Rapid response to a measles outbreak in Ifanadiana District, Madagascar

In 2019, Madagascar experienced the nation’s largest documented measles outbreak ever. From September 2018 to January 2020, nearly 225,000 individuals were infected, slightly more than 1,000 of whom died. Madagascar is one of the poorest countries in the world with one of the least funded health systems. Here, we present the experience of how Madagascar’s Ministry of Health (MoH) partnered with a non-governmental organization, PIVOT, to rapidly respond to a measles outbreak in the rural district of Ifanadiana, in the southeast of the country. The epidemic reached Ifanadiana in January of 2019. By August, there were more than 4,800 identified cases of suspected measles, including 157 hospitalizations. Over the course of two weeks in February 2019, the MoH and PIVOT mobilized nine teams of 220 total staff to vaccinate 69,949 children aged 6 months to 10 years at schools and community events. Surrounding the campaign, health workers were trained in measles identification and provided with medication for symptom management. The measles response required overcoming health system weaknesses and geographic barriers which are endemic throughout the country and create chronic challenges for the provision of routine preventive and curative care. This response demonstrates that rapid mobilization of an organized health system response is feasible even in hard-to-reach areas. KEY POINTS ### Competing Interest Statement KEF, JH, LFC, BR, LR, BA, AG, MHB, and MAO received salary support from PIVOT. AR and ER received salary support from Madagascar's Ministry of Public Health. ### Funding Statement No external funding was received for the preparation of this manuscript. Program activities which are reported on were funded by grants and donations received by PIVOT. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: This work uses publicly available data and was authorized by the leadership of Madagascar's Ministry of Public Health. This study was determined to be non human subjects research by the IRB at Harvard University. All necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes The corresponding author can provide information on the process of accessing the data.