This document summarizes a measles outbreak that occurred in Pohnpei, Federated States of Micronesia between May and August 2014. It describes the study design, data sources, methods of analysis, key findings and public health response. A total of 247 measles cases were reported, with the highest attack rates among children under 5 years old. A mass vaccination campaign was conducted in June and August 2014, achieving over 94% vaccination coverage. The outbreak investigation identified gaps and made recommendations to strengthen surveillance and response efforts.

1. Measles Outbreak – Pohnpei 2014
Federated States of Micronesia
24 February 2016 -
Colonia, Yap

2. Overview of data and study design
• Descriptive Cross-sectional study design
• Time frame: May 27, -September-2014
• Data sources
– Line list
– Case reports
– Vaccination records
– Laboratory reports
– Census data
– Hospitalization records
– Death records

3. Methods of data analysis
 Analysis mainly done on Exel software
 Frequency of cases by date
 Incidence rate by age group and municipality using census
data
 Vaccination coverage using vaccination records 844 and
master list
 Frequency of cases by case type
 Clinical data to verify case definition
 Measles case definition- Acute fever and rash with one or
more of the following; cough, coryza, conjunctivitis

4. Measles case report form

5. Measles line list

6. Epi Overview
• Total cases: 247
• First rash onset date: May 12, 2014
• Last rash onset date: August 2, 2014
– Lab confirmed: 101
– Epi-linked*: 136
– Clinically compatible†: 4
– Lab pending: 6
• Median age: 24 (range: 3 wks, 57 y)
• Female: 47%
• 1 Death
*Residing in same municipality as a lab confirmed case 7-21 days before rash onset
†Rash, fever, and ≥1 “C” AND no or indeterminate lab AND no epi-link

7. Measles Outbreak Epi-curve, Pohnpei May-August
2014 (n=247)
0
2
4
6
8
10
12
14
16
18
20
Numberofcases
Rash onset date
First case reported
Mass MMR Campaign

8. First case

9. Measles Outbreak Epi-curve, Pohnpei May-August 2014
0
2
4
6
8
10
12
14
16
18
20
5/12/2014
5/14/2014
5/16/2014
5/18/2014
5/20/2014
5/22/2014
5/24/2014
5/26/2014
5/28/2014
5/30/2014
6/1/2014
6/3/2014
6/5/2014
6/7/2014
6/9/2014
6/12/2014
6/14/2014
6/16/2014
6/18/2014
6/20/2014
6/22/2014
6/24/2014
6/26/2014
6/28/2014
6/30/2014
7/2/2014
7/4/2014
7/6/2014
7/8/2014
7/10/2014
7/12/2014
7/14/2014
7/16/2014
7/20/2014
7/22/2014
7/24/2014
7/26/2014
7/28/2014
7/30/2014
8/1/2014
Numberofcases
Rash Onset Date
Clinically Compatible
Epi-linked
Pending Lab
Lab confirmed

10. Clinical presentation of measles cases-Pohnpei May-August 2014
n=247
1
4
4
5
6
7
21
38
50
73
96
100
0 20 40 60 80 100 120
Sorethroat
Bodyache
SOB
Vomiting
Headache
Koplik spots
diarrhea
conjunctivitis
coryza
Cough
Fever
Rash
Percentage
Clinicalpresentation

11. Proportion of measles cases by municipality, Pohnpei
May-August 2014 (n=247)
KITTI
16%
KOLONIA
23%
MADOLENIHMW
6%
NETT
32%
SOKEHS
15%
U
7%
(blank)
1%

12. Attack rates by municipality, Pohnpei May-August 2014
n=245
0.0
2.0
4.0
6.0
8.0
10.0
12.0
14.0
KITTI KOLONIA MADOLENIHMW NETT SOKEHS UH
Cummulativeincidenceper1000population
Municipality

13. Attack rates by age group-Pohnpei Measles Outbreak,
May-August 2014 (n=247)
46.3
6.9
0.2
3.9
13.2
9.5
6.4
1.8
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
40.0
45.0
50.0
<1Y 1-4Y 5-9Y 10-19Y 20-29Y 30-39Y 40-49Y 50-59Y
Cummulativeincidence/1000population
Age group

14. Vaccination* Status of CasesVaccination Status Count (%)
NOT VACCINATED 54 (22)
UNKNOWN 49 (20)
VACCINATED 110 (45)
(blank) 34 (14)
TOTAL 247 (100)
# Doses Count (%)
Not Vaccinated 64(25.9)
1 Dose 25(10.1)
2 Doses 84(34.0)
3 Doses 7(2.8)
4 Doses 1(0.4)
Unknown 30(12.1)
Pending 36(14.6)
*Vaccination >=7 days before rash onset

16. • Task Force: EpiNet, FSM Health,PSH, PH
– PH : Mass Measles Vaccination Campaign
– FSM Health: MMR, MR vaccine and Essential
supply
– CDC, WHO, UNICEF: Technical Assistant, VE study
– EpiNet: Surveillance and Case Investigation
– PSH: Treatment for ill/admitted patients- Isolation
Ward
Mobilization of Working group

17. • Contact tracing and case investigation of confirmed
and suspected measles cases.
• Isolation protocol in place for isolation of suspect
cases at Pohnpei State Hospital
• Vaccination of hospital staff and household
members and contact cases
• Planning, scheduling, and needs estimation for an
emergency vaccination campaign.
• Heightened surveillance for acute fever and rash
• Specimen collection, storage, and shipment to
reference lab for measles testing.
Action:

18. • Mass Vaccination Campaign:
– MMR, 6mos-24yrs
– MR, 25-49yrs
• Mobilized 7 mobile outreach team and one stationary(PH)
• Pamphlets, awareness/health ed. on sites
• Media-Radio spot, posters, flyers, banner and radio
announcements via AM/FM
• Daily Pohnpei EpiNet meeting to incorporate an action plan
and monitor progress.
• ICS comment system was established and follow through
• Health advisory for Measles developed & disseminated to
Public
Actions Cont.

19. TYPE TARGET POPULATION COMMENCED
Age Number % of Pop*
Main Non-selective 6 months-49 years 28,492 95.8 June 16, 2014^
Outer Non-selective 6 months-49 years 1,117 79.4 August 12, 2014^
Overall Non-selective 6 months-49 years 30,869 85.8 -
Measles Emergency Mass Vaccination
Campaign in Pohnpei
Abbreviations: FSM, Federated States of Micronesia; Pop, Population
* % of respective (main or outer island) population
•% of overall population Started
•^ Campaign
^ Campaign completed
Note: % of Pohnpei population based on the 2010 census

20. DOSES VACCINATION COVERAGE
MMR MR Overall Administrative n (%) Assessment(%)*
Main 19,193 9,299 28,492 28,492 (95.8) 86.6
Outer 667 0 667 667 (59.7) None
Overall 19,860 9,299 29,159 29,159 (94.5) -
Vaccination Coverage for MMR and MR Vaccine during
the Emergency Vaccination Campaign on Pohnpei State.
*Rapid Coverage Assessment

23. Data dissemination and use
•Present results to health authorities,
policy makers, stakeholders
•Present results to stakeholders
•Updated sitrep through PACNET and CDC
•Responding to queries
•Write report and submit for publication

24. Recommendations
 Ensure clear case definitions are used
 Update and clean data periodically
 Complete case reports
 Timely reporting from sentinel sites
 Timely dissemination of reports to reporting sites and
stakeholder
 Training and engagement of stakeholders

25. KALAHNGAN