healthcare - seeking behaviors declined markedly during the ebola epidemic ( 2 ) , which likely contributed to probable underreporting of measles cases , a fact further substantiated by the lack of fatalities reported to dps .
although there are wide variances in estimates of measles case - fatality rates , a large study has suggested an average case - fatality rate of 3.7% for africa ( 13 ) , which would correspond with 26 deaths from the 702 suspected cases reported in lola during january  june 2015 .
the lack of reported fatalities may also be related to the effect of the ebola epidemic on burial practices ; any families notifying authorities about deaths would be required to conduct  safe and dignified burials ,  a protocol that had been met with resistance by many local groups ( 2 ) .
when the full shipment of vaccines arrived in lola in mid - april , logistical planning was challenged by shortages of personnel , fuel for automobiles , and appropriate vehicles for traversing difficult terrain during the onset of the rainy season . the campaign is estimated to have reached 92% of the target population , but persons in some urban areas and villages were reluctant to receive vaccinations .
the launch of the campaign coincided with reduced measles transmission ( figure ) , but further modeling research would be required to assess its effect on the course of the outbreak . in the aftermath of the ebola epidemic ,
. the front lines of disease surveillance and outbreak detection often occur in rural settings that are understaffed and underresourced . as guinea transitions to a post - ebola phase
this reduction would be unfortunate , because the technical and cultural expertise of the doctors from guinea in lola and other similar settings transcends ebola and could be harnessed to support a wide range of public health activities . strengthened investments in local public health systems will be essential to ensure the population of guinea can recover from the ebola epidemic and be better protected from future disease outbreaks . aside from personnel , the public health infrastructure , including surveillance , information and communications technology , and temperature - controlled supply chains , particularly requires attention
. meanwhile , great efforts will also be needed to restore and enhance community trust in medicine and public health ( 2 ) .
 during public health crises such as the recent outbreaks of ebola virus disease in west africa , breakdowns in public health systems can lead to epidemics of vaccine - preventable diseases . 
 we report here on an outbreak of measles in the prefecture of lola , guinea , which started in january 2015 . 
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