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Case study

Measles outbreak investigation, Lebanon, 2018: a teaching-case study student´s guide

Measles outbreak investigation, Lebanon, 2018: a teaching-case study student´s guide

Lina Chaito1,&, Mona Beaini2, Nada Ghosn1


1Epidemiological Surveillance Program, Ministry of Public Health (MOPH), Beirut, Lebanon, 2Department of Laboratoy Medecine, Rafic Hariri University Hospital (RHUH), Beirut, Lebanon



&Corresponding author
Lina Chaito, Epidemiological Surveillance Program, Ministry of Public Health (MOPH), Beirut, Lebanon




Measles is a highly contagious vaccine-preventable disease that affects susceptible individuals and can lead to serious complications and death among young children. Despite the availability of a safe and effective vaccine in Lebanon, measles immunization coverage rates have fallen far below the recommended threshold that is necessary to prevent illness and outbreaks. Lebanon has witnessed several measles outbreaks in recent history. In 1997-1998, an outbreak in the north of Lebanon caused 980 measles cases and led to 3 deaths. In 2003-2007, annual epidemic waves were observed with recurring outbreaks every 2 years in northern Lebanon. In 2013, a national measles outbreak occurred with 1,760 cases and 4 deaths. Since the first week of January 2018, the country experienced another large measles outbreak. This case study aimed to develop competencies in analyzing measles surveillance data based on a measles outbreak in Lebanon in 2018. This case study is based on the actions taken by the Ministry of Public Health to respond to the outbreak and limit its spread. It simulates outbreak investigation and focuses on analyzing surveillance data, communicating findings, and identifying strengths and weakness of surveillance systems. This case study is designed for training basic level field epidemiology trainees or any other health care workers working in public health-related fields. It can be administered in 2-3 hours. Used as adjunct training material, the case study provides the trainees with competencies in investigating an outbreak in preparation for the actual real-life experience of such outbreaks.



How to use this case study    Down

General instructions: this case study should be used as adjunct training material for novice epidemiology trainees to reinforce the concepts taught in prior lectures. The case study is ideally taught by a facilitator in groups of about 20 participants. Participants are to take turns reading the case study, usually a paragraph per student. The facilitator guides the discussion on possible responses to questions. The facilitator may make use of flip charts to illustrate certain points. Additional instructor´s notes for facilitation are coupled with each question in the instructor´s guide to aid facilitation.

Audience: this case study was developed for novice field epidemiology students. These participants are commonly health care workers working in the county departments of health whose background may be as medical doctors, nurses, environmental health officers or laboratory scientists who work in public health-related fields. Most have a health science or biology background.

Prerequisites: before using this case study, participants should have received lectures on disease surveillance and outbreak investigation.

Materials needed: Flash drive, flip charts, markers, computers with MS Excel

Level of training and associated public health activity: Novice - Outbreak investigation

Time required: 2-3 hours

Language: English



Case study material Up    Down

  • Download the case study student guide
  • Request the case study facilitator guide



Competing interest Up    Down

The authors declare no competing interests.



Acknowledgement Up    Down

Authors would like to thank the Eastern Mediterranean Public Health Network (EMPHNET) for their technical support. We also acknowledge officers at the Epidemiological Surveillance Program and Expanded Program on Immunization at the Ministry of Public Health who investigated and responded to the measles outbreak on which this case study is based.



References Up    Down

  1. CDC. About Measles. Update 2019.

  2. CDC. Measles (Sign and Symptom). Update 2019.

  3. WHO. Fact Sheet. Measles. Update 2019.

  4. WHO. Measles elimination field guide. 2005.

  5. WHO. Emergencies preparedness, response. Measles global situation. Update 2019.

  6. Mansour Z, Hamadeh R, Rady A et al. Vaccination coverage in Lebanon following the Syrian crisis: results from the district-based immunization coverage evaluation survey 201. BMC Public Health. 2019 Jan 14;19(1):58. PubMed | Google Scholar

  7. Ministry of public health, Epidemiological surveillance program. Measles Surveillance guideline. 2015.