Ethiopia Field Epidemiology Training Program (EFETP) Compiled Body of Works in Field Epidemiology
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Date
2015-05
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Addis Abeba University
Abstract
Background: Measles is one of the most communicable infectious diseases with greater than 90% attack rate on susceptible persons. Although efforts have been made to improve vaccination coverage, there have been encounters of outbreaks here and there in Ethiopia. On September 8, 2014 unknown cause of respiratory disease outbreak was reported from Kbebe-Tsehay Orphanage, Addis Ababa the Capital City of Ethiopia. We investigated to confirm the outbreak, identify risk factors and implement control measures. Methods: Both descriptive and unmatched case-control study, using two controls was `conducted in Kbebe-Tsehay Orphanage. Patient observation was made at Health-Care Facilities. Suspected Cases were defined as: Children with fever and cough and with or without diarrhea, vomiting, respiratory distress and coryza. Controls were defined as any children living in Kbebe-Tsehay orphanage without sign and symptom of the disease. A suspected case with laboratory confirmation (positive IgM antibody) or epidemiological link to confirmed cases in an epidemic. We reviewed Hospital records where patients were admitted (Girum, Betsega, St.Yared, Yekatit12 Hospitals and Kbebe-Tsehay Orphanage Clinic) and line list was also prepared to gather information about new cases which was maintained until the end of the outbreak. We interviewed cases and controls using a questionnaire through their Guardian and the camp nurses. Five blood samples were collected for laboratory confirmation. We used Epi Info version 7.3.1 and micro- soft excel for data entry and analysis.
Results: Three of five blood samples tested positive for measles IgM antibodies. A total of 22 measles cases with one death were reported starting August 25, 2014 to September 10, 2014. The overall attack rate (AR) and Case Fatality Rate (CFR) were 14.7/100 population and 4.5% respectively. From all cases (22), none developed clinical sign of rash. Among all, the total numbers of measles cases were higher in females 13 (59.1 %) than males 9 (40.9 %). The median age of cases was 7 months and controls 48 month. Only 9 (40.9%) of the cases were vaccinated and 13 (59.1%) were not vaccinated, whereas 9 (20.5%) of the controls had recorded measles
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vaccination history and 35 (79.5%) had no vaccination cards. From the study groups 22 (100%) cases and 9 (20.5%) controls had contact history to a suspected case. Sharing a bed with two or more children (OR: 8.11; 95% CI: 2.5 – 26.6) and the new children admitted to the dorms (OR: 13.2; 95% CI: 3.8 – 45.6) were found to be significantly associated with the disease. Conclusion: A measles outbreak without rash was confirmed with one death (CFR 4.5%). Sharing a bed with more than one child and being a new child in the orphanage were noted to be significant risk factors for developing the disease. Therefore, using a separate bed and knowing the vaccination status of new children admitted into the orphanage are recommended as mechanisms to limit transmission of measles epidemic. Key Words: Measles: Outbreak: Case Control: Kbebe-Tsehay Orphanage.
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Measles: Outbreak: Case Control: Kbebe-Tsehay Orphanage.