A. Situation analysis
Description of the disaster
On 23 August 2017, the first case of measles was reported in the Vanimo Green District (VGD) of West Sepik Province in North-West Papua New Guinea (PNG), near the border with Indonesia. As of 31 October, 57 cases have been reported, with eight having been confirmed by laboratory tests, and two deaths. Figure 1 below shows the affected and immediate risk districts identified by the National Department of Health and the National Measles Outbreak Taskforce. A measles outbreak has been ongoing in areas of neighbouring Indonesia directly beside the Vanimo Green District. The high mobility of people along this border may have resulted in measles being brought over to PNG, including new cases. The vaccination coverage rates on the Indonesia border side are low. The government is putting in place vaccination at the official border crossing; however, there are also other border sites where the spread of measles can occur.
The latest reported case was on 20 October, noting that there are delays with receiving up to date information from the field due to communication challenges. A concern is that new cases are now being identified in additional villages throughout the district, indicating the outbreak is not contained and spreading. With poor access to health services and reporting delays, case numbers are expected to be higher than identified at present. Vaccination campaigns have commenced in some villages; however social mobilization and awareness activities have been identified by the National Department of Health (NDOH) and partners as a major gap that will impact on the success of the vaccination campaign.
The last reported measles outbreak in PNG occurred in 2013-2014 and began in September 2013 in the same province.
It spread to the western province in December 2013 and then cases were reported nationwide over the next eight months. The outbreak eventually made its way to Solomon Islands and Vanuatu. In 2014, the country reported 2,299 lab-confirmed measles cases from 22 provinces. During this outbreak, 54 per cent of cases occurred among children under the age of five, and 12 per cent occurred in children between the ages of five to nine. This is a similar age distribution to what is being seen in the current outbreak. More than 365 measles deaths were reported by the end of December 2014 with the case fatality rate (CFR) of 0.46 per cent. Following this outbreak, a dramatic decrease in reported suspected measles cases occurred, with only 49 of 3,469 suspected measles cases tested in 2016 and no labconfirmed cases.
A large immunity gap affecting a wide age distribution exists in PNG, due to many years of extremely low routine and variable immunization coverage. This varies as well from province to province. Following the last nationwide outbreak, the same risk factors continue to exist for measles introduction, spread, and poor containment. Of particular concern is that the measles-mumps-rubella (MMR) vaccination coverage for the affected region over the last five years has never risen above 56 per cent, and is currently estimated at 33 per cent coverage. This is well below the recommended 95 per cent coverage rate to prevent an outbreak of cases. Measles mortality can be high in settings with high levels of undernutrition and vitamin A deficiency. Treatment of acute cases with vitamin A can lower measles mortality. At present, PNG is facing a nutrition crisis with more than one in two children with chronic malnutrition, the fourth highest rate in the world and double the global average. According to a 2011 National Department of Health survey, rates of underweight children in rural areas are approximately 25 per cent, or one in four children, and wasting is at 11 per cent. The high rate of malnutrition, low vaccination coverage and poor access to appropriate health services means there is an urgent need to respond to prevent further cases from spreading.