An Integrative Study of Measles Outbreaks
in the City of Cape Town, South Africa:
2000-2011

Vimbai Chasi & Ailsa Holloway...
Overview
One Health Approach

Disaster Risk Science
lens

Human vulnerability

Institutional vulnerability

Epidemiology

...
Integrative methodology
“One Health does not supplement disciplinary
responsibilities but it helps us ask questions that m...
Study site: Cape Town, South Africa
Maps: Fortune, 2013
Facts about measles

Measles vaccine:
- Cost of vaccine <USD2 per dose
- 2 dose routine vaccination (even in developing
co...
Facts about measles
Continent Country
N. America USA

Dates
Jan – Aug ’13

Cases
>150

Deaths
-

Island
state
Europe

New
...
MayJan-May 2000 outbreak
2009-Feb 2011outbreak
Is this anJan 2004-Mar2005 outbreak
accurate calculation of outbreak risk?
...
Underpinning assumption
Given the central role of the health sector in
administering the measles vaccine, institutional
sh...
25 health sector
shortcomings in:

-Notification procedure
-Outbreak notification
-Routine vaccination
-Mass immunisation
...
What are the recurring risk governance
shortcomings in Cape Town?
– Failure to understand population at risk: use of
inacc...
What are the emerging risk governance
shortcomings in Cape Town?
– Failure to diagnose and contain index measles
cases con...
Value Added by the One Health Approach
- Profile sectoral deficits related to prevention
and control of measles
- Identifi...
Thank you
What is risk governance?
Risk governance represents how all institutional
mechanisms and actors collect, analyse, manage
a...
What does measles outbreak risk reduction
research entail?
Movement from:
- studying events to studying changing exposure
...
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An Integrative Study of Measles Outbreaks in the City of Cape Town, South Africa: 2000-2011

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GRF 2nd One Health Summit 2013: Presentation by Vimbai Z.J. Chasi, Research Alliance for Disaster and Risk Reduction (RADAR), Stellenbosch University

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An Integrative Study of Measles Outbreaks in the City of Cape Town, South Africa: 2000-2011

  1. 1. An Integrative Study of Measles Outbreaks in the City of Cape Town, South Africa: 2000-2011 Vimbai Chasi & Ailsa Holloway Research Alliance for Disaster and Risk Reduction (RADAR), Stellenbosch University Session: Integrative One Health Risk Management, One Health Summit
  2. 2. Overview One Health Approach Disaster Risk Science lens Human vulnerability Institutional vulnerability Epidemiology Risk governance
  3. 3. Integrative methodology “One Health does not supplement disciplinary responsibilities but it helps us ask questions that might lead to better answers” Q uantitative (epidemiological) data smc and cmcs case data analysis NICD S patial City Health Department Temporal Q ualitative (risk science) data Informant interviews NICD Incidence Measles symposium participation W CDoH Measles symposium Document review Informant interviews Outbreak prevention and control Institutional constraints Research methods Data source Analysis Chasi, in press
  4. 4. Study site: Cape Town, South Africa Maps: Fortune, 2013
  5. 5. Facts about measles Measles vaccine: - Cost of vaccine <USD2 per dose - 2 dose routine vaccination (even in developing countries)
  6. 6. Facts about measles Continent Country N. America USA Dates Jan – Aug ’13 Cases >150 Deaths - Island state Europe New Zealand France May ’11 - Jul ’12 >400 - Jan ’08 - Apr ’11 Bulgaria Apr ’09 – Jul ’08 >17,00 8 0 >23,00 24 0 >8,000 517 Africa Sep ’09 – May ’10 South Africa Sep ’09 – May ’10 Zimbabwe >15,00 18 0
  7. 7. MayJan-May 2000 outbreak 2009-Feb 2011outbreak Is this anJan 2004-Mar2005 outbreak accurate calculation of outbreak risk? Jan 2004-Mar2005 -- MCV Coverage: 103-95% - MCV coverage: 91-92% MCV coverage: 73% - Duration: 5 months - Duration: 21 months - Duration: 14 months - Cases: 69 May 2009-Feb Follow-up - Cases: 2,539 2011 - Cases: 91 ? - Sub-districts: 4 (Eastern, - Sub-districts: 4 - Sub-districts: All Northern, Tygerberg & (Northern, Klipfontein, Western) Southern & Western) Jan-May 2000 Chasi, in press
  8. 8. Underpinning assumption Given the central role of the health sector in administering the measles vaccine, institutional shortcomings or ‘risk governance deficits’ would significantly drive measles epidemic risk. Study objectives 1. Identify and differentiate key health sectoral shortcomings associated with the progression of measles risk and recorded outbreak management, 2. Examine the findings in relation to prevailing epidemiological and disaster risk reduction approaches,
  9. 9. 25 health sector shortcomings in: -Notification procedure -Outbreak notification -Routine vaccination -Mass immunisation -Outbreak control priority
  10. 10. What are the recurring risk governance shortcomings in Cape Town? – Failure to understand population at risk: use of inaccurate client numbers based on live births alone Holloway et al, 2010
  11. 11. What are the emerging risk governance shortcomings in Cape Town? – Failure to diagnose and contain index measles cases consequently exposing more people Artist: Mike
  12. 12. Value Added by the One Health Approach - Profile sectoral deficits related to prevention and control of measles - Identified intervention entry points for other prevention and control projects - Identified feedback necessary to give to education and training institutions for health professionals
  13. 13. Thank you
  14. 14. What is risk governance? Risk governance represents how all institutional mechanisms and actors collect, analyse, manage and communicate risk information. Categories include: - Risk governance failures Actions that are either unsuccessful or not taken - Risk governance deficiencies Missing elements in risk governance structures and processes
  15. 15. What does measles outbreak risk reduction research entail? Movement from: - studying events to studying changing exposure & conditions - urgent and immediate timeframes to moderate & comparative timeframes of realised events - primary and singular information sources to multiple & diverse changing sources of information

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