MEASLES CASE-BASED SURVEILLANCE AND OUTBREAK RESPONSE IN NIGERIA; AN UPDATE FOR CLINICIANS AND PUBLIC HEALTH PROFESSIONALS

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E.E Isere1 and A.A Fatiregun1

Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria.

Abstract

The Federal Ministry of Health recommendations for response during measles epidemics in Nigeria previously focused on case management using antibiotics and Vitamin. A supplements and did not include outbreak response immunization (ORI) campaigns. However, with the revision of the existing national technical guideline on measles casebased surveillance and outbreak response in Nigeria in 2012 in line with the World Health Organization recommendation on response to measles outbreak in measles mortality reduction settings, there is a need to update members of the Nigerian public health community on these revisions to ensure appropriate implementation and compliance. This article therefore seeks to provide clinicians and other public health professionals in Nigeria with updates on recent developments in measles case-based surveillance and outbreak response in Nigeria

Keywords: Measles surveillance, Outbreak response, Clinicians, Nigeria.

Introduction

Measles outbreaks pose a continuing public health problem in Africa and other developing nations of the world¹. Measles case fatality has been estimated to be between 3 to 5% in developing countries and may be as high as 10% during epidemics². Despite the efforts made at increasing immunization, measles remains a leading cause of under-five mortality in Africa³. There were about 139, 300 measles deaths globally in 2011 representing nearly 380 deaths every day or 15 deaths every hour⁴. Nigeria presently together with other developing countries accounts for about 94% of global deaths caused by measles annually⁵.

In an effort to address the high mortality caused by measles annually in Africa, countries in the World Health Organization, (WHO) African region in 2001 adopted the accelerated measles control activities using the measles mortality reduction strategies recommended by the WHO and the United Nations Children’s Fund (UNICEF). These strategies includes ; (1) achieving and maintaining e” 80% coverage with routine measles vaccination of infants, (2) providing a second dose of measles vaccine through supplemental immunization activities (SIAs), (3) intensified measles case-based surveillance with laboratory confirmation and (4) improve measles case management during outbreaks^6-7. In Nigeria, literatures on measles outbreaks investigation have shown that outbreaks of measles annually are detected too late resulting in either no or late response with minimal impact⁸. This could partly be attributed to poor awareness among clinicians and public health professionals of the measles case based surveillance process and their role in immediate case notification using the standard case definition. Also, between epidemiological weeks 1 to 43 of 2013, about six hundred and forty-three measles outbreaks were confirmed in 83% of the seven hundred and seventy four Local Government Areas (LGAs) in Nigeria with outbreak response conducted in few of these LGAs according to the revised national measles technical guideline⁹. However, with the strengthening of the measles case based surveillance in the country with laboratory support to enhance early outbreak detection, there is a need to update clinicians and public health professionals on the measles case based surveillance process, their roles and on the recent developments in the conduct of measles outbreak response activities in Nigeria to ensure proper implementation during subsequent measles outbreaks in Nigeria.