Outbreaks and Emergencies Bulletin, Week 39: 23 - 29 September 2019
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Measles Nigeria
54 902 Cases
275 Deaths
0.5% CFR
EVENT DESCRIPTION
The number of measles cases reported in several states steadily
continued to rise in Nigeria from the beginning of 2019, when
approximately 500 cases were reported in epidemiological week 2
(week ending 13 January 2019). With the number of cases rising to
over 2 000 per week as of week 11 (week ending 17 March 2019), a
National Measles Emergency Operations Centre (EOC) was activated
on the 11 March 2019 to coordinate a nationwide response to the
outbreak. Multiple reactive vaccination campaigns have been conducted
to contain the spread of the outbreak, in addition to deployment of
multi-disciplinary Rapid Response Teams (RRTs), intensification
of surveillance activities and laboratory diagnostics and review of
treatment protocols.
Between 1 and 31 August 2019, 1 336 suspected measles cases were
reported from all 36 states of the country. The majority were reported
from Katsina (238), Borno (234), Yobe (161), Sokoto (83) and Kaduna
(56) states, accounting for 58% of cases reported in the period. The
number of cases reported weekly has been on a downward trend
since epidemiological week 18 (week ending on 5 May 2019) when
over 2 000 cases were reported compared to week 34 (week ending
25 August 2019) when less than 500 cases were reported. As of week
37 (week ending 15 September 2019), the total number of suspected
cases reported was 54 902 with 275 associated deaths (CFR 0.5%).
So far, 2 089 (21.3%) of 9 797 serum samples were IgM positive for
measles. The most affected age group is children aged 12 months to
59 months.
The national immunization coverage for the first dose of the measles
containing vaccine (MCV1) in Nigeria has remained below the
prescribed 80% target in the past ten years. According to the annual
WHO and UNICEF estimates of national immunization coverage
(WUENIC), the coverage has remained at 65% since 2016.
PUBLIC HEALTH ACTIONS
The multi-agency EOC that coordinated the response from 11
March 2019 was de-escalated in June 2019 and replaced with a
measles surveillance technical working group (MSTWG) which
closely monitors activities at state level through data review and
follow up phone calls to affected states.
Rapid response teams (RRT)were deployed to affected states to
support intensified surveillance, reactive vaccination and other
response activities. The first RRTs were deployed to Borno,
Katsina, Ogun and Bauchi states in epi weeks 5 and 6, 2019.
Another RRT was deployed to Yobe and Katsina states on 25
March 2019. The last RRT was deployed to Kaduna in week 30
(week ending 28 July 2019).
Phase II of the measles reactive vaccination campaign was
conducted in Borno state in May 2019 targeting children between
the ages of 6 months and 5 years.
Laboratory capacity has been improved as testing of blood
samples is ongoing in three national measles laboratories across
the geopolitical zones.
An Incidence Action Plan was developed to address gaps
in response mainly with measles surveillance. Weekly data
submission using an updated line-list has been ongoing from all
states.
Since the onset of their activities, WHO-supported community
health champions have sensitized 89 935 people in 49 582
households and identified and reported 123 suspected cholera
cases. TV and radio programmes and jingles on cholera
prevention messages, supported by UNICEF, are ongoing.
SITUATION INTERPRETATION
The measles outbreak has been ongoing in Nigeria with each of the 36 states reporting
cases. Over 77.4% of cases reported in 2019 have been reported from eight northern
states, some of which have the lowest immunization coverages in the country. Though
the number of cases reported weekly has steadily declined since week 18 (week
ending on 5 May 2019), many districts have remained above the epidemic threshold
for the disease. The improvements in enhanced surveillance, laboratory diagnostic
capacity, case management and risk communication under the leadership of the
national measles EOC and Surveillance Technical Working group (MSTWG) should be
sustained to fully interrupt the spread of the outbreak. Furthermore, with the national
immunization coverage remaining low, intensification of activities to improve routine
and supplementary immunization using measles containing vaccines is paramount.
https://apps.who.int/iris/bitstream/handle/10665/328264/OEW39-2329092019.pdf
https://www.afro.who.int/node/11807