WHO | Measles – Burundi

Burundi has seen an increase in confirmed cases of measles since November 2019. This outbreak initially began at a refugee transit camp (Center de transit de Cishemere, Cibitoke Health District) whose residents came from the provinces of measles. Democratic Republic of the Congo. Refugees spend 21 days at the Cishemere transit camp before being sent to permanent camps at the Nyankanda and Bwagiriza refugee camps in Buteza, the Kavumu Camp in Cankuz, the Garsowe Camp in Muyinga and the Mulumba Camp in Kiremba.

Avoidance was found when locals in the surrounding area reported suspected measles, pointing out pockets of the non-vaccinated population. According to WHO / UNICEF 2018 estimates, vaccination coverage for the first measles vaccine is relatively high (88%) and slightly lower for the second dose (77%). However, this does not reflect the coverage of vaccination of refugees who have arrived.

As of April 27, 2020, 857 confirmed cases of measles were reported from four districts, including: Cibitoke (624 cases), Butezi (221 cases), Cankuzo (6 cases) and South Bujumbura (6 cases). Of the measles cases in Cibitoke, 601 cases were epidemiologically related, 20 were laboratory confirmed, and three were clinically diagnosed. In Butezi district, 27 were laboratory confirmed, 192 were epidemiologically linked, and two were clinically diagnosed. In Cankuz, all six cases are laboratory confirmed, while in Southern Bujumbura, three are laboratory confirmed and three are epidemiologically related. Children aged 9-59 months were the most affected by the age group, with 80% of cases in children aged 9 years or younger.

Table 1. Distribution of confirmed measles cases by age and gender

No new cases have been reported in the southern districts of Bujumbura and Cankuzo since December 2019. The most recent cases were reported in Butezi on March 2, 2020.

It is underway in Cibitoke. The last case at Cishemere transit camp was reported on January 14, 2020). Globally, the total cases reported at Cishemere Transit Camp and Cibitoke Health District are 67 and 557, respectively.

Measles circulation in a population with low immunity is the cause of this epidemic. Most cases (77%) were unvaccinated or unsure of their vaccination status.

Public health response

Burundi’s Ministry of Public Health, with partners including WHO, UNICEF, Doctors Without Borders (MSF) and Gruppo di Volontariato Civile (GVC), has drawn up a comprehensive plan for responding to the measles epidemic, which includes the following public health measures:

• Establishing a technical committee responsible for developing and monitoring the implementation of the plan, chaired by the Director-General for Health Services and AIDS;
• Vaccine response targeted at children from 9 months to 14 years in camps, including the Cishemere Transit Center in Cibitoke, Nyankanda and the Bwagiriza Refugee Camps in Buteza; and Kavumu Camp in Cankuz;
• Strengthening vaccination programs for children in refugee camps and affected neighborhoods by establishing vaccination sites at the Cishemere Refugee Transit Camp;
• Strengthening surveillance in the affected health districts with a focus on active case finding has expanded to all neighborhoods where the refugee camps are Garsowe (Muyinga) and Mulumba (Kiremba).
• The mobilization of resources to fund a national response plan, endorsed by the Ministry of Public Health and AIDS, is ongoing;
• Capacity building of healthcare providers in case management and supervision;
• With the support of community health professionals, actively seek and vaccinate children who have not previously been vaccinated with the first and second doses of the measles vaccine (MCV).

WHO risk assessment

The WHO estimates that the current measles epidemic poses a high risk for Burundi for the following reasons:

• Increase in number of reported cases since November 2019;
• The epidemic is spreading from refugee camps to the community;
• Lack of infrastructure, insufficient inputs and resources to provide free care and staff capable of ensuring the clinical management of complications of measles infection;
• Suboptimal immunization coverage – 88% for MCV 1 and 77% for MCV 2 (according to the WHO / UNICEF Joint Estimate for 2018);
• A major population shift between localities and concurrent measles outbreaks in the neighboring Democratic Republic of Congo.

Apart from low immunity, differences in the control of measles and rubella in the country, confirmed by the 2019 Risk Analysis for measles, showed that 63% of districts (29/46 health districts) were at high risk, including 13 districts with a very high risk of the measles epidemic . This shows that the country’s monitoring system may not be able to detect measles outbreaks unless it intensifies.

Tip of WHO

Measles is a vaccine-preventable disease and two doses of MCV are recommended to provide immunity. Conducting targeted reactive vaccination campaigns and strengthening routine vaccination are essential for effective epidemic control. Vitamin A administration, especially in the case of malnutrition, can reduce mortality and mortality from measles.

WHO calls on all Member States to:

• Provide routine measles vaccination for children in combination with mass immunization campaigns in countries with a high incidence and mortality rate to reduce measles deaths.
• Achieve and maintain at least 95% coverage of the first and second doses of MCV.
• Vaccine at-risk populations, including refugees, internally displaced persons, young children, pregnant women, healthcare professionals, people working in tourism and transport, and international travelers.
• Reinforce epidemiological surveillance of fever and rash cases to detect in a timely manner all suspected cases of measles in public and private health care facilities and to ensure that samples are immediately obtained from laboratories.
• Ensure that vitamin A is integrated in response, in accordance with recent WHO guidelines.

WHO does not recommend restricting travel and trade in Burundi based on information available on the current epidemic.

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