Measles Outbreak in Lambu Internally Displaced Persons´ Camp, Maiduguri, Borno State, Nigeria, 2017

Abstract

Introduction: Measles, a highly infectious disease caused by the Measles virus, is endemic in Nigeria. Although children are vaccinated against measles at the age of nine months which has led to a significant reduction in morbidity and mortality, Nigeria still ranks among the top countries with endemic and uninterrupted transmission of measles infection yearly in Sub-Saharan Africa. This study was carried out to confirm the existence of a measles outbreak, characterize the outbreak in place, person, and time and identify factors associated with the outbreak in Lambu Internally-Displaced Persons' (IDP) camp, Maiduguri, Nigeria. Methods: An unmatched case-control study was conducted among children living in Lambu internally displaced persons (IDP) camp. A suspected case was any person with fever and generalized maculopapular rash and cough, coryza, or conjunctivitis in Lambu IDP camp between February 13 to March 7, 2017. A pre-tested interviewer-administered structured questionnaire was used to gather information on demographic characteristics, socio-economic status, educational status, and potential associated factors. Specimens from five cases were collected and sent to a laboratory for confirmatory diagnosis. An active case search in health facilities close to the Camp was performed. The epidemic curve was drawn, and the odds ratio was calculated at a 95% confidence interval using Epi Info version 7.2 Results: The first case was a 12-month-old girl who presented with fever, nasal discharge, conjunctivitis and generalized rashes. A total of 28 cases were identified. The outbreak lasted for 3 weeks between February 13, 2017, and March 7, 2017, with 3 deaths. The median age of cases was 48 (IQR: 24-60) months. Eighteen cases (18/28=64.3%) were 12-59 months old, while six (6/28=21%) were aged 5 to 9 years. Two of the 3 (66.7%) deaths were reported in under-five children. Three out of the five samples collected for laboratory analysis were positive for Measles virus. Measles vaccination coverage was low. Only 3 of the 28 cases (10.7%) and 4 of the 48 controls (8.5%) had received measles vaccine before the outbreak. Eligible children were offered reactive measles vaccination during the outbreak. Residing close (<5km) to a health facility was associated with lower odds (aOR=0.083, 95%CI: 0.008-0.460) of developing measles and so was a prior visit to a health facility for a previous illness episode (aOR=0.127, 95%CI: 0.003-0.976). Conclusion: There was an outbreak of measles among children in Lambu IDP camp and the instituted control measures included reactive vaccination. The infection was introduced to the IDP camp by children with low or zero immunization coverage from hard-to-reach settlements. Community sensitization on measles and immunization was done.