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      Measles outbreak investigation in an urban slum of Kaduna Metropolis, Kaduna State, Nigeria, March 2015

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          Abstract

          Introduction

          Despite availability of an effective vaccine, the measles epidemic continue to occur in Nigeria. In February 2015, we investigated a suspected measles outbreak in an urban slum in Rigasa, Kaduna State, Nigeria. The study was to confirm the outbreak, determine the risk factors and implement appropriate control measures.

          Methods

          We identified cases through active search and health record review. We conducted an unmatched case-control (1:1) study involving 75 under-5 cases who were randomly sampled, and 75 neighborhood controls. We interviewed caregivers of these children using structured questionnaire to collect information on sociodemographic characteristics and vaccination status of children. We collected 15 blood samples for measles IgM using Enzyme Linked Immunosorbent Assay. Descriptive, bivariate and logistic regression analyses were performed using Epi-info software. Confidence interval was set at 95%.

          Results

          We recorded 159 cases with two deaths {case fatality rate = 1.3%}. 50.3% (80) of the cases were male. Of the 15 serum samples, 11(73.3%) were confirmed IgM positive for measles. Compared to the controls, the cases were more likely to have had no or incomplete routine immunization (RI) [adjusted odds ratio (AOR) (95% confidence interval (CI)]: 28.3 (2.1, 392.0), contact with measles cases [AOR (95% CI)]: 7.5 (2.9, 19.7), and having a caregiver younger than 20 years [AOR (95% CI)]: 5.2 (1.2, 22.5). Measles serum IgM was positive in 11 samples.

          Conclusion

          We identified low RI uptake and contact with measles cases as predictors of measles outbreak in Rigasa, Kaduna State. We recommended strengthening of RI and education of care-givers' on completing RI schedule.

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          Most cited references10

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          Predictors of defaulting from completion of child immunization in south Ethiopia, May 2008 – A case control study

          Background Epidemiological investigations of recent outbreaks of vaccine preventable diseases have indicated that incomplete immunization was the major reason for the outbreaks. In Ethiopia, full immunization rate is low and reasons for defaulting from immunization are not studied well. The objective of the study was to identify the predictors of defaulting from completion of child immunization among children between ages 9–23 months in Wonago district, South Ethiopia. Methods Unmatched case control study was conducted in eight Kebeles (lowest administrative unit) of Wonago district in south Ethiopia. Census was done to identify all cases and controls. A total of 266 samples (133 cases and 133 controls) were selected by simple random sampling technique. Cases were children in the age group of 9 to 23 months who did not complete the recommended immunization schedule. Pre-tested structured questionnaire were used for data collection. Data was analyzed using SPSS 15.0 statistical software. Results Four hundred eighteen (41.7%) of the children were fully vaccinated and four hundred twelve (41.2%) of the children were partially vaccinated. The BCG: measles defaulter rate was 76.2%. Knowledge of the mothers about child immunization, monthly family income, postponing child immunization and perceived health institution support were the best predictors of defaulting from completion of child immunization. Conclusion Mothers should be educated about the benefits of vaccination and the timely administration of vaccines.
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            Measles outbreak investigation in Zaka, Masvingo Province, Zimbabwe, 2010

            Background A measles outbreak was detected at Ndanga Hospital in Zaka district Masvingo Province on the 5th of May 2010 and there were five deaths. Source of infection was not known and an investigation was carried out to determine factors associated with contracting measles in Zaka district. Materials and methods A 1:1 unmatched case control study was conducted. A case was a person residing in Zaka district who developed signs and symptoms of measles or tested IgM positive from 06 May 2010 to 30 August 2010. A control was a person residing in the same community who did not have history of signs and symptoms of measles during the same period. A structured interviewer administered questionnaire (translated into shona) was used to solicit information from cases and controls. Ethical consideration like written consent from all participants, respect and confidentiality were observed. Permission to carry out the study was obtained from the medical research Council of Zimbabwe and the provincial Medical Directors Masvingo. Epi info was used to calculate frequencies, odds ratios and perform logistic regression to control for confounding variables. Findings A total of 110 cases and 110 controls were recruited. Most cases (63.03%) were from the apostolic sect while 44.7% of controls were from orthodox churches. Contact with a measles case [AOR= 41.14, 95% CI (7.47-226.5)],being unvaccinated against measles [AOR= 3.96, 95%CI (2.58-6.08)] and not receiving additional doses of measles vaccine [AOR 5.48, 95% CI (2.16-11.08)] were independent risk factor for contracting measles. Measles vaccination coverage for Zaka district was 75%. The median duration for seeking treatment after onset of illness was three days (Q1=2; Q3=7). There were no emergency preparedness plans in place. Conclusion This outbreak occurred due to a large number of unvaccinated children and a boarding school that facilitated person to person transmission. We recommend mandatory vaccination for all children before enrolling into schools. As a result of the study one day training on outbreak management and surveillance was done with all District Nursing Officers and Environmental Health Officers in personnel in the province.
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              Increased susceptibility to measles in infants in the United States.

              Women born in the United States after measles vaccine licensure in 1963 transfer less measles antibody to their infants than do older women. This may result in increased susceptibility to measles among infants. To determine the effect of maternal year of birth on the risk for measles in infants. We enrolled 128 unvaccinated infants
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                Author and article information

                Journal
                Pan Afr Med J
                Pan Afr Med J
                PAMJ
                The Pan African Medical Journal
                The African Field Epidemiology Network
                1937-8688
                28 March 2019
                2019
                : 32
                : 150
                Affiliations
                [1 ]Nigeria Field Epidemiology and Laboratory Programme, Abuja, Nigeria
                [2 ]Federal Neuropsychiatry Hospital, Barnawa Kaduna State, Nigeria
                [3 ]Department of Haematology and Blood Transfusion, Ahmadu Bello University, Zaria, Kaduna State, Nigeria
                [4 ]Medical Microbiology and Parasitology Department, Ahmadu Bello University, Zaria, Kaduna State, Nigeria
                [5 ]Department of Community Medicine, Ahmadu Bello University, Zaria, Kaduna State, Nigeria
                Author notes
                [& ]Corresponding author: Ismaila Nda Ibrahim, Department of Haematology and Blood Transfusion, Ahmadu Bello University, Zaria, Kaduna State, Nigeria
                Article
                PAMJ-32-150
                10.11604/pamj.2019.32.150.15764
                6607246
                57fcf31c-4358-449b-a6c5-4d8c1986a356
                © Obafemi Joseph Babalola et al.

                The Pan African Medical Journal - ISSN 1937-8688. This is an Open Access article distributed under the terms of the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 22 April 2018
                : 23 January 2019
                Categories
                Research

                Medicine
                measles,outbreak investigation,routine immunization,urban slum
                Medicine
                measles, outbreak investigation, routine immunization, urban slum

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