Factors contributing to measles transmission during an outbreak in Kamwenge District, Western Uganda, April to August 2015

dc.contributor.authorNsubuga, Fred
dc.contributor.authorBulage, Lilian
dc.contributor.authorAmpeire, Immaculate
dc.contributor.authorMatovu, Joseph K. B.
dc.contributor.authorKasasa, Simon
dc.contributor.authorTanifum, Patricia
dc.contributor.authorRiolexus, Alex Ario
dc.contributor.authorZhu, Bao-Ping
dc.date.accessioned2018-07-25T12:22:50Z
dc.date.available2018-07-25T12:22:50Z
dc.date.issued2018
dc.descriptionThis article discusses in April 2015, Kamwenge District, western Uganda reported a measles outbreak. We investigated the outbreak to identify potential exposures that facilitated measles transmission, assess vaccine effectiveness (VE) and vaccination coverage (VC), and recommend prevention and control measures.en_US
dc.description.abstractBackground: In April 2015, Kamwenge District, western Uganda reported a measles outbreak. We investigated the outbreak to identify potential exposures that facilitated measles transmission, assess vaccine effectiveness (VE) and vaccination coverage (VC), and recommend prevention and control measures. Methods: For this investigation, a probable case was defined as onset of fever and generalized maculopapular rash, plus ≥1 of the following symptoms: Coryza, conjunctivitis, or cough. A confirmed case was defined as a probable case plus identification of measles-specific IgM in serum. For case-finding, we reviewed patients’ medical records and conducted in-home patient examination. In a case-control study, we compared exposures of case-patients Nand controls matched by age and village of residence. For children aged 9 m-5y, we estimated VC using the percent of children among the controls who had been vaccinated against measles, and calculated VE using the formula, VE = 1 - ORM-H, where ORM-H was the Mantel-Haenszel odds ratio associated with having a measles vaccination history. Results: We identified 213 probable cases with onset between April and August, 2015. Of 23 blood specimens collected, 78% were positive for measles-specific IgM. Measles attack rate was highest in the youngest age-group, 0-5y (13/10,000), and decreased as age increased. The epidemic curve indicated sustained propagation in the community. Of the 50 case-patients and 200 controls, 42% of case-patients and 12% of controls visited health centers during their likely exposure period (ORM-H = 6.1; 95% CI = 2.7–14). Among children aged 9 m-5y, VE was estimated at 70% (95% CI: 24–88%), and VC at 75% (95% CI: 67–83%). Excessive crowding was observed at all health centers; no patient triage-system existed. Conclusions: The spread of measles during this outbreak was facilitated by patient mixing at crowded health centers, suboptimal VE and inadequate VC. We recommended emergency immunization campaign targeting children <5y in the affected sub-counties, as well as triaging and isolation of febrile or rash patients visiting health centers.en_US
dc.identifier.citationNsubuga et al. Factors contributing to measles transmission during an outbreak in Kamwenge District, Western Uganda, April to August 2015. BMC Infectious Diseases Vol. 18 No. 21 (2018) DOI 10.1186/s12879-017-2941-4en_US
dc.identifier.urihttps://hdl.handle.net/20.500.11951/284
dc.language.isoenen_US
dc.publisherBMC Infectious Diseasesen_US
dc.subjectMeaslesen_US
dc.subjectVaccine effectivenessen_US
dc.subjectVaccine failureen_US
dc.subjectGlobal health securityen_US
dc.titleFactors contributing to measles transmission during an outbreak in Kamwenge District, Western Uganda, April to August 2015en_US
dc.typeArticleen_US
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