Measles in Tunisia

Measles in Tunisia

Event background

• The first case of the outbreak was reported on 18 January 2019, with onset of symptoms on 9 January, in the district of Feriana, Kasserine governorate, in Western Tunisia bordering Algeria. This case was a child in a migrant family from Algeria who was admitted to a hospital in Feriana district. 
• Since 1 January through 13 March 2019, the total number of reported suspected measles cases was 1 267, of which 481 (38%) were laboratory confirmed and 368 (29%) epidemiologically linked cases including 13 deaths (CFR: 1.5%) from Kasserine (6) and Sfax (7) governorates.
• A total of 20 (out of 24) governorates reported cases; highest incidences were observed in Kasserine (134/100 000) and Sfax (13/100 000).
• In Kasserine, 253 (42%) laboratory confirmed cases, 165 cases (27%) epidemiologically linked and 188 (31%) clinically compatible cases were reported. Male to female ratio was 1.02
• most affected age groups were older than 15 years (31%) and children between 6-12 months (28%).
• 63% of affected children between 1-15 years were not vaccinated; 421 (69%) cases were hospitalized and 15 (2.5%) developed complication.
• The number of reported measles cases is above the average annual number registered in the past 10 years in the country. The highest number reported in the previous 10 years was in 2012 with 48 cases of theses 92% were unvaccinated.

Further Information:

WHO Risk Assessment

Despite the spike of cases in 2019, the risk at the national level is still moderate due to the immediate government response (vaccination of all 6 to 12 months old infants in the affected governorates (Kasserine and Sfax). In addition, the country has had high levels of second dose vaccination coverage (>95) for multiple years, which should help protect many birth cohorts from disease. A total of seven governorates have a border with Algeria; there is no official number for people crossing the border, but the fact that many families move freely between the two countries induces a moderate risk at regional level. The risk at global level remains low.

Actions requested:

• All individuals, whether travelling or staying in Ireland, should ensure that they are age appropriately vaccinated with MMR vaccine.
• Children aged 6-11 months of age, travelling to other countries and regions where measles outbreaks are reported, are recommended MMR vaccine. A dose given before 12 months of age does not replace the dose that would normally be given at 12 months of age.

Additional documents included:

• WHO Immunization, Vaccines and Biologicals- Measles https://www.who.int/immunization/diseases/measles/en/
• WHO Measles and Rubella Surveillance Data: https://www.who.int/immunization/monitoring_surveillance/burden/vpd/surveillance_type/active/measles_monthlydata/en/

Further sources of information: 

• http://www.hpsc.ie/a-z/vaccinepreventable/measles/
• https://www.hse.ie/eng/health/immunisation/hcpinfo/guidelines/chapter12.pdf