Impacts Of The Measles Outbreak In Koinadugu/falaba And Pujehun Districts

Introduction

Measles is a disease caused by a virus called paramyxovirus. It is a vaccine-preventable disease and children who are unvaccinated are more susceptible to acquiring diseases1. The virus is spread through contact with nose and throat secretions of infected people and through airborne droplets released when an infected person sneezes or coughs.

In Sierra Leone, a safe, free and effective vaccine is available to protect children against measles virus, with two doses given as part of the routine vaccination schedule in Sierra Leone (the first dose at 9 months and the second at 15 months).

The measles virus is one of the major epidemic-prone disease that is of concern in Sierra Leone. It is a disease targeted for elimination therefore much emphasis is being placed on the surveillance and detection of cases around the country.

The function of the surveillance system

In 2004, Sierra Leone adopted the Integrated Disease Surveillance and Response (IDSR) as a strategy to streamline and improve data collection, reporting, and analysis from previously disparate disease reporting systems in the country3. This system tracks the occurrence of priority diseases, conditions, and events. Reports on the occurrence of health-related events are made through health facilities based weekly reports and the community-based disease surveillance system (CBS).

Measles is one of the priority conditions that should be notified to the health authorities immediately it is suspected and the disease surveillance program system in place is a robust one were in district surveillance officers (DSO) go on active case search for the disease and report cases to the national level via the District Health Information system (DHIS 2). On alert of a case, the DSO investigates the case and if measles is suspected blood samples are collected and immediately sent to the Central Public Health Reference laboratory for analyses.

Recently there have been two outbreaks of the disease in the country but in different districts in mid and late 2018 respectively. The districts affected were Falaba district in the northern region and Pujehun district in the southern region

In June 2018 clusters of measles cases were reported among children in two remote rural communities in Koinadugu/Falaba district4. On June 14th, 2018 the Sierra Leone Ministry of Health and Sanitation declared an outbreak of measles virus in the country in which 19 confirmed cases were reported from two chiefdoms that share a boundary with neighboring Guinea5.

On the 13th of December 2018, the Ministry declared another outbreak of the disease in Pujehun district in which there were three confirmed case.

The Central Public Health Reference Laboratory (CPHRL)

The central public health reference laboratory is the referral laboratory that has been provisionally accredited for Measles confirmatory testing6. Before this time samples were sent to Cote d'Ivoire for confirmation.

On the investigation of a suspected case of measles, the DSO collects samples and send s to the CPHRL for confirmation. Laboratory testing found that 14 of the (15) specimens from Koindukura CHP and 5 (out of the 8) from Mansandu CHP were positive for measles in Koinadugu/Falaba districts. For a measles outbreak to be declared, a cluster of 3 suspected cases (within a month) that turn out to be positive by laboratory testing satisfies the criteria.

According to the Chief Medical Officer, 3 cases were also confirmed for Pujehun district and the cases were recorded from unvaccinated children traveling across the border to access healthcare in the neighboring countries (either Sierra Leone or Guinea)7.

Actions Taken

For Koinadugu and Pujehun districts a meeting was held at the Public Health Emergency Operation Centre (PHEOC) wherein the MoHS released the national Rapid Response Teams (RRT) to join the district RRT to visit the affected chiefdoms, assess the situation and provide recommendations and they were accompanied by personnel from the World Health Organization to the field. The district RRT, national RRT and WHO embarked on a fact-finding mission to the affected chiefdoms, health facilities, and villages

On arrival at the districts the RRTs jointly conducted a record review in the health facility registers, searched for additional cases in the communities and referred the suspected cases to the nearest health facilities for treatment, evaluated surveillance and EPI activities and record keeping at health facility level, interacted with the Community Health Workers (CHW), made note of available Expanded Program for Immunization (EPI) stocks and surveillance tools, met members of the community and prepared outbreak investigation report.

As an effort to end the outbreak the Ministry of health and Sanitation alerted the Expanded program for immunization to conduct vaccination activities in the districts. To achieve results the health education and promotion arm of the ministry conducted radio programs and jingles on the district radio stations and had social mobilization personnel to get children from the communities and homes to come out for the vaccines.

In Koinadugu district only children in the affected chiefdoms were vaccinated while in Pujehun district the entire district was vaccinated. The vaccination campaign targeted children with the age bracket of 6mnths- 15 yrs.

Pujehun District could not reach their target which was 160,326 and only vaccinated 159,431 which falls little below their district target8

Role of stakeholders

The outbreak brought together several International partner Non-governmental Organizations (NGO) who rendered help in the fight to stop the outbreak from spreading. The World Health Organization (WHO), US Centers for Disease Prevention and Control (CDC) were the two main partners involved in the provision of logistics and funds to combat the outbreak. Investigation and EPI tools and vaccines where provided by WHO and funding support by the US CDC. Epidemiologist from the Field Epidemiology Training Program (FETP) supported by US CDC accompanied the team to the field.

The outbreaks were well managed as they were limited to the areas where there were cases. No spillover occurred in the neighboring chiefdoms. The fact that the outbreak was picked up promptly due to robust laboratory confirmation enabling the MOHS to tackle the matter and prevented the disease from spreading further.