MCV coverage, by age and IDP status.

There was a protracted measles outbreak in Kismayo, Somalia between 2020–2021. The outbreak persisted despite availability of measles containing vaccine (MCV) through Expanded Program on Immunization (EPI) services and reactive vaccination campaigns. We sought to estimate measles burden and MCV coverage during the outbreak while further identifying barriers and facilitators to care and vaccinations. We adopted a cross-sectional, sequential mixed-method approach with a retrospective household survey followed by key informant interviews (KIIs) and focus group discussions (FGDs). We used proxy-reported interview data from a household survey with a two-year recall period to estimate attack rates (ARs), case fatality ratios (CFRs), measles-specific mortality and MCV coverage. We performed thematic analysis on qualitative data from 12 KIIs and 8 FGDs. We surveyed 1,050 households representing 6,664 individuals and estimated an urban population of 405,181 (95%CI: 389,335–422,331). We identified 338 measles cases (AR: 5.1% [95%CI: 4.6-5.6]) and 11 measles deaths (CFR: 3.3% [95%CI: 1.4-5.2]). During the outbreak, we interpolated that 20,664 (95%CI: 17,909–21,651) measles cases and 682 (95%CI: 251–1230) deaths occurred across Kismayo. At start of recall, 49.5% (95%CI: 46.5-52.6) aged 6–59 months had one-or-more doses of MCV and this increased to 69.6% (95%CI: 66.9-72.2) by end of recall. Thematic analysis produced qualitative insights on barriers to accessing medical care, barriers to routine vaccination through EPI, barriers to vaccination through mass campaigns and facilitating factors for care and vaccination. We show an unacceptably high burden of measles due to limited access to medical care and low MCV coverage despite a widespread willingness to be vaccinated. To mitigate the problem of protracted outbreaks, we suggest adopting a consistent, community-centered approach to risk communication and community engagement, reducing non-healthcare costs associated with accessing care, ensuring daily availability of EPI vaccinations in all public facilities and overhauling the ways in which mass vaccination campaigns are implemented.2020至2021年间，索马里基斯马尤市暴发了一场迁延不愈的麻疹疫情。尽管扩大免疫规划（Expanded Program on Immunization, EPI）服务可提供含麻疹成分疫苗（measles containing vaccine, MCV），且开展了反应性疫苗接种活动，此次疫情仍持续蔓延。本研究旨在估算本次麻疹疫情期间的疾病负担与MCV接种覆盖率，同时进一步明确疫苗接种与医疗服务可及性的阻碍因素及促进因素。本研究采用横断面序贯混合研究方法，先开展回顾性家庭调查，随后进行关键知情人访谈（key informant interviews, KIIs）与焦点小组讨论（focus group discussions, FGDs）。研究通过回忆周期为2年的家庭调查的代理报告访谈数据，估算麻疹罹患率（attack rates, AR）、病例病死率（case fatality ratios, CFR）、麻疹特异性死亡率以及MCV接种覆盖率；对12场关键知情人访谈与8场焦点小组讨论获得的定性数据开展主题分析。本次共调查1050户家庭，涉及6664名个体，并估算基斯马尤市城市人口为405181（95%置信区间：389335–422331）。研究共确认338例麻疹病例（罹患率：5.1%[95%CI:4.6–5.6]），11例麻疹死亡病例（病死率：3.3%[95%CI:1.4–5.2]）。经插值推算，本次疫情期间基斯马尤全市共发生20664例麻疹病例（95%CI:17909–21651），682例死亡病例（95%CI:251–1230）。在调查回忆周期初始阶段，6–59月龄儿童中49.5%（95%CI:46.5%–52.6%）已接种至少1剂MCV；至回忆周期结束时，该比例升至69.6%（95%CI:66.9%–72.2%）。主题分析得到的定性结果揭示了医疗服务可及性障碍、扩大免疫规划常规接种障碍、大规模疫苗接种活动接种障碍，以及医疗与疫苗接种的促进因素。本研究显示，尽管民众普遍愿意接种疫苗，但由于医疗服务可及性有限且MCV接种覆盖率偏低，麻疹疾病负担高得令人无法接受。为缓解迁延性疫情问题，本研究建议采用统一的、以社区为中心的风险沟通与社区参与策略，降低就医相关的非医疗成本，确保所有公立医疗机构每日均可提供EPI疫苗接种服务，并全面改革大规模疫苗接种活动的实施方式。