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Central African Republic: 2020 - 2021 Measles

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  • Central African Republic: 2020 - 2021 Measles

    Source: Measles - Central African Republic

    Disease outbreak news
    4 March 2020

    The Central African Republic (CAR) has experienced an upsurge in measles cases as a result of outbreaks since 2019. The first case of measles was recorded in week 5 of 2019 (week commencing 28 January 2019) and the outbreak has continued through to week 7 of 2020 (week commencing 10 February 2020), with eighteen health districts affected including twelve newly affected in 2020 (Bimbo, B?goua, Bangui I, Bangui II and Bangui III in the urban area, Boss?mb?l?, Bouar, Bozoum, Baboua-Abba, Haute-Kotto, Nangha-Boguila, and Ouango-Gambo in the rural area).

    From 1 January 2019 through 16 February 2020, a total of 7,626 suspected cases including 83 deaths (case fatality rate 1.08%) were reported. A large proportion of cases (72%) were below five years old and 18% of cases were between 5 and 10 years old. A total of 1,167 samples from suspected cases were tested at the reference laboratory of the Institut Pasteur in Bangui, of which 180 were positive for measles using Immunoglobulin M (IgM).

    The low vaccination coverage for routine measles vaccine over the past 5 years (below 60% for the first dose at 9 months), the absence of a second measles vaccine dose in the national immunization schedule, and inadequate follow-up campaigns resulted in a high proportion of people susceptible to measles, contributing to the ongoing epidemic. All 35 health districts are at risk of a measles outbreak, and without adequate response, the epidemic could spread through the entire country. The number of districts affected by the measles outbreak is increasing, and as of 1 March 2020, 15 health districts have been affected: Alindao, Alindao-Mingala, Baboua-Abba, Bambari, Bangui I, Bangui II, Bangui III, B?goua, Bimbo, Bococaranga-Koui, Boss?mb?l?, Bouar, Bozoum, Haute-Kotto, Nangha-Boguila, Ngaoundaye, and Ouango-Gambo.

    In December 2019, outbreaks affected eight health districts, and the country organized local measles vaccination campaigns that targeted children aged 6 to 59 months in seven districts (Bambari, Batangafo, Bocaranga-Koui, Grimari-Kouango, K?mo, Ngaoundaye, and Nana-Gribizi). Despite vaccination coverage of more than 95%, as confirmed by the vaccination coverage survey, new cases are being recorded in these districts and neighboring health districts in children aged from 5 to 15 years old. Based on the age distribution of cases as indicated by epidemiological investigations, the proposed vaccination strategy is to target the risk group from 6 months to 10 years to help stop transmission. Public health response

    Since the official declaration of the outbreak by Ministry of Health on 24 January 2020, the following public health actions have been conducted:
    • COUSP (Center for Emergency Operations in Public Health) and the Local Crisis Committee have been activated to coordinate the response.
    • The Ministry of Health with support from WHO and other partners are developing a comprehensive response plan, which includes the vaccination campaigns.
    • Epidemiological surveillance in the affected areas has been strengthened.
    • Referral system of severe measles cases to the district health hospital has been set up with free care being offered to measles cases.
    • Distribution of drugs and medical supplies to support provision of free medical care is ongoing.
    • Isolation units have been established at the district hospital.
    • The routine immunization program is being strengthened.
    • Health promotion and risk communication activities are ongoing.
    • Efforts are underway to mobilize resources to respond to the outbreak.
    WHO risk assessment

    WHO estimates the overall risk for the CAR from the current measles outbreak to be “high” due to the following reasons:
    • The geographic expansion of the epidemic into new health districts.
    • The large number of districts with high risk for measles outbreaks, due to low vaccination coverage.
    • An increase in the number of cases reported in 2019 compared to 2018.
    • The security context of the country which limits access to set up rapid response measures in affected health districts.
    • The lack of infrastructure, inputs and resources to ensure free health care.
    • The lack of trained staff available for the clinical management of complications of measles.
    • Suboptimal measles-containing-vaccine first-dose (MCV1) vaccination coverage of 49% for the past 5 years according to joint WHO / UNICEF estimates, and administrative coverage of 71% in 2019.
    • Large population movements between vaccinated and unvaccinated localities.

    Risk at the regional level is assessed as moderate given the large cross border movements of populations to and from neighboring countries including Chad, Democratic Republic of the Congo and Cameroon, both for security reasons and commercial activities.

    The risk is considered low at the global level. WHO recommendations

    Measles is a vaccine-preventable disease and two doses of measles-containing-vaccine (MCV) are recommended to ensure immunity.

    WHO urges all Member States to:
    • Ensure routine measles vaccination for children combined with mass immunization campaigns in countries with high case and death rates to reduce deaths due to measles.
    • Reach and maintain coverage of 95% and more with the first and second dose of MCV.
    • Vaccinate at-risk populations including young children, pregnant women, health workers, people working in tourism and transportation and international travelers.
    • Strengthen epidemiological surveillance of fever / rash cases for timely detection of all suspected cases of measles in public and private healthcare facilities and ensure that samples are received by laboratories within five days of being taken.
    • Include the administration of Vitamin A to children in addition to measles vaccination as this is a key public health strategy to reduce morbidity and mortality due to measles infection and to interrupt transmission.
    • WHO does not recommend any restriction on travel and trade to the Central African Republic based on the information available on the current outbreak.

    For more information on measles

  • #2

    Week 29: 12 - 18 July 2021
    Data as reported by: 17:00; 18 July 2021
    Measles Central African Republic

    35 339 Cases
    197 Deaths
    0.6% CFR


    Since the beginning of 2020, the Central African Republic has
    been facing a resurging measles outbreaks. The ongoing measles
    outbreak in the Central African Republic was declared on 24
    January 2020. The outbreak began early in 2019 under a context of
    accumulation of susceptible individuals due to low administrative
    vaccination coverage both from routine immunization (< 75.0%
    between 2015 and 2019) and from various supplementary
    immunization activities (SIA).

    From 1 January to 22 September 2020, 28 633 cases were
    reported, including 137 deaths, compared to 3 388 cases
    registered in 2019 and 241 in 2018. However, in 2021, the
    number of suspected measles cases reported in the Central
    African Republic from week 1 to week 26 (ending 4 July 2021)
    remains low compared to the same period in 2020, with 26 481
    cases in 2020 and 1 823 cases in 2021. Since the beginning of
    the outbreak in 2019 to 4 July 2021, there have been 35 339
    suspected measles cases including 197 deaths (case fatality ratio
    0.6%) identified through the routine surveillance system. Of the
    suspected measles cases recorded in 2021, 487 were confirmed
    and four died (case fatality ratio: 0.2%).

    Of these confirmed cases, 41 tested IgM positive for measles,
    148 were epidemiologically linked and 298 were compatible
    cases. The epidemic has affected more than half of the country’s
    35 health districts with a high prevalence in the capital Bangui,
    the west and the centre-east.

    Six health districts (HD) reached the measles epidemic threshold
    (Sangha-Mbaéré, Berberati, Mbaïki and Nana-Grebizi, Batangafo,
    Nangha-Boguila) of which two were active in epi week 26. Four of
    these HDs, including Berbérati, Nana Gribizi and Sangha-Mbaéré
    have organized local reactive vaccination campaigns.

    A national vaccination campaign targeting children aged between
    6 months and 10 years, with an emphasis on the children aged
    6 months up to 5 years, given their particular vulnerability
    was planned in two phases in 2020. Despite this progress
    in immunization, 1 in 4 of the confirmed cases in 2021 are
    unvaccinated and the vaccination status of 45.0% is still unknown.


    The Ministry of Health and Population, with the technical
    support of its partners (WHO, UNICEF and non-governmental
    organizations), developed a response plan for the measles
    epidemic declared in 2020 and has mobilized resources for
    the implementation of the various response components.
    Holding of meetings of the Technical Support Committee for
    the Expanded Program on Immunization (CTAPEV) on the
    preparation of the measles immunization campaign in Mbaïki
    health district in compliance with immunization standards in
    the context of COVID-19.

    Development and submission of a project proposal for the
    2022 measles vaccination campaign. In addition, the country
    is in the process of developing the national plan for the same
    follow-up campaign scheduled for 2022.

    Strengthening of immunization logistics in accessible health
    districts to improve routine immunization coverage.

    Discussions in favour of reviving measles communication in
    the context of COVID-19 are underway.

    Strengthening of active measles surveillance in the health
    districts of; Nana-Grebizi, Berberati, Bouar-Baoro, Mbaiki,
    Baboua-Abba, Paoua, Haute-Kotto, Bambari and Nangha
    Boguila is ongoing.


    The measles outbreak in Central African Republic, which was
    declared on 24 January 2020, continues to show a declining trend
    after peaking in early March 2020. Response efforts including the
    intensified routine immunization and SIAs could have certainly
    contributed to preventing major flare-ups and thus slowing the
    measles outbreak. In this epidemic, 45% of confirmed cases
    in 2021 have an unknown vaccination status, while 25% have
    not been vaccinated despite the national vaccination campaign
    organized in 2020.

    In addition, administrative vaccination coverage at the national
    level was 70% in the first quarter of 2021, which falls short of the
    95% herd immunity threshold and does not make the districts
    safe from future measles outbreaks. National authorities and
    partners need to keep up the momentum for ongoing, regular
    vaccination against vaccine preventable diseases, particularly
    with the disruption of the COVID-19 outbreak, in order to prevent
    future outbreaks.
    "Safety and security don't just happen, they are the result of collective consensus and public investment. We owe our children, the most vulnerable citizens in our society, a life free of violence and fear."
    -Nelson Mandela