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Madagascar: Measles Outbreak - Oct 2018

Madagascar has been experiencing a measles outbreak since early October 2018. The outbreak started in the urban health district of Antananarivo Renivohitra (in the heart of the capital city, Antanarivo) on 4 October 2018 when three measles cases were confirmed at the Pasteur Institute of Madagascar (IPM) by serology. The disease then spread to other health districts (Tanà South, Tanà North and Ambohidratrimo) in Analamanga Region (where the capital city is located) and subsequently to other parts of the country. The Ministry of Public Health formally declared the measles outbreak on 26 October 2018.

As of 18 November 2018, a total of 3 239 measles cases have been reported, of which 182 were confirmed immunoglobulin M (IgM) positive and 3 057 were epidemiologically linked. No deaths have been reported to date. A total of 23 districts (out of 114) in 12 regions (out of 22) are currently in epidemic phase. The urban health district of Antananarivo-Renivohitra is the most affected, accounting for 84% (2 730) of all reported cases. The other health districts with high numbers of cases are Ambatondratrimo (6%, 200), Antananarivo-Atsimondrano (3%, 91). The remaining health districts have fewer cases..The current measles outbreak has occurred at a time when there is some resurgence of plague in the country, straining the public health response system. The ongoing political election, with the risks of social tensions and conflict, has also downgraded the response to these public health events. ([WHO, 23 Nov 2018](

As of 26 November 2018, 4104 confirmed cases have been reported (207 lab-confirmed and 3 897 epi-linked) from 31 healths districts in 17 regions. No deaths were reported. The most affected district is Antananarivo Renivohitra with 3 080 confirmed cases. ([WHO, 30 Nov 2018](

The measles outbreak in Madagascar has seen a dramatic increase in incidence cases in the last three weeks. Since our last report on 23 November 2018 (Weekly Bulletin 47), 6 125 additional cases have been reported, of which 89 were laboratory-confirmed (immunoglobulin M (IgM) positive) and 6 036 were epidemiologically linked. Eleven new districts have been affected during the past three weeks...The continuous propagation and the rapid increase in the number of measles cases in Madagascar is concerning. The outbreak is already in highly populated areas, and in a largely non-immune population as indicated by the wide range of the age groups affected. Given the high transmissibility of measles, it can be expected that this outbreak may evolve exponentially. ([WHO, 14 Dec 2018](

As of 18 December 2018, a total 13 079 cases have been reported, of which 325 were laboratory-confirmed (IgM positive) and 12 754 were epidemiologically linked. A total of 55 districts in 20 regions have been reporting cases. ([WHO, 21 Dec 2018](

Over the past two weeks, 19 new districts and two additional regions have been affected. Since the peak of the outbreak in week 49, there has been a downward trend in the weekly incidence of cases nationally. ([WHO, 28 Dec 2018](

From 4 October 2018 to 7 January 2019, 19 539 measles cases and 39 “facility-based” deaths (case fatality ratio: 0.2%) have been reported by the Ministry of Public Health (MoH) of Madagascar. Cases were reported from 66 of 114 total districts in all 22 regions of Madagascar. ([WHO, 17 Jan 2019](

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