Measles is a viral vaccine preventable disease which presents as generalized maculopapular rash and fever with one or more of the following; cough, coryza and conjunctivitis (IDSR guidelines, Liberia 2016). Globally about 314 measles related deaths occur which is mainly among children 5 years of age (WHO, 2015). The last outbreak of measles in Foya district occurred in May, 2015.
On the 15th August 2016, a general community health volunteer (gCHVs) from Saadu-Yelayaloe community alerted the Officer in Charge (OIC) of Shelloe Clinic in Foya district of four suspected cases of measles. Upon information reaching the District Health Team, they planned and moved in to investigate the outbreak on the same day. The team led by the Foya district Surveillance officer (Graduate of Liberia FETP – Frontline) was later joined by the County Health Team, WHO, and other District Surveillance Officers from other districts in the county.
The objectives of the investigation were;
- To establish the existence of the outbreak
- To determine the source of the outbreak
- To describe the outbreak in person place and time
- To control the outbreak
Out of 31 suspected cases that were identified, 23 (74%) were males. The ages of the suspected cases ranged from 11months – 17 years (median: 6.5 years). Children under 5 accounted for 10 of the cases and all 10 cases were vaccinated against measles. In all, 17 (55%) cases were vaccinated against measles. The attack rate was 26 cases per 10000 population. Laboratory test results for samples submitted to the laboratory were measles IgM positive.
The primary case was a 17 year old female from Sierra Leone who crossed into Liberia for healthcare. She reported at Mendikoma Clinic on 4th August, 2016 whose date of onset was 2nd August, 2016. The highest number of cases occurred on 16th August, 2016. The pattern of the spread suggested that the outbreak originated from a primary case with propagated spread. To control the outbreak, cases were isolated, managed with Vitamin A, Calamine lotion and tetracycline eye ointment. Routine immunization and community outreach was intensified to improve immunization coverage. Community meetings were held to sensitize the community members on symptoms of Measles and measures to take to prevent the spread of the infection.
The likely source of infection was the case from Sierra Leone who sought healthcare from Mendikoma clinic where members of Chaysenin community seek care. From the investigation, it was found that members of Chaysenin community were the first group of people that came down with the infection before spreading to other neighbouring communities. Considering the fact that all children under five who were vaccinated came down with the infection requires an assessment of the efficacy of the vaccines taking into consideration the cold chain system. Authorities in Seirra Leone were informed about the outbreak for them to take action. A mass measles vaccination campaign was recommended as a long term protective measure taking into consideration the cold chain and other factors that might affect the efficacy of the vaccines.
Surveillance on Measles has been intensified in the communities. Immunization is ongoing. The outbreak has subsided. Active case search in still ongoing.