Measles resurgence in southern Africa: challenges to measles elimination.

Printable Copy

Vaccine. 2014 Apr 1;32(16):1798-807. doi: 10.1016/j.vaccine.2014.01.089. Epub 2014 Feb 13.

Measles resurgence in southern Africa: challenges to measles elimination.

Shibeshi ME¹ Masresha BG² Smit SB³ Biellik RJ⁴ Nicholson JL⁵ Muitherero C¹ Shivute N¹ Walker O⁶ Reggis K² Goodson JL⁷.

Author information

• ¹Immunization and Vaccines Development East and South Africa Inter-Country Support Team World Health Organization Harare Zimbabwe.
• ²Immunization and Vaccines Development African Regional Office World Health Organization Brazzaville Congo.
• ³Measles and Rubella Regional Reference Laboratory National Institute of Communicable Diseases Johannesburg South Africa.
• ⁴Consultant Epidemiologist Geneva Switzerland.
• ⁵Department of Epidemiology Rollins School of Public Health and Laney Graduate School Emory University Atlanta GA United States.
• ⁶Immunization and Vaccines Development West Africa Inter-Country Support Team World Health Organization Ouagadougou Burkina Faso.
• ⁷Global Immunization Division United States Centers for Disease Control and Prevention Atlanta GA United States. Electronic address: JGoodson@cdc.gov.

Abstract

INTRODUCTION:

In seven southern African countries (Botswana Lesotho Malawi Namibia South Africa Swaziland and Zimbabwe) following implementation of a measles mortality reduction strategy starting in 1996 the number of annually reported measles cases decreased sharply to less than one per million population during 2006-2008. However during 2009-2010 large outbreaks occurred in these countries. In 2011 a goal for measles elimination by 2020 was set in the World Health Organization (WHO) African Region (AFR). We reviewed the implementation of the measles control strategy and measles epidemiology during the resurgence in the seven southern African countries.

METHODS:

Estimated coverage with routine measles vaccination supplemental immunization activities (SIA) annually reported measles cases by country and measles surveillance and laboratory data were analyzed using descriptive analysis.

RESULTS:

In the seven countries coverage with the routine first dose of measles-containing vaccine (MCV1) decreased from 80% to 65% during 1996-2004 then increased to 84% in 2011; during 1996-2011 79696523 people were reached with measles vaccination during 45 SIAs. Annually reported measles cases decreased from 61160 cases to 60 cases and measles incidence decreased to <1 case per million during 1996-2008. During 2009-2010 large outbreaks that included cases among older children and adults were reported in all seven countries starting in South Africa and Namibia in mid-2009 and in the other five countries by early 2010. The measles virus genotype detected was predominantly genotype B3.

CONCLUSION:

The measles resurgence highlighted challenges to achieving measles elimination in AFR by 2020. To achieve this goal high two-dose measles vaccine coverage by strengthening routine immunization systems and conducting timely SIAs targeting expanded age groups potentially including young adults and maintaining outbreak preparedness to rapidly respond to outbreaks will be needed.

Published by Elsevier Ltd.