A low-cost; community-based measles outbreak investigation with follow-up action

ABSTRACT

An outbreak of measles in Kampala; Uganda; in 1990 raised concern about the effectiveness of the measles vaccine that was used. The Uganda EPI programme and the medical office of the Kampala City Council therefore conducted a community-based investigation; with door-to-door interviews in two selected communities. They revealed 68 measles cases ranging in age from 5 months to 12 years; the highest age-specific attack rate (32pc) was found in children aged 12 to 23 months. BCG immunization coverage was high (85pc); but measles immunization coverage was moderate (48pc). One community; served by a mobile clinic; presented a vaccine efficacy of only 55pc. Responses by mothers revealed that many had failed to have their children completely immunized because of a lack of information; and not because of difficulties in access to the service. In a follow-up; community leaders initiated monthly checking of immunization cards of both children and mothers. The low vaccine efficacy found in one of the communities resulted in a thorough assessment of the city's cold chain. This community-based approach proved to be cost-effective and practical for identifying the obstacles to effective immunization delivery