combination with wasting accounted for 22% of 159 deaths of children under 5 years, and 17% of 72 deaths of children aged 5-14 years. 20 Progress in global control has reduced the likelihood of measles outbreaks in some regions, although outbreaks can occur in refugee and internally displaced populations with low levels of immunity or vaccination coverage.…”

Section: Measlesmentioning

confidence: 99%

Child health in complex emergencies

Moss¹

2004

Bull World Health Organ

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Coordinated and effective interventions are critical for relief efforts to be successful in addressing the health needs of children in situations of armed conflict, population displacement, and/or food insecurity. We reviewed published literature and surveyed international relief organizations engaged in child health activities in complex emergencies. Our aim was to identify research needs and improve guidelines for the care of children. Much of the literature details the burden of disease and the causes of morbidity and mortality; few interventional studies have been published. Surveys of international relief organizations showed that most use World Health Organization (WHO), United Nations Children's Fund (UNICEF), and ministry of health guidelines designed for use in stable situations. Organizations were least likely to have formal guidelines on the management of asphyxia, prematurity, and infection in neonates; diagnosis and management of children with human immunodeficiency virus (HIV) infection; active case-finding and treatment of tuberculosis; paediatric trauma; and the diagnosis and management of mental-health problems in children. Guidelines often are not adapted to the different types of health-care workers who provide care in complex emergencies. Evidence-based, locally adapted guidelines for the care of children in complex emergencies should be adopted by ministries of health, supported by WHO and UNICEF, and disseminated to international relief organizations to ensure appropriate, effective, and uniform care.Keywords Child welfare; Child health services; Emergencies; Disasters; Diarrhea/therapy; Measles/epidemiology; HIV infections/ diagnosis/therapy; Malaria/prevention and control; Nutrition disorders/therapy; Infant mortality; Child mortality; Refugees; Infant, Newborn; Child; Practice guidelines; Review literature (source: MeSH, NLM). Voir page 62 le résumé en français. En la página 62 figura un resumen en español. Mots clés

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“…In Malawi, measles vaccine is given after 9 months of age as in other developing countries. It has been reported that measles VE was 95 % at 9 months in Niger [4], and more than 90 % in Mozambican refugee camps in Malawi [5]. However, measles accounted for 10n4% of hospital admissions (the fourth cause), and 8n7% of in-patient mortality (the fifth cause) in children under 5 years in 1992 [6].…”

Section: Introductionmentioning

confidence: 99%

Epidemiology of measles in Blantyre, Malawi: analyses of passive surveillance data from 1996 to 1998

et al. 2002

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SUMMARYMeasles surveillance data in Blantyre, Malawi were reviewed for 1996-8 to describe the epidemiology of infection and to estimate vaccine efficacy (VE) by the screening method. A total of 674 measles cases were reported to the Blantyre District Health Office during this period. Age distribution showed that 108 (16n1 %) of the cases were aged less than 1 year. The median age was 5 years. Eighty percent of the cases between 1 and 19 years had been previously vaccinated. VE was 68n6 % (95 % CI, 52n7-79n2) for children 12-23 months of age and 67n3 % (95 % CI, 48n3-79n3) for infants 9-11 months of age. Reasons for this low vaccine efficacy are discussed. Previous vaccination history was negatively associated with the risk for developing cough during measles infection (odds ratio (OR), 0n30 ; 95 % CI, 0n09-0n91), diarrhoea (OR, 0n64 ; CI, 0n44-0n95) and pneumonia (OR, 0n40 ; CI, 0n25-0n62). Logistic regression analysis showed that pneumonia in adults was negatively associated with vaccination history. The passive surveillance system for measles in Malawi was useful to describe the epidemiology of measles.

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Measles Outbreaks in the Mozambican Refugee Camps in Malawi: The Continued Need for an Effective Vaccine

Cited by 34 publications

References 0 publications

Measles outbreaks in displaced populations: a review of transmission, morbidity and mortality associated factors

Measles outbreaks in displaced populations: a review of transmission, morbidity and mortality associated factors

Child health in complex emergencies

Epidemiology of measles in Blantyre, Malawi: analyses of passive surveillance data from 1996 to 1998

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