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The effectiveness of outbreak response imunization had for a long time had contradicting schools of thought. In fact, WHO guidelines for measles outbreak response published in 1999 had recommendations against immunization in outbreaks occurring in high incidence countries. In this article, the authors report on a review of publications on outbreak response and conclude that outbreak response immunization is recommended in both middle- and low-income countries. The defining difference being the tailored decisions must be made depending on context in the outbreak. More details available at: http://jid.oxfordjournals.org/content/204/suppl_1/S35.long
Abstract
BACKGROUND: Measles caused mortality in >164,000 children in 2008, with most deaths occurring during outbreaks. Nonetheless, the impact and desirability of conducting measles outbreak response immunization (ORI) in middle- and low-income countries has been controversial. World Health Organization guidelines published in 1999 recommended against ORI in such settings, although recently these guidelines have been reversed for countries with measles mortality reduction goals.
METHODS: We searched literature published during 1995-2009 for papers reporting on measles outbreaks. Papers identified were reviewed by 2 reviewers to select those that mentioned ORI. World Bank classification of country income was used to identify reports of outbreaks in middle- and low-income countries.
RESULTS: We identified a total of 485 articles, of which 461 (95%) were available. Thirty-eight of these papers reported on a total of 38 outbreaks in which ORI was used. ORI had a clear impact in 16 (42%) of these outbreaks. In the remaining outbreaks, we were unable to independently assess the impact of ORI.
CONCLUSIONS: These findings generally support ORI in middle- and low-income countries. However, the decision to conduct ORI and the nature and extent of the vaccination response need to be made on a case-by-case basis.