Molecular detection of measles virus from children during a sporadic outbreak in two semi-urban areas in Nigeria

Background: According to the World Health Organization (WHO); African region accounts for 36 of deaths caused by measles worldwide. Nigeria has; over the years; recorded the highest average annual measles incidence per 100;000 populations in Africa. Measles epidemics have consistently been reported in northern Nigeria; but not in the South; reports of reduced protective haemagglutination inhibition antibody titers among children in Ibadan; southern Nigeria was made. Investigation of the viral agent responsible for the disease outbreak among children presenting with rash in two semi urban areas in southern Nigeria was carried out to confirm the etiology of the disease. Methodology: Twenty six throat swabs (TS); and nineteen urine samples were collected from twenty six children residing in Onireke and Sabo areas of Ibadan following the report of an outbreak of rashes among children. Active case finding with the support of community leaders was used to locate the affected children. Multiplex reverse transcriptase polymerase chain reaction (MRT-PCR); was used to identify the agent. Results: 21 of the 26 children screened tested positive for measles virus; but none was positive for Rubella virus. There was significant association between measles infection; and households with higher number of persons. Conclusion: Mass measles vaccination that targets overcrowded; rural and inaccessible areas is needed to increase herd immunity. Public health enlightenment on the benefits of vaccination is encouraged

Investigating outbreaks: Practical guidance in the Indian scenario.

The new International Health Regulations, 2005, which came into force in 2007, establish a national focal point in each country to manage public health emergencies of international concern, including outbreaks. Investigating outbreaks is a challenging task. Often, pressure from decision-makers to hasten investigation may preclude proper evidence-based conclusions. Furthermore, the task of outbreak investigation is given to senior staff, who have limited time for field activities. The classical 10-step approach includes 4 main stages of (i) confirmation of the presence of the outbreak and of diagnosis using laboratory tests, (ii) generation of hypotheses regarding causation using descriptive epidemiology findings, (iii) hypothesis-testing using analytical epidemiology techniques, and (iv) institution of prevention measures. Peer-review at all stages of the investigation and reporting is the keystone of the quality assurance process. It is important to build capacity for outbreak investigation. Two Field Epidemiology Training Programmes in India are trying to do this. In these programmes, epidemiologists-intraining take a lead in investigating outbreaks, while learning the ropes, with full technical support from the faculty. This training should spawn a culture of generating and using evidence for decision-making in the context of public health, and help strengthen health systems even beyond the domain of outbreaks.

Crimean congo haemorrhagic fever [CCHF] outbreak in Karachi

A retrospective investigation was conducted in Karachi during November 2000 to determine the cause of death of a butcher and his contacts who were exposed to the body fluids and vomitus of the butcher while he was being treated at the Aga Khan Hospital, Karachi. The Laboratory analysis of blood samples of HCWs at CDC proved the secondary cases as CCHF infection. This is another example of the risk of nosocomial spread of CCHF in a hospital when health care workers are exposed to the body fluids of a CCHF patient. Case Report: A butcher from Sliah Faisal Colonv Karachi was brought to Aga Khan University Hospital [AKUH]. Karachi with complaints of fever, body aches and bleeding from gums who was admitted on 12th October 2000. He also had severe hematemesis and vomited fresh blood. He was transfused large number of blood bags [approx. 40] 40]. These could possibly be blood products such as whole blood, plasma and platelets. Despite all efforts lie could not survive and died on 16th October 2000. Blood sample of the deceased Nvas not tested for Viral Haemorrhagic Fever [VHF]. Two health care workers [HCW] of AKUH contracted CCHF from index case when they were dealing and clearing tire blood and vomitus from mouth of the index case. One HCW died on November 3. 2000 and another recovered. A team from National Institute of Health [NIH] Islamabad conducted a retrospective investigation to determine the cause of the disease; transmission risks among close contacts; and advised preventive measures to the provincial health authorities and community. The blood samples of both health care workers were confirmed as CCHF positive by CDC Atlanta and the blood samples of mother and wife of the deceased were confirmed as Polymerase Chain Reaction [PCR] negative for CCHF and none of them had IgG or IgM antibodies to CCHF when lab confirmed at National Institute of Virology [NIV], South Africa