Notes From The Field: Mumps Outbreak in a Recently Vaccinated Population — Kosrae, Federated States of Micronesia, August–December, 2017

Surveillance strategies for the detection of disease outbreaks in the Pacific islands: meta‐analysis of published literature, 2010–2019

“…Of 860 articles identified by the search, 37 reports describing 39 outbreaks met the inclusion criteria (Figure 1). There was seven reported outbreaks in PNG [8,13–18]; six in each of Solomon Islands, [19–25] French Polynesia, [25–30] and FSM [31–36]; three in each of American Samoa[37–39] and Marshall Island[40–42]; two from Fiji [43,44] and Guam [45,46] and one in each of Kiribati, [47] Tuvalu, [48] New Caledonia, [30] and Wallis and Futuna [30]. The aetiological agents responsible for the outbreaks were dengue virus ( n = 7), [25,19,23,26,34,39,41] influenza virus ( n = 5), [16,30,31] chikungunya virus ( n = 3), [17,28,29] Hepatitis A causing Hepatovirus ( n = 3), [35,44,40] Shigella spp .…”

“…The aetiological agents responsible for the outbreaks were dengue virus ( n = 7), [25,19,23,26,34,39,41] influenza virus ( n = 5), [16,30,31] chikungunya virus ( n = 3), [17,28,29] Hepatitis A causing Hepatovirus ( n = 3), [35,44,40] Shigella spp . ( n = 3), [13,16,38] Vibrio cholerae ( n = 2), [18,15,14,46] mumps virus ( n = 2), [32,45] Rotavirus ( n = 2), [21,47] Zika virus ( n = 2), [27,37] measles Rubeola virus ( n = 1), [33] Mumps, circulating vaccine‐derived poliovirus type 1 ( n = 1), [8] and Rickettsia parasite causing scrub typhus ( n = 1) [20]. In addition, outbreaks of unspecified enteric disease ( n = 3), [36,42,48] peripheral neuropathy syndrome associated with malnutrition ( n = 1), [15] congenital rubella syndrome ( n = 1), [24] severe acute respiratory illness ( n = 1), [43] and a clinically diagnosed measles outbreak ( n = 1) [22] were reported (Table 1).…”

“…For 15 reports, the first author was a staff member at a national institution including ministries of health, national laboratories and universities [8,13,17,18,25,22,26–29,35,34,42,44,47]. Of international first authors, nine were from the United States Centers for Disease Control and Prevention [33,32,39,37,38,40,41,46,45]; seven were staff of WHO or the Pacific Community (the two main technical agencies providing outbreak‐related support to PICTs) [15,16,14,24,23,31,36]; five were academics from non‐PICT countries [19,21,20,43,48]; and one was from the French Government, which has responsibility for French Pacific territories [30].…”

“…Of these, 22 reports were made by clinicians (doctors and nurses) who signalled an outbreak based on their clinical judgement or after noticing temporospatial clustering of cases, [30,33,46,45,38,23,16,31,36,20,44,25,22,17,13,34,35,42,43,28] and eight were detected by laboratories. [24,26,29,32,39,37,40,41]. For six (15%) papers outbreak, alerts were raised by syndromic surveillance systems, [8,19,21,27,47,48] and two (5%) came from ad hoc notification from the community [14,15,18].…”

“…through use of rapid diagnostic test kits or preliminary laboratory analysis) with confirmation provided by an overseas laboratory at a later date, [19,23–25,30,34,39,41,46] and five through transport of specimens to an overseas laboratory for primary testing [20,31,37,38,47]; the location where testing was performed was not reported for five confirmed outbreaks. While the number of reports that provide details about the time between outbreak detection and aetiology confirmation was small ( n = 3) [8,32,33], it appears that at least in some cases, long delays are experienced, particularly if domestic capacity for confirmatory diagnosis was not available.…”