Investigation and control of measles outbreak in Puli-Khumri and Baghlan-Markazi Districts, Baghlan province, Afghanistan: a teaching case-study
Khwaja Mir Islam Saeed, Nooria Atta, Tawfiqulhakim Nazri
Corresponding author: Khwaja Mir Islam Saeed, Afghanistan Field Epidemiology Training Program, Afghanistan National Public Health Institute, Ministry of Public Health, Kabul City, Afghanistan 
Received: 02 Jul 2020 - Accepted: 20 Jul 2020 - Published: 04 Aug 2020
Domain: Infectious diseases epidemiology
Keywords: Measles, outbreak, vaccination
This article is published as part of the supplement Teaching case-studies in Field Epidemiology with a focus on the Eastern Mediterranean Region, commissioned by The Eastern Mediterranean Public Health Network (EMPHNET).
©Khwaja Mir Islam Saeed et al. Pan African Medical Journal (ISSN: 1937-8688). This is an Open Access article distributed under the terms of the Creative Commons Attribution International 4.0 License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Cite this article: Khwaja Mir Islam Saeed et al. Investigation and control of measles outbreak in Puli-Khumri and Baghlan-Markazi Districts, Baghlan province, Afghanistan: a teaching case-study. Pan African Medical Journal. 2020;36(1):9. [doi: 10.11604/pamj.supp.2020.36.1.24761]
Available online at: https://www.panafrican-med-journal.com//content/series/36/1/9/full
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Investigation and control of measles outbreak in Puli-Khumri and Baghlan-Markazi Districts, Baghlan province, Afghanistan: a teaching case-study
Investigation and control of measles outbreak in Puli-Khumri and Baghlan-Markazi Districts, Baghlan province, Afghanistan: a teaching case-study
Khwaja Mir Islam Saeed1,&, Nooria Atta2, Tawfiqulhakim Nazri3
&Corresponding author
Measles is a highly contagious viral disease that remains a significant cause of death among young children globally despite the availability of a safe and effective vaccine. Measles is transmitted via droplets from the nose, mouth, or throat of infected persons, and initial symptoms include a high fever, runny nose, bloodshot eyes, and tiny white spots on the inside of the mouth. Several days later, a rash develops, starting on the face and upper neck and gradually spreading downwards. Routine measles vaccination for children, combined with mass immunization campaigns in countries with low routine coverage, are key public health strategies to reduce global measles deaths. In Afghanistan, 25,000 cases were reported in 2017 of which 85% were among children under the age of 10. These cases span over 20 of the 34 provinces across Afghanistan, with the worst affected provinces being Kabul, Paktika, Kunar, Badghis and Ghor. The majority of outbreaks are reported, investigated, and responded to throughout recent years in the country. This current outbreak of measles with an almost two-year duration is investigated and reported from Baghlan province. The goal of this case study is to develop competencies and consolidate understanding of participants to investigate and control outbreaks. This case study stimulates the students to investigate and control a measles outbreak and critically appraise an epidemic report. The case study is designed for training novice field epidemiology trainees. The case study can be administered in 3-4 hours. Used as adjunct training material, the case study provides the trainees with competencies in investigating outbreaks and identifying factors affecting outbreaks.
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 country 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 and Epi info
Level of training and associated public health activity: Novice - Outbreak investigation
Time required: 3-4 hours
Language: English
- Download the case study student guide (PDF - 390 KB)
- Request the case study facilitator guide
The authors declare no competing interests.
We would like to acknowledge The Eastern Mediterranean Public Health Network (EMPHNET) for their technical support. We wish to acknowledge staff of surveillance department at the national and provincial level who conducted the outbreak investigation on which this case study is based. We also would like to thank the Afghan Ministry of Health for providing data for development of this case study. The EPI time is appreciated for taking part in outbreak investigation and conducting immunization campaigns.
Annex 1: Investigation and Control of Measles Outbreak in Puli-Khumri and Baghlan-Markazi Districts, Baghlan province, Afghanistan
- World Health Organization. Immunization, Vaccines and Biologicals. Measles. 2019.
- World Health Organization. Emergencies preparedness, response. Measles - Global situation. 2019.
- Mc Sweeney C, New M, Lizcano G. UNDP Climate Change Country Profiles: Afghanistan. 2019.
- World Bank Data. Arable land. 2019.
- World Health Organization. Afghanistan. News. Press release. 2019.
- Ministry of Public Health. National Disease Surveillance and Response. Annual reports of 2010 to 2018. 2019.
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