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 had 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 for immediate action. 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. To further increase the risk, 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.
In late 2013 into 2014, a nationwide measles outbreak occurred in PNG. The outbreak started in the same province and rapidly spread into other province, making its way into Solomon Islands and Vanuatu over an eight-month period. Indications pointed to similarities with this outbreak. In 2014, 54% of the reported cases occurred among children under the age of 5, and 12 per cent occurred in children between the ages of 5 to 9. This is a similar age distribution to what was 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. In 2014, the outbreak was contained with only 49 of 3,469 suspected measles cases tested in 2016 and no lab-confirmed cases. The National Department of Health and the National Measles Outbreak Taskforce wanted to ensure the quickest possible containment of cases and hence declared an outbreak. Due to the remarkably low (14%) indicator for laboratory confirmation, alongside incomplete or partially available data on epidemiological linkage, there is a very high chance of there being clinically measles compatible cases. However, given the context, it was more prudent to label everyone as “suspected measles” cases and do a blanket campaign for ALL which helped in containing the outbreak within certain districts in the Province.
The last case of measles was confirmed on 19 October. After a grace period of 30 days with no further reports of outbreaks, the National Department of Health and the National Measles Outbreak Taskforce declared an end to the outbreak on 28 November. A mass vaccination campaign had already commenced in Sandaun Province, focusing on the areas where cases were confirmed. With that, improved cold chain capacities were put in place. Initially there was very poor operational cold chain facilities in the remote locations where cases were detected. The cold chain coverage stood at no more than 10% within the Vanimo-Green District area. UNICEF assisted to ensure adequate cold chain in the affected areas by installing new fridges in designated health facilities. Measles vaccines as well as vaccines for routine immunisation programs were transported and available to launch regular vaccination campaigns. The District Health Manager for Vanimo-Green, nonetheless received information that a number of children under 15 years of age in three areas of Vanimo Green district were left out of the campaign. As such, it was decided to launch a “mop-up” vaccination campaign in those areas. The District Health Manager requested the involvement of PNGRC to support in awareness campaign. The target population for measles mop-up campaign is children between 6 months and 15yrs in three areas of Vanimo-Green District.
Following the mass vaccination campaign a Rapid Convenience Monitoring (RCM) was conducted in Vanimo-Green district. Twenty household in each of the three areas were randomly selected to assess coverage of the target group (6 months – 15yrs). As Ossima area has an overall immunisation rate of 29%, a RCM was not done here but instead the area was immediately prioritized for inclusion in the measles mop-up campaign. Results of the RCM revealed coverage of 77% for measles in Vanimo urban catchment; 83% in Lote catchment. The District Health Manager requested PNGRC volunteers to focus on social mobilization and awareness in these three areas (Lote, Vanimo urban and Ossima) to precede and support the health department’s mop up immunisation schedule commencing on 27th Nov 2017.