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Research article

Measles Outbreak Amplified in a Pediatric Ward: Lyantonde District, Uganda, August 2017

Claire Biribawa, Joselyn Annet Atuhairwe, Lilian Bulage, Denis Othuba Okethwangu, Benon Kwesiga, Alex Riolexus Ario, Bao-Ping Zhu
DOI: 10.21203/rs.2.12738/v1

Abstract

Background

Measles is a highly infectious viral disease. In August 2017, Lyantonde District, Uganda reported a measles outbreak to Uganda Ministry of Health. We investigated to assess the outbreak scope, factors facilitating transmission, and recommend control measures.

Methods

We defined a probable case as sudden onset of fever and generalized rash in a resident of Lyantonde, Lwengo, or Rakai Districts from 1 June-30 September 2017, plus ≥1 of the following: coryza, conjunctivitis, or cough. A confirmed case was a probable case with serum positivity of measles-specific IgM. We conducted a neighborhood- and age-matched case-control study to identified exposure factors, and used conditional logistic regression to analyze the data. We estimated vaccine effectiveness and vaccination coverage.

Findings

We identified 81 cases (75 probable, 6 confirmed); 4 patients (4.9%) died. In the case-control study, 47% of case-patients and 2.3% of controls were hospitalized at Lyantonde Hospital pediatric department for non-measles conditions 7-21 days before case-patient’s onset (ORadj=34, 95%CI: 5.1-225). Estimated vaccine effectiveness was 95% (95%CI: 75-99%) and vaccination coverage was 76% (95%CI: 68-82%). During the outbreak, an “isolation” ward was established inside the pediatric ward. Measles and non-measles patients were mixed in regular pediatric wards.

Conclusion

This outbreak was amplified by nosocomial transmission and facilitated by low vaccination coverage. We recommended moving the isolation ward outside of the building, supplemental vaccination, and vaccinating pediatric patients during measles outbreaks.

Keywords
Pediatric Measles outbreak; Disease outbreaks; Nosocomial infection; Global health security; Vaccine Effectiveness; Vaccination Coverage

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Preprint: Please note that this article has not completed peer review.
Research article

Measles Outbreak Amplified in a Pediatric Ward: Lyantonde District, Uganda, August 2017

Claire Biribawa, Joselyn Annet Atuhairwe, Lilian Bulage, Denis Othuba Okethwangu, Benon Kwesiga, Alex Riolexus Ario, Bao-Ping Zhu

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Abstract

Background

Measles is a highly infectious viral disease. In August 2017, Lyantonde District, Uganda reported a measles outbreak to Uganda Ministry of Health. We investigated to assess the outbreak scope, factors facilitating transmission, and recommend control measures.

Methods

We defined a probable case as sudden onset of fever and generalized rash in a resident of Lyantonde, Lwengo, or Rakai Districts from 1 June-30 September 2017, plus ≥1 of the following: coryza, conjunctivitis, or cough. A confirmed case was a probable case with serum positivity of measles-specific IgM. We conducted a neighborhood- and age-matched case-control study to identified exposure factors, and used conditional logistic regression to analyze the data. We estimated vaccine effectiveness and vaccination coverage.

Findings

We identified 81 cases (75 probable, 6 confirmed); 4 patients (4.9%) died. In the case-control study, 47% of case-patients and 2.3% of controls were hospitalized at Lyantonde Hospital pediatric department for non-measles conditions 7-21 days before case-patient’s onset (ORadj=34, 95%CI: 5.1-225). Estimated vaccine effectiveness was 95% (95%CI: 75-99%) and vaccination coverage was 76% (95%CI: 68-82%). During the outbreak, an “isolation” ward was established inside the pediatric ward. Measles and non-measles patients were mixed in regular pediatric wards.

Conclusion

This outbreak was amplified by nosocomial transmission and facilitated by low vaccination coverage. We recommended moving the isolation ward outside of the building, supplemental vaccination, and vaccinating pediatric patients during measles outbreaks.

Figures

Introduction

Methods

Results

Discussion

List of Abbreviations

Declarations

References

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