Measles outbreak response among adolescent and adult Somali refugees displaced by famine in Kenya and Ethiopia, 2011

J Infect Dis. 2014 Dec 15;210(12):1863-70. doi: 10.1093/infdis/jiu395. Epub 2014 Aug 12.


Background: The refugee complexes of Dadaab, Kenya, and Dollo-Ado, Ethiopia, experienced measles outbreaks during June-November 2011, following a large influx of refugees from Somalia.

Methods: Line-lists from health facilities were used to describe the outbreak in terms of age, sex, vaccination status, arrival date, attack rates (ARs), and case fatality ratios (CFRs) for each camp. Vaccination data and coverage surveys were reviewed.

Results: In Dadaab, 1370 measles cases and 32 deaths (CFR, 2.3%) were reported. A total of 821 cases (60.1%) were aged ≥15 years, 906 (82.1%) arrived to the camps in 2011, and 1027 (79.6%) were unvaccinated. Camp-specific ARs ranged from 212 to 506 cases per 100 000 people. In Dollo-Ado, 407 cases and 23 deaths (CFR, 5.7%) were reported. Adults aged ≥15 years represented 178 cases (43.7%) and 6 deaths (26.0%). Camp-specific ARs ranged from 21 to 1100 cases per 100 000 people. Immunization activities that were part of the outbreak responses initially targeted children aged 6 months to 14 years and were later expanded to include individuals up to 30 years of age.

Conclusions: The target age group for outbreak response-associated immunization activities at the start of the outbreaks was inconsistent with the numbers of cases among unvaccinated adolescents and adults in the new population. In displacement of populations from areas affected by measles outbreaks, health authorities should consider vaccinating adults in routine and outbreak response activities.

Keywords: acute malnutrition; adults; famine; measles; mortality; population displacement; refugees; vaccination.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Child
  • Child, Preschool
  • Disease Outbreaks*
  • Ethiopia
  • Female
  • Humans
  • Infant
  • Infant, Newborn
  • Kenya
  • Male
  • Measles / epidemiology*
  • Measles / mortality
  • Measles Vaccine / administration & dosage
  • Middle Aged
  • Refugees*
  • Somalia
  • Starvation
  • Vaccination / statistics & numerical data
  • Young Adult


  • Measles Vaccine