Madagascar has been experiencing a measles outbreak since early October 2018. The outbreak started in the urban health district of Antananarivo Renivohitra (in the heart of the capital city, Antanarivo) on 4 October 2018 when three measles cases were confirmed at the Pasteur Institute of Madagascar (IPM) by serology. The disease then spread to other health districts (Tanà South, Tanà North and Ambohidratrimo) in Analamanga Region (where the capital city is located) and subsequently to other parts of the country. The Ministry of Public Health formally declared the measles outbreak on 26 October 2018.
As of 18 November 2018, a total of 3 239 measles cases have been reported, of which 182 were confirmed immunoglobulin M (IgM) positive and 3 057 were epidemiologically linked. No deaths have been reported to date. A total of 23 districts (out of 114) in 12 regions (out of 22) are currently in epidemic phase. The urban health district of Antananarivo-Renivohitra is the most affected, accounting for 84% (2 730) of all reported cases. The other health districts with high numbers of cases are Ambatondratrimo (6%, 200), Antananarivo-Atsimondrano (3%, 91). The remaining health districts have fewer cases..The current measles outbreak has occurred at a time when there is some resurgence of plague in the country, straining the public health response system. The ongoing political election, with the risks of social tensions and conflict, has also downgraded the response to these public health events. (WHO, 23 Nov 2018)
The measles outbreak in Madagascar has seen a dramatic increase in incidence cases in the last three weeks. Since our last report on 23 November 2018 (Weekly Bulletin 47), 6 125 additional cases have been reported, of which 89 were laboratory-confirmed (immunoglobulin M (IgM) positive) and 6 036 were epidemiologically linked. Eleven new districts have been affected during the past three weeks...The continuous propagation and the rapid increase in the number of measles cases in Madagascar is concerning. The outbreak is already in highly populated areas, and in a largely non-immune population as indicated by the wide range of the age groups affected. Given the high transmissibility of measles, it can be expected that this outbreak may evolve exponentially. (WHO, 14 Dec 2018)
The measles outbreak in Madagascar continues to improve, with the trend showing a marked decline. Since our last report on 28 December 2018 (Weekly Bulletin 52), there have been 2 317 additional measles cases reported, of which 231 were confirmed (immunoglobulin M (IgM) positive) and 87 epidemiologically linked...While the situation is improving, the risk of the outbreak spreading to the few remaining unaffected regions of the country remains. Although the first phase of the reactive vaccination campaign progressed well, there is still a shortage of vaccines and funds for response in those districts at risk, and funding gaps need to be filled for phases two and three of the campaign, planned for February through April 2019. (WHO, 25 Jan 2019)
In February 2019 (weeks 7 to 8), an overall 774 new cases were recorded in 3 newly affected districts including ANDILAMENA (145 cases in week 7 and 167 cases in week 8); MAHAJANGA II (142 cases in week 7 and 241 cases in week 8) and MAHANORO (22 cases in week 7 and 57 cases in week 8). Despite stabilizing in some areas, the above-mentioned spikes show that the epidemic is progressing, and the epidemic is now posing significant risk to remote and hard to reach communities as seen in below table, which summarizes the rate at which the disease has been spreading with 7,288 new cases in March 2019 (weeks 9 to 12). (IFRC, 28 Mar 2019)
A decreasing trend in the incidence of suspected cases of measles continues to be observed since week 7 (week ending 17 February 2019), following the series of reactive vaccination campaigns that have been recently conducted in the country. Between 3 September 2018 and 26 May 2019, 146 277 cases have been registered, among which 19 708 had symptoms of complications and 910 had deceased (CFR 0.62%). Out of the 146 277 cases, 1 394 have been laboratory confirmed by serology (IgM positive) (WHO, 9 Jun 2019)