SHOULD OUTBREAK RESPONSE IMMUNIZATION BE RECOMMENDED FOR MEASLES OUTBREAKS IN MIDDLE- AND LOW-INCOME COUNTRIES? AN UPDATE

Tuesday, 22nd of October 2013

[source]Journal of Infectious Diseases[|source]

The last time I checked, this was the latest update on measles outbreak response immunization recommendations. In this article, Cairns L et al unequivocally argue that outbreak response should include enhanced surveillance, efforts to limit case contact with susceptible persons, and case management, particularly treatment with vitamin A. The article also presents evidence in almost all six WHO regions that outbreak response immunization can be effective in controlling measles outbreaks. However, the article concludes that the best and most cost-effective approach to outbreak control is the primary prevention of epidemics entirely by ensuring high coverage with 2 doses of measles vaccine for all children. More details are available at:  http://jid.oxfordjournals.org/content/204/suppl_1/S35.long

 

This update formed the major bulk of the material leading to the revision and development of measles outbreak response guidelines in mortality reduction settings. May the force be with these great brains as they dig through recent literature for yet another update. I trust that the next guidelines on measles outbreak response will be more robust in providing a menu of options for all possible disease elimination settings.

 

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.