Infection control: Responding to measles

outbreak Atoifi Hospital

Christopher Jimuru, RN, PHC Coordinator

James Asugeni, RN, Ronald Oleka, RN Mike Puia, RNA John Maomatekwa, RN

BACKGROUNDAtoifi Hospital serves the population of East Kwaio. Aprproximately 10,00 people including inpatient, outpatient and outreach

Measles is a very infectious viral illness that causes rash and fever. Complications include ear infection, pneumonia and encephalitis.

Rash from measles on face

BACKGROUND

Outbreak first reported in Honiara in June 2014 First case was a 21 year old female acquired infection in Papua New Guinea (PNG)People from East Kwaio area often go to HoniaraFirst case in area was a 1 year old from a village south of Atoifi on 28/7/2014. Outbreak response commenced (Measles Taskforce Team).

Background

Routine immunisation is provided by PHC- outreach and clinic

Immunisation coverage for catchment area is about 48% for measles in 1 year olds for 2014

Method

Epidemiological review of the measles outbreak 2014:Case definitionEpi- curveDemographicsVaccination status of casesHospitalisation

Case definition used

Case definition- clinical

-fever, rash, plus cough, conjunctivitis or koplick spot

No Lab confirmation available

Epi-curve

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 210

5

10

15

20

25

30

Measles Cases, epi curve, by outbreak week, AAH, 2014

Outbreak weeks, July-Dec 2014

Cases

Age-groups

0-4 5y-9 10y-14 15y-19 20y-24 25y-29 30y-34 35+0

5

10

15

20

25

30

35

40

45

50

Measles cases by age group, AAH, 2014 outbreak

Gender and Hospitalisations

Male Female0

10

20

30

40

50

60

70

Measles cases by gender, AAH, 2014

outbreak

Hospitalisation: 71/123 (57.7%)

were hospitalised, at a rate of 746/100,000 population for catchment

In New South Wales Australia the hospitalisation rate was 0.20 per 100,000 population over a 10 year period to 2012

Location

Coastal Bush0

10

20

30

40

50

60

70

Measles cases by lo-cation, AAH, 2014

outbreak

Vaccination status cases is unknown because data were not collected

Outbreak response – 1st step Photo staff being vaccinated

Vaccines given during the response Staff and families – 264 doses given Community – 1734 doses given, over

2 weeks

Outbreak response

Outbreak response include:-organise a measles response team- Immunize high risk 6mnth-5years, OPD staff, ward staff

and kids- Immunize immediate family members of suspected cases- Mass immunization first to the villages of suspected cases

and to the whole catchment-establish two isolation ward to admit measles cases-conduct health awareness talk on measles to schools and

surrounding communities - Develop guide lines, case definitions, form for reporting

cases during outbreak- Use of pineapple juice as home remedy to help recovery

Infection control

Infection control- Measles is very infectious- Increased hand washing, staff wearing

mask, isolation of the case, separate entrance, restrict visitors and vaccinate family members.

- But best infection control is immunisation beforehand

- Measles vaccine twice gives 98% of people protection

Conclusion

Immunisation at very high levels is essential because measles is very infectious. Outreach clinics need to occur to achieve this. This is an area for further research.

Data collection during outbreak to be improved e.g. vaccination status

Use an Excel spread sheet daily to enter data

Infection control is best done by infection prevention. Immunise!

Thank you