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

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. Overview
One Health Approach
Disaster Risk Science
lens
Human vulnerability
Institutional vulnerability
Epidemiology
Risk governance

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. Study site: Cape Town, South Africa
Maps: Fortune, 2013

5. Facts about measles
Measles vaccine:
- Cost of vaccine <USD2 per dose
- 2 dose routine vaccination (even in developing
countries)

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. 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. 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. 25 health sector
shortcomings in:
-Notification procedure
-Outbreak notification
-Routine vaccination
-Mass immunisation
-Outbreak control priority

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. 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. 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. Thank you

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. 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