Department of Public Health (DPH)

Measles Update: Sunday 27^th March 2005

Table 1: Number of measles cases by month for epidemiological year 2005

Year	Month	Total No. of Cases
2004 (from Dec 27^th)	December	0
2005	January	2
	February	16
	March (to 26th)	45
Total		63

Figure 1

Epidemic curve for notified measles cases for Male and Atolls for Epidemiological year 2005 to date (Dec 27^th 2004 to 26^th March 2005)

Figure 2

Epidemic Curve for Measles cases in Male to March 26^th 2005 (n=35)

Table 2 Age distribution of measles cases

Age range	Number	%
0-9 months	1	1.6
9 months – 4 years	1	1.6
5-9 years	4	6.3
10-14 years	15	23.8
15-19 years	18	28.6
20-25 years	19	30.2
>26 years	5	7.9
	63	100

Figure 3 Graph showing age distribution of notified measles cases

Table 3 Measles cases by gender

Sex	Number	%
Male	29	46.0
Female	34	54.0
Total	63	100

Table 4 Measles cases by Atoll and Island

Atoll	Island	Number (%)
Kaafu	Male	35 (55.5)
Alif Dhaal	Fenfushi	11 (17.4)
Alif Alif	Feridhoo	4 (6.3)
Laamu	Mundhoo	3 (4.8)
Dhaal	Hulhudheli	1 (1.6)
Gaaf Dhaal	Fiyoaree	1 (1.6)
Gnaviyani	Fuvahmulah	1 (1.6)
Haa Alif	Ihavandhoo	1 (1.6)
H Dhaal	Hanimaadhoo	1 (1.6)
H Dhaal	Vaikaradhoo	1 (1.6)
Kaafu	Villingili	1 (1.6)
Laamu	Fonadhoo	1 (1.6)
Laamu	Kalhaidhoo	1 (1.6)
Seenu	Meedhoo	1 (1.6)
Total		63 (100)

Laboratory Diagnosis

14 samples were submitted for measles specific IgM testing. Four were positive; six tested negative and 4 were indeterminate. The indeterminate tests are being repeated.

Negative and indeterminate tests are automatically tested for rubella. One indeterminate test was positive for rubella (Table 5).

Table 5

Table showing lab results in relation to dates of rash onset, dates of lab sample and immunization history

Initials	Age	Date of onset of rash	Date of consultation	Date of lab sample	Measles IgM	Measles vaccine received	Rubella IgM
HA	23y	Unknown	19/1	22/1	Indeterminate	Unknown	Pending
HS	22y	11/2	14/2	19/2	Negative	Yes	Indeterminate
KR	19y	Unknown	19/2	19/2	Negative	Yes	Negative
NU	24y	Unknown	21/2	21/2	Negative	Unknown	Negative
IM	19y	28/2	28/2	27/2	Indeterminate	Unknown	Indeterminate
MJJ	7mths	Unknown	28/2 but parents treated during the week before	27/2	Positive	No	-
AV	15y	1/3	6/3	5/3	Indeterminate	Yes	Positive
AF	21y	7/3	8/3	8/3	Positive	Unknown	-
HS	19y	27/2	5/3	5/3	Positive	Yes	-
TJ	36y	Unknown	9/3	9/3	Indeterminate	Unknown	Pending
IS	10y	11/3	12/3	12/3	Negative	Yes	Pending
NI	11y	Unknown	13/3	13/3	Positive	Yes	-
KH	18y	14/3	15/3	15/3	Negative	Unknown	Pending
MA	18y	18/3	18/3	18/3	Negative	Unknown	Pending

Figure 4

Graph showing Measles cases by week for 2002-2005 (to wk 13 provisional)

NB.

A Fenfushi notified DPH of 11 measles cases over the past week (See Appendix). A doctor from the neighbouring Health centre in Maamigili was sent to investigate. Advice has been given re timing of laboratory testing and Vitamin A administration. Vaccination priorities have been discussed. There are adequate vaccine supplies to vaccinate at risk groups. Information on measles vaccination coverage from A Fenfushi is being obtained. A team (DPH and WHO) will visit A Fenfushi this week.

Wider Actions Taken

1. Health care professionals are being advised to take laboratory samples to confirm the infection and to take the samples at least 4 days after the rash appears.

2. A measles management protocol is in draft form for review. This includes administration of Vitamin A to those diagnosed with measles and reminds doctors to complete measles specific case notification forms.

3. The measles case definition is being reviewed to make it consistent with the WHO recommended case definition. The measles case notification form has been amended – in draft format for review.

4. A measles fact sheet is being prepared.

Appendix

Measles cases reported from ADh Fenfushi 22- 26 March 2005 (n=11)

Eleven cases were reported from ADh Fenfushi between 22-26 March 2005. Figures 1 and 2 show epidemic curve and age range of cases.

Figure 1 Epidemic curve for ADh Fenfushi (n=11)

Figure 2 Age range of cases from ADh Fenfushi (n=11)