Measles outbreak investigation process in low- and middle-income countries: a systematic review of the methods and costs of contact tracing

Etheldreda L. Mbivnjo*, Mary Lynch, Jaci C. Huws

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

Abstract

Aim: The occurrence of measles outbreaks has increased, and previously measles-free countries are experiencing a resurgence, making measles elimination by 2020 unlikely. Therefore, outbreak prevention and rapid response strategies will need to be intensified. This systematic review therefore examines whether contact tracing (CT) as compared to no CT is an effective means of reducing measles spread during outbreaks in low- and middle-income countries (LMICs).

Subject and methods: A systematic review was conducted by searching six databases (CINAHL, Global Health, Medline, Cochrane Library, Web of Science and PubMed). The 17 included articles were appraised using the Critical Appraisal Skills Programme checklists and analysed using a narrative synthesis.

Results: CT is often used alongside mass communication strategies and hospital record checks. Interviewing measles cases to identify contacts, and considering everyone who has shared a space with a case as a contact are common CT methods. Also, CT can be done backwards and/or forwards with the measles case as the focal point of the investigation process. The cost per case of an outbreak response dominated by CT is high especially in terms of labour for the health sector and productivity losses for households. However, overall outbreak expenditure can be low if CT results in fewer and less severe measles cases and a short outbreak duration.

Conclusion: CT data as a standalone and comparative active surveillance approach in LMICs is scarce. If CT is initiated early, it can prevent large outbreaks, thereby reducing the economic burden of measles and drive LMICs towards measles elimination.
Original languageEnglish
JournalJournal of Public Health: From Theory to Practice
DOIs
Publication statusPublished - 15 May 2021
Externally publishedYes

Keywords

  • measles outbreak
  • contact tracing
  • economic costs
  • low- and middle-income countries

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