Rapid response to a measles outbreak in Ifanadiana District, Madagascar

ABSTRACT In 2019, Madagascar experienced the nation’s largest documented measles outbreak ever. From September 2018 to January 2020, nearly 225,000 individuals were infected, slightly more than 1,000 of whom died. Madagascar is one of the poorest countries in the world with one of the least funded health systems. Here, we present the experience of how Madagascar’s Ministry of Health (MoH) partnered with a non-governmental organization, PIVOT, to rapidly respond to a measles outbreak in the rural district of Ifanadiana, in the southeast of the country. The epidemic reached Ifanadiana in January of 2019. By August, there were more than 4,800 identified cases of suspected measles, including 157 hospitalizations. Over the course of two weeks in February 2019, the MoH and PIVOT mobilized nine teams of 220 total staff to vaccinate 69,949 children aged 6 months to 10 years at schools and community events. Surrounding the campaign, health workers were trained in measles identification and provided with medication for symptom management. The measles response required overcoming health system weaknesses and geographic barriers which are endemic throughout the country and create chronic challenges for the provision of routine preventive and curative care. This response demonstrates that rapid mobilization of an organized health system response is feasible even in hard-to-reach areas. KEY POINTS Madagascar experienced the island’s worst measles outbreak in history as a result of low vaccination coverage. In Ifanadiana District, the Ministry of Health and a non-governmental health organization collaborated to respond to the measles outbreak with a mass vaccination campaign, sensitization, and provision of supplies to health facilities for the management of disease complications. The measles outbreak in Madagascar highlights the need for an increased focus on routine preventive care, especially in hard-to-reach communities; calls attention to the consequences of ruptures in the care continuum; and highlights the need for timely, continuous, de-centralized epidemiologic data. The response to the outbreak in one rural district is evidence that health care can be delivered in remote areas.