WHO | Measles – Central African Republic

The Central African Republic (CAR) has experienced an increase in measles as a result of the 2019 epidemic. The first case of measles was recorded in Week 5 of 2019 (the week beginning January 28, 2019) and the epidemic continued until Week 7 of 2020 ( week begins February 10, 2020), with eighteen affected areas of health, including twelve newly diagnosed 2020 (Bimbo, Bégoua, Bangui I, Bangui II and Bangui III in the urban area, Bossémbélé, Bouar, Bozoum, Baboua-Abba, Haute -Kotto, Nangha-Boguila and Ouango-Gambo in the rural area).

From January 1, 2019 to February 16, 2020, a total of 7,626 suspected cases were reported, including 83 deaths (1.08% case fatality rate). A large proportion of cases (72%) were younger than five years and 18% of cases were between 5 and 10 years old. In the reference laboratory of the Pasteur Institute in Bangui, 1167 samples were tested for suspected cases, 180 of which were positive for measles using immunoglobulin M (IgM).

Low coverage of the routine measles vaccine in the last 5 years (below 60% for the first dose in 9 months), the absence of a second dose of the measles vaccine in the national immunization schedule, and inadequate follow-up campaigns have resulted in a high proportion of measles-sensitive people, contributing to an epidemic that has in process. All 35 health districts are threatened with measles, and without an adequate response, the epidemic could spread across the country. The number of measles outbreaks is increasing and as of March 1, 2020, 15 health districts have been affected: Alindao, Alindao-Mingala, Baboua-Abba, Bambari, Bangui I, Bangui II, Bangui III, Bégoua, Bimbo, Bococaranga-Koui , Bossémbélé, 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 actions targeting children aged 6 to 59 months in seven districts (Bambari, Batangafo, Bocaranga-Koui, Grimari-Kouango, Kémo, Ngaoundaye and Nana-Gribizi). Despite vaccination coverage of more than 95%, as evidenced by the vaccination coverage survey, new cases in children aged 5 to 15 years were reported in these districts and neighboring health districts. Based on the age distribution of cases as indicated by epidemiological studies, the proposed vaccination strategy should target the risk group from 6 months to 10 years to stop transmission.

Public health response

Since the official announcement of the outbreak of the Ministry of Health on January 24, 2020, the following public health actions have been implemented:

• The COUSP (Center for Emergency Public Health Operations) and the Local Crisis Board were activated to coordinate responses.
• The Ministry of Health, with the support of WHO and other partners, is developing a comprehensive response plan that includes vaccination campaigns.
• Epidemiological surveillance in the affected areas has increased.
• A system for referral of severe measles cases to a district health hospital was established, and free care was provided to patients with measles.
• Distribution of medicines and medical supplies to provide free medical care is ongoing.
• Isolation units were established at the district hospital.
• A routine immunization program is being strengthened.
• Health promotion and risk communication activities are ongoing.
• Efforts are being made to activate resources to respond to the epidemic.

WHO risk assessment

WHO estimates that the overall risk of CAR from the current measles epidemic is “high” for the following reasons:

• The geographical spread of the epidemic to new health districts.
• A large number of high-risk districts for the measles epidemic due to low vaccination coverage.
• Increase in the number of cases reported in 2019 compared to 2018.
• The country’s security context that limits access to setting up rapid response measures in threatened health care settings.
• Lack of infrastructure, inputs and resources to provide free healthcare.
• Lack of trained staff for clinical management of measles complications.
• According to joint WHO / UNICEF estimates and an administrative coverage of 71% in 2019, covered by a 49% vaccine vaccine comprising the vaccine (MCV1) of 49% vaccination in the last 5 years.
• Large population movements between vaccinated and unvaccinated sites.

The risk at the regional level is considered moderate given the large cross-border movements of the population to and from neighboring countries, including Chad, the Democratic Republic of Congo and Cameroon, for both security and commercial activities.

The risk is considered to be low globally.

WHO Recommendations

Measles is a preventable disease and two doses of the measles vaccine (MCV) are recommended to provide immunity.

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.
• The first and second doses of MCV reach and maintain coverage of 95% and above.
• Vaccine at-risk populations, including young children, pregnant women, healthcare professionals, people working in tourism and transport, and international travelers.
• Reinforce epidemiological surveillance of fever / rash cases to timely detect all suspected cases of measles in public and private healthcare facilities and ensure that laboratories receive samples within five days of sampling.
• Turn on the administration of vitamin A to children with measles vaccination, as this is a key public health strategy to reduce the morbidity and mortality of measles infections and interrupt transmission.
• WHO does not recommend any restrictions on travel and trade in the Central African Republic based on information available on the current epidemic.

For more information on measles