Measles outbreak investigation in Female prison Herat province, Afghanistan April 2024

Measles, a highly contagious viral disease, spreads via respiratory droplets when infected individuals cough, sneeze, or breathe. It primarily affects children, though anyone can contract it. Symptoms include high fever, cough, runny nose, rash, and Kolpik spots. Vaccination is the most effective prevention method. Despite the introduction of a reliable vaccine in 1963, measles still caused 128,000 deaths globally in 2021, mostly in children under five. Between 2000 and 2021, vaccination efforts prevented 56 million deaths, reducing annual deaths from 761,000 to 128,000. In Afghanistan, measles remains a significant public health challenge. In 2023, 25,940 cases with 64 deaths were reported nationwide, including 744 cases and 3 deaths in the western region. Closed spaces like prisons and camps facilitate the rapid spread of communicable diseases like measles. Herat province, with a population of 4 million, hosts a female prison with 320 inmates, including 79 children. On March 31, 2024, Herat's National Disease Surveillance and Response (NDSR) received a report of suspected measles cases in the female prison. An investigation team comprising two doctors and a lab technician was dispatched. Upon arrival, the team identified 10 suspected cases based on fever, cough, rash, runny nose, and Kolpik spots. Suspected cases were isolated in one room, and five blood samples were collected and sent to the Herat Regional Reference Laboratory (HRRL), all testing positive for measles. Due to a shortage of effective drugs in the prison, one complicated case was referred to Herat Regional Hospital for advanced care. Coordination with the World Health Organization (WHO) provided pneumonia kits for treatment. The outbreak affected 10 individuals (3.1% attack rate) out of 320 inmates. Half of the cases were children under five, with the median age being 3 years (IQR: 2-9 years). Cases ranged from 2 months to 20 years. The outbreak began on March 25, 2024, peaked on March 27, and was confirmed via laboratory testing of IgG and IgM antibodies. The outbreak equally impacted males and females, with fever and rash present in 100% of cases. It likely originated from an external source, potentially through a visitor, as children reside with their mothers in the prison. These findings highlight the need for routine immunization programs within women's prisons, as well as further investigation into external contacts that may have introduced the disease.