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Nationwide Measles and Rubella Outbreaks in South Sudan, 2019
Megan E Peck1, Sylvester Maleghemi2, Lidia Kayembe3
1Epidemic Intelligence Service, Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Background:
South Sudan confirmed a measles outbreak in December 2018. An investigation was conducted to assess underlying causes of the outbreak.
Methods:
Vaccination coverage and measles surveillance data were analyzed. A suspected measles case had fever, maculopapular rash, and cough or conjunctivitis. A confirmed measles case had generalized maculopapular rash lasting >3 days, a temperature >38°C, and cough or conjunctivitis; or serologic confirmation (anti-measles immunoglobin M [IgM] antibody detection) in serum samples collected ≤30 days from rash onset. A confirmed rubella case tested measles IgM-negative and rubella IgM-positive.
Results:
Nationwide, 3727 suspected measles cases were reported in 2019. Seventy-five percent of all suspected measles cases were in children aged <5 years. Thirty-six percent of patients with suspected measles were admitted to the hospital, and 36 measles-related deaths were reported. Among cases, 922 (25%) were tested for measles; of these, 317 (34%) were measles IgM-positive. Among cases that tested measles IgM-negative, 149 (33%) were rubella IgM-positive. Immunization coverage for 1 dose of measles-containing vaccine (MCV) varied by state, ranging from 6% to 67%.
Conclusions:
Measles and rubella remain public health problems in South Sudan. To reduce measles incidence, South Sudan needs to achieve >95% coverage with 2 doses of MCV.
Insights
Measles and rubella outbreaks persist in South Sudan, with low vaccination coverage contributing to the problem. Achieving over 95% coverage of measles-containing vaccine (MCV) is crucial to reduce incidence.
Area of Science:
- Epidemiology
- Public Health
- Immunization
Background:
- South Sudan experienced a measles outbreak starting in December 2018.
- An investigation was launched to determine the outbreak's root causes.
Purpose of the Study:
- To analyze vaccination coverage and measles surveillance data.
- To assess the underlying factors contributing to the measles outbreak in South Sudan.
Main Methods:
- Analysis of vaccination coverage and measles surveillance data.
- Case definitions for suspected and confirmed measles and rubella were established.
- Serologic testing for measles immunoglobulin M (IgM) antibodies was performed.
Main Results:
- In 2019, 3727 suspected measles cases were reported, with 75% affecting children under 5.
- Measles-related deaths totaled 36, and 34% of tested cases were measles IgM-positive.
- Measles-containing vaccine (MCV) coverage varied significantly by state, from 6% to 67%.
Conclusions:
- Measles and rubella continue to be significant public health concerns in South Sudan.
- High vaccination coverage, specifically over 95% with two doses of MCV, is essential to decrease measles incidence.
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