Risk factors for measles outbreak in Ataq and Habban districts, Shabwah governorate, Yemen, February to May 2018

Abstract

Background Recent conflict and war in Yemen lead to collapse of the health system, decrease of immunization coverage and spread of many outbreaks. On May 22, 2018, the surveillance officer in Shabwah governorate reported an increased number of suspected measles. On May 24, 2018, a team from Yemen-Field Epidemiology Training Program was sent to investigate. The aims were to describe the outbreak, determine the risk factors for measles infection and recommend control measures. Methodology A descriptive followed by case-control study design (1:2 ratio) were performed. National Measles Surveillance Program case definition and predesigned questionnaire were used to collect data from 73 cases and 146 controls. Attack rate (AR), adjusted odds ratios (aOR) and 95% confidence intervals (95%CI) were calculated. P value < 0.05 was considered as the cut point for significant. Epi info version 7.2 was used. Results A total of 73 suspected cases were found. Almost 53% were from Habban district, 63% were males and 56% were among age group < 5 years. The overall AR was 82/100,000 population. Measles was significantly associated with contact with case (aOR = 27.3, 95% CI:1.3–551.7), malnourished children aged 6–60 months (aOR = 24.9, 95% CI;1.9–329.6) and unvaccinated children (aOR = 17.2, 95% CI:2.9–100.7). The six collected blood samples found to be positive for measles IgM. Conclusions Measles outbreak in Ataq and Habban districts was confirmed. Contact with measles cases, malnutrition and un-vaccination were the potential contributing factors of measles outbreak in Shabwah governorate. An urgent vaccination campaign with health education interventions are highly recommended. Reactivation of the outreach immunization services and strengthening surveillance and response systems are top priority to take place at district and governorate levels.

Measles Outbreak Investigation in Garda Marta District, Southwestern Ethiopia, 2022: Community-Based Case-Control Study

“…This outbreak investigation result is in line with a study conducted in southeastern Ethiopia, Yemen, and northeastern Ethiopia. 8 , 42 , 43 Evidences from previous studies conducted in India and Nigeria found a link between measles and malnutrition that malnourished children are more likely than well-nourished children to get severe measles infections. 2 , 44 …”

A scoping review on the associations and potential pathways between malnutrition and measles

“…In all 5 studies, undernutrition significantly increased reported measles incidence by 1.7 to 24.9 times (OR: 1.7, 3.0, 3.0, 3.4, 24.9). (23,(44)(45)(46)48) 3 studies also found that measles was an important contributing factor to malnutrition, and that it could increase the risk of malnutrition threefold. (42,47,48) The evidence for an association between malnutrition and measles mortality is less consistent, though 6 out of 10 studies found a positive correlation between malnutrition and measles mortality.…”

“…aged 6 to 60 months) (95% CI: 1.9-329.6). (23) In Romania, reported measles cases were 3.4 times more likely than controls to have had a history of malnutrition (95% CI: 1.1-9.9). (45) In 2018, modelling from sub-national regions of Namibian aggregated measles incidence data from 2005 to 2014 found the risk of measles to be associated with the prevalence of underweight children under 5 years of age (95% CI: 0.0019, 0.1128).…”

“…Several community-and hospital-based studies reported significant associations between measles incidence and undernutrition. (23,42,(44)(45)(46)(47)(48) In Yemen, suspected measles infections were three times higher among SAM cases (4.5%, p< 0.00) than in adequately nourished (1.4%) and in moderately malnourished (1.2%) children. (44) Another community study found that the identification of measles cases with fever and skin rash symptoms during an outbreak was 24.9 times more likely among malnourished children (i.e.…”

“…(20)(21)(22) Six studies also used mid-upper arm circumference (MUAC) as an indicator for severe acute malnutrition ("SAM") in infants and children 0 to 95 months. (23)(24)(25)(26)(27)(28)…”