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Outbreaks and Emergencies Bulletin, Week 44: 28 October - 3 November 2019
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Measles Lesotho
4 Cases
0 Deaths
0% CFR
EVENT DESCRIPTION
On 26 October 2019, the Ministry of Health notified the World Health
Organization of an outbreak of measles in the Qacha’s Nek district of
Lesotho following a report of four serum samples testing positive
for measles virus by the National Reference Laboratory in Maseru
on 25 October 2019. The samples were collected at a health centre,
which has a catchment area located in the hard to reach areas of
Qacha’s Nek district. The samples were collected from a total of 50
suspected cases between 14 and 21 October 2019 who presented to
the health facility with symptoms of fever and generalized body rash.
All cases were from the neighbouring villages of Ha Letete, Leseling
and Molomo. The cases from Ha Letete were all pupils of a local
primary school. The majority (48%) of the cases were between the
ages of 5 and 12 years with girls being more affected (M:F 1:2.1).
There have been no deaths recorded to date. Of the 50 blood samples
analysed at the National Reference Laboratory, four tested positive
for measles virus and one for rubella. The remaining 45 samples
were negative and were discarded.
Measles is one of the diseases targeted for elimination in Lesotho
and is selected for immediate reporting using a detailed case-based
form. As per the country’s integrated disease surveillance and
response guidelines an outbreak is considered when three or more
cases are confirmed from the same health facility.
The vaccination coverage for measles containing vaccine 1
(MCV1) has remained low in the affected district in the past four
years with a current cumulative coverage of 65% for 2019. The
national coverage of Lesotho has, however, remained high in the
last five years according to the WHO/UNICEF Estimates of National
Immunization Coverage with MCV1 and MCV2 reported as 90% and
82% for each of the years. These coverages are in keeping with the
Global Vaccine Action Plan 2011–2020 (GVAP) endorsed by the
World Health assembly in 2012, which calls on all countries to reach
≥90% national coverage with all vaccines in the country’s national
immunization schedule by 2020.
PUBLIC HEALTH ACTIONS
The Deputy Minister of Health briefed the media on the current
situation of the outbreak on 28 October 2019.
An IHR NFP led measles outbreak coordination mechanism has
been established to oversee the outbreak response activities.
Rapid response teams (RRT) were deployed to affected areas
on 27 October 2019 to conduct an initial rapid response.
All districts and health facilities have been alerted to enhance
surveillance for measles in line with the Integrated Disease
Surveillance and Response (IDSR) guidelines.
Planning for a mass reactive vaccination campaign has started,
targeting the population aged 9 months to 15 years in the
affected areas.
SITUATION INTERPRETATION
The current outbreak is the first in nearly ten years and is occurring in an area that
has not been affected in previous outbreaks. The last outbreak in Lesotho occurred in
2010, affecting more than 3 000 persons with 7 associated deaths. All the districts in
Lesotho were affected and the most affected age groups were children aged 6 to 11
months and 6 to 10 years. Only one confirmed case of measles was reported in 2018
from the capital city, Maseru.
Over the last five years, the national immunization coverage has remained high and
only one confirmed case was reported in 2018. However, when disaggregated to
district level, the high immunity coverage has not been uniform as demonstrated
by the suboptimal coverage in Qacha’s Nek district where the current outbreak is
occurring. Therefore, a detailed review of the immunization coverage at district
level is paramount to ascertain the true resilience to vaccine preventable diseases
in the country. The government of Lesotho is encouraged to improve immunization
coverage in all districts through targeted catch up immunization campaigns in
districts with low coverage.
Gaps in detecting and reporting suspected cases of priority diseases is also an issue
of concern as the cases were not reported through the routine disease surveillance
network. As public health measures are being put in place to contain the outbreak,
the government is encouraged to improve disease surveillance performance with
emphasis on training of frontline workers on case identification and reporting.
...
Measles Lesotho
4 Cases
0 Deaths
0% CFR
EVENT DESCRIPTION
On 26 October 2019, the Ministry of Health notified the World Health
Organization of an outbreak of measles in the Qacha’s Nek district of
Lesotho following a report of four serum samples testing positive
for measles virus by the National Reference Laboratory in Maseru
on 25 October 2019. The samples were collected at a health centre,
which has a catchment area located in the hard to reach areas of
Qacha’s Nek district. The samples were collected from a total of 50
suspected cases between 14 and 21 October 2019 who presented to
the health facility with symptoms of fever and generalized body rash.
All cases were from the neighbouring villages of Ha Letete, Leseling
and Molomo. The cases from Ha Letete were all pupils of a local
primary school. The majority (48%) of the cases were between the
ages of 5 and 12 years with girls being more affected (M:F 1:2.1).
There have been no deaths recorded to date. Of the 50 blood samples
analysed at the National Reference Laboratory, four tested positive
for measles virus and one for rubella. The remaining 45 samples
were negative and were discarded.
Measles is one of the diseases targeted for elimination in Lesotho
and is selected for immediate reporting using a detailed case-based
form. As per the country’s integrated disease surveillance and
response guidelines an outbreak is considered when three or more
cases are confirmed from the same health facility.
The vaccination coverage for measles containing vaccine 1
(MCV1) has remained low in the affected district in the past four
years with a current cumulative coverage of 65% for 2019. The
national coverage of Lesotho has, however, remained high in the
last five years according to the WHO/UNICEF Estimates of National
Immunization Coverage with MCV1 and MCV2 reported as 90% and
82% for each of the years. These coverages are in keeping with the
Global Vaccine Action Plan 2011–2020 (GVAP) endorsed by the
World Health assembly in 2012, which calls on all countries to reach
≥90% national coverage with all vaccines in the country’s national
immunization schedule by 2020.
PUBLIC HEALTH ACTIONS
The Deputy Minister of Health briefed the media on the current
situation of the outbreak on 28 October 2019.
An IHR NFP led measles outbreak coordination mechanism has
been established to oversee the outbreak response activities.
Rapid response teams (RRT) were deployed to affected areas
on 27 October 2019 to conduct an initial rapid response.
All districts and health facilities have been alerted to enhance
surveillance for measles in line with the Integrated Disease
Surveillance and Response (IDSR) guidelines.
Planning for a mass reactive vaccination campaign has started,
targeting the population aged 9 months to 15 years in the
affected areas.
SITUATION INTERPRETATION
The current outbreak is the first in nearly ten years and is occurring in an area that
has not been affected in previous outbreaks. The last outbreak in Lesotho occurred in
2010, affecting more than 3 000 persons with 7 associated deaths. All the districts in
Lesotho were affected and the most affected age groups were children aged 6 to 11
months and 6 to 10 years. Only one confirmed case of measles was reported in 2018
from the capital city, Maseru.
Over the last five years, the national immunization coverage has remained high and
only one confirmed case was reported in 2018. However, when disaggregated to
district level, the high immunity coverage has not been uniform as demonstrated
by the suboptimal coverage in Qacha’s Nek district where the current outbreak is
occurring. Therefore, a detailed review of the immunization coverage at district
level is paramount to ascertain the true resilience to vaccine preventable diseases
in the country. The government of Lesotho is encouraged to improve immunization
coverage in all districts through targeted catch up immunization campaigns in
districts with low coverage.
Gaps in detecting and reporting suspected cases of priority diseases is also an issue
of concern as the cases were not reported through the routine disease surveillance
network. As public health measures are being put in place to contain the outbreak,
the government is encouraged to improve disease surveillance performance with
emphasis on training of frontline workers on case identification and reporting.
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