ABSTRACTS ON MEASLES

Monday, 13th of June 2011

Dear All,

Next month, the Journal of Infectious Diseases will publish a supplement devoted to measles and CRS, ‘Global Progress Toward Measles Eradication and Prevention of Rubella and Congenital Rubella Syndrome,’ Volume 204 suppl 1 July 1, 2011.

I reproduce below abstracts from several authors writing on global issues. As a check to premature optimism, I include the article on Somalia. Failed states will not accelerate the pace of measles eradication.

Readers can access the table of contents and all abstracts at

http://jid.oxfordjournals.org/content/204/suppl_1.toc Full text is available to JID subscribers.

Good reading.

BD

Full list of articles at http://jid.oxfordjournals.org/content/204/suppl_1.toc :

INTRODUCTION 

Commentary: A World Without Measles

Proceedings of the Global Technical Consultation to Assess the Feasibility of Measles Eradication, 28–30 July 2010

The Measles Initiative: Moving Toward Measles Eradication

 

PUBLIC HEALTH IMPORTANCE OF MEASLES AND RUBELLA

 

Measles Mortality Reduction Contributes Substantially to Reduction of All Cause Mortality Among Children Less Than Five Years of Age, 1990–2008

 

Progress Toward Control of Rubella and Prevention of Congenital Rubella Syndrome—Worldwide, 2009

 

Strategic Planning for Measles Control: Using Data to Inform Optimal Vaccination Strategies

 

Should Outbreak Response Immunization Be Recommended for Measles Outbreaks in Middle- and Low-Income Countries? An Update

 

FEASIBILITY OF MEASLES ERADICATION

 

Biological Feasibility of Measles Eradication

 

Comparing Measles With Previous Eradication Programs: Enabling and Constraining Factors

 

Is There Enough Vaccine to Eradicate Measles? An Integrated Analysis of Measles-Containing Vaccine Supply and Demand

 

Risk Analysis for Measles Reintroduction After Global Certification of Eradication

 

How Can Measles Eradication Strengthen Health Care Systems?

 

Impact of Measles Elimination Activities on Immunization Services and Health Systems: Findings From Six Countries

 

Impact of Measles Eradication Activities on Routine Immunization Services and Health Systems in Bangladesh

 

ECONOMIC STUDIES

 

Global Eradication of Measles: An Epidemiologic and Economic Evaluation

 

The Cost-Effectiveness of Supplementary Immunization Activities for Measles: A Stochastic Model for Uganda

 

Assessing the Cost-Effectiveness of Measles Elimination in Uganda: Local Impact of a Global Eradication Program

 

Using Cost-Effectiveness Analysis to Support Research and Development Portfolio Prioritization for Product Innovations in Measles Vaccination

 

MEASLES VACCINE SAFETY AND EFFECTIVENESS

 

Field Effectiveness of Live Attenuated Measles-Containing Vaccines: A Review of Published Literature

 

Persistence of Vaccine-Induced Measles Antibody Beyond Age 12 Months: A Comparison of Response to One and Two Doses of Edmonston-Zagreb Measles Vaccine Among HIV-Infected and Uninfected Children in Malawi

 

International Measles Incidence and Immunization Coverage

 

Measles Vaccination in HIV-Infected Children: Systematic Review and Meta-Analysis of Safety and Immunogenicity

 

Safety and Immunogenicity of Early Measles Vaccination in Children Born to HIV-Infected Mothers in the United States: Results of Pediatric AIDS Clinical Trials Group (PACTG) Protocol 225

 

Measles Supplementary Immunization Activities and GAVI Funds as Catalysts for Improving Injection Safety in Africa

 

REGIONAL AND COUNTRY EXPERIENCES

AFRICAN REGION

 

Measles Mortality Reduction and Pre-Elimination in the African Region, 2001–2009

 

Changing Epidemiology of Measles in Africa

 

Rubella Epidemiology in Africa in the Prevaccine Era, 2002–2009

 

Measles Resurgence Following a Nationwide Measles Vaccination Campaign in Nigeria, 2005–2008

 

Progress in Measles Mortality Reduction in Ethiopia, 2002–2009

 

The Epidemiology of Rubella Disease in Ethiopia: Data From the Measles Case-Based Surveillance System

 

A Long-Lasting Measles Epidemic in Maroua, Cameroon 2008–2009: Mass Vaccination as Response to the Epidemic

 

Impact of a Measles Outbreak Response Immunization Campaign: Maroua, Cameroon, 2009

 

Preplanned National Measles Vaccination Campaign at the Beginning of a Measles Outbreak—Sierra Leone, 2009–2010

AMERICAN REGION

 

The Americas: Paving the Road Toward Global Measles Eradication

 

Measles and Rubella Elimination Initiatives in the Americas: Lessons Learned and Best Practices

 

The Caribbean Experience in Maintaining High Measles Vaccine Coverage

EASTERN MEDITERRANEAN REGION

 

Progress Toward Measles Elimination in the Eastern Mediterranean Region

 

Toward Measles Elimination in Bahrain—A Middle East Country Experience

 

Successful Control and Impending Elimination of Measles in the Islamic Republic of Iran

 

Measles Control and Elimination in Somalia: The Good, the Bad, and the Ugly

 

Progress Toward Measles and Rubella Elimination in Egypt

EUROPEAN REGION

 

What Will It Take to Achieve Measles Elimination in the World Health Organization European Region: Progress From 2003–2009 and Essential Accelerated Actions

 

Molecular Genotyping and Epidemiology of Measles Virus Transmission in the World Health Organization European Region, 2007–2009

 

Supplementary Immunization Activities to Achieve Measles Elimination: Experience of the European Region

 

Who Gets Measles in Europe?

 

Progress Toward Measles Elimination in the Russian Federation, 2003–2009

 

Closer to the Goal: Efforts in Measles Elimination in Germany 2010

 

Status of Rubella and Congenital Rubella Syndrome Surveillance, 2005–2009, the World Health Organization European Region

 

Toward Rubella Elimination in Poland: Need for Supplemental Immunization Activities, Enhanced Surveillance, and Further Integration with Measles Elimination Efforts

SOUTHEAST ASIA REGION

 

South-East Asia Regional Update on Measles Mortality Reduction and Elimination, 2003–2008

 

Molecular Epidemiology of Measles in India, 2005–2010

 

Stability of the Age Distribution of Measles Cases Over Time During Outbreaks in Bangladesh, 2004–2006

 

The Heterogeneity of Measles Epidemiology in India: Implications for Improving Control Measures

 

Measles in Rural West Bengal, India, 2005–6: Low Recourse to the Public Sector Limits the Use of Vitamin A and the Sensitivity of Surveillance

 

Developing Rubella Vaccination Policy in Nepal—Results From Rubella Surveillance and Seroprevalence and Congenital Rubella Syndrome Studies

WESTERN PACIFIC REGION

 

Progress and Challenges for Measles Elimination by 2012 in the Western Pacific Region

 

Progress Toward Measles Elimination in the People's Republic of China, 2000–2009

 

Impact of Supplementary Immunization Activities in Measles-Endemic Areas: A Case Study From Guangxi, China

 

Innovative Use of Surveillance Data to Harness Political Will to Accelerate Measles Elimination: Experience From Guangxi, China

 

Measles Outbreak on a College Campus Transmitted Through Internet Cafés

 

Epidemiology of a Measles Epidemic in Vietnam 2008–2010

 

Outbreak of Measles in the Republic of Korea, 2007: Importance of Nosocomial Transmission

 

MOLECULAR EPIDEMIOLOGY AND LABORATORY ASPECTS OF MEASLES AND RUBELLA SURVEILLANCE

 

Expansion of the Global Measles and Rubella Laboratory Network 2005–09

 

Evaluation of the World Health Organization Global Measles and Rubella Quality Assurance Program, 2001–2008

 

Improving Global Virologic Surveillance for Measles and Rubella

 

Global Distribution of Measles Genotypes and Measles Molecular Epidemiology

 

Status of Global Virologic Surveillance for Rubella Viruses

 

Genetic Characterization of Measles Vaccine Strains

 

Laboratory Characterization of Measles Virus Infection in Previously Vaccinated and Unvaccinated Individuals  

 

Two Case Studies of Modified Measles in Vaccinated Physicians Exposed to Primary Measles Cases: High Risk of Infection But Low Risk of Transmission  

 

Dried Blood Spots on Filter Paper as an Alternative Specimen for Measles Diagnostics: Detection of Measles Immunoglobulin M Antibody by a Commercial Enzyme Immunoassay

 

 

• THE MEASLES INITIATIVE: MOVING TOWARD MEASLES ERADICATION

 

Abstract below; free full text available to JID subscribers

 

1. 1.      Athalia S. Christie1 and
2. 2.      Andrea Gay2

+ Author Affiliations

1. 1.      ¹International Services, American Red Cross
2. 2.      ²United Nations Foundation, Washington, D.C
3. Correspondence: Ms Athalia S. Christie, MIA, Senior Technical Advisor, American Red Cross–International Services, NW3-117C, 2025 E St NW, Washington, DC 20006 (christieat@usa.redcross.org).

Abstract

The World Health Assembly should establish a target date for measles eradication based on continued progress toward existing mortality reduction goals. We have a safe, effective, and inexpensive vaccine; a proven elimination strategy; high country demand; and an effective global partnership. Since it was founded in 2001, the Measles Initiative has supported the vaccination of >900 million children in supplementary immunization activities. Largely as a result, global measles deaths decreased by 78% between 2000 and 2008, averting an estimated 4.3 million deaths. The Measles Initiative has exceeded its targets and evolved to address increasingly ambitious goals. The current challenges include a decline in funding and weak routine immunization systems in some countries. Skeptics of measles eradication raise 3 main objections: the yet-to-be-achieved polio eradication goal, the high cost, and the impact on health systems. These are important concerns that can be addressed with judicious program planning. All 6 World Health Organization regions have committed to measles elimination, and 5 have set a target date. The World Health Assembly has endorsed interim targets toward eradication, and an independent global measles advisory group has determined measles can and should be eradicated. A target date for eradication will focus efforts and capitalize on the achievements of the last decade.

 

• PROGRESS TOWARD CONTROL OF RUBELLA AND PREVENTION OF CONGENITAL RUBELLA SYNDROME—WORLDWIDE, 2009

 

1. 1.      S. E. Reef1,
2. 2.      P. Strebel2,
3. 3.      A. Dabbagh2,
4. 4.      M. Gacic-Dobo2 and
5. 5.      S. Cochi1

+ Author Affiliations

1. 1.      ¹Global Immunization Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
2. 2.      ²Department of Immunization, Vaccines, and Biologicals, World Health Organization, Geneva, Switzerland
3. Correspondence: Susan Reef, MD, Centers for Disease Control and Prevention, MS E-05, 1600 Clifton Rd, NE, Atlanta, GA 30333 (ser2@cdc.gov).

Abstract

Rubella, usually a mild rash illness in children and adults, can cause serious consequences when a pregnant woman is infected, particularly in early pregnancy. These serious consequences include miscarriage, fetal death or an infant born with birth defects (i.e., congenital rubella syndrome (CRS)). The primary purpose for rubella vaccination is the prevention of congenital rubella infection including CRS. Since 1969, several rubella virus vaccines have been licensed for use; however, until the 1990s, use of rubella-containing vaccine (RCV) was limited primarily to developed countries. In 1996, it was estimated that 110,000 infants with CRS were born annually in developing countries. In 2000, the first World Health Organization rubella vaccine position paper was published to guide introduction of RCV in national childhood immunization schedules. From 1996 to 2009, the number of countries that introduced RCV into their national routine childhood immunization programs increased by 57% from 83 countries in 1996 to 130 countries in 2009. In addition, three of the six WHO regions established rubella control and CRS prevention goals: Region of the Americas and Europe rubella elimination by 2010 and 2015, respectively, and Western Pacific Region-accelerated rubella control and CRS prevention by 2015. Also, during this time period, the number of rubella cases reported decreased from 670,894 in 2000 to 121,344 in 2009. Rubella control and prevention of CRS can be accelerated by integrating with current global measles mortality reduction and regional elimination activities.

 

• MEASLES MORTALITY REDUCTION AND MDG 4

 

With four years to 2015, it is good to remember how much measles vaccination has contributed to cuts in under-five mortality. The logical conclusion: any reverses in measles mortality reduction would seriously compromise the prospects of reaching MDG 4.

Abstract below; free full text to subscribers of JID.

Measles Mortality Reduction Contributes Substantially to Reduction of All Cause Mortality Among Children Less Than Five Years of Age, 1990–2008

1. 1.      Maya M. V. X. van den Ent1,
2. 2.      David W. Brown1,
3. 3.      Edward J. Hoekstra1,
4. 4.      Athalia Christie2 and
5. 5.      Stephen L. Cochi3

+ Author Affiliations

1. 1.      ¹United Nations Children’s Fund (UNICEF), New York, New York
2. 2.      ²International Services, American Red Cross, Washington, DC
3. 3.      ³Global Immunization Division, Centers for Disease Control and Prevention, Department of Health and Human Services, Atlanta, Georgia
4. Correspondence: Maya van den Ent, PharmD, MPH, UNICEF Headquarters, 3 UN Plaza, New York, NY 10017 (mvandenent@unicef.org).

Abstract

Background. The Millennium Development Goal 4 (MDG4) to reduce mortality in children aged <5 years by two-thirds from 1990 to 2015 has made substantial progress. We describe the contribution of measles mortality reduction efforts, including those spearheaded by the Measles Initiative (launched in 2001, the Measles Initiative is an international partnership committed to reducing measles deaths worldwide and is led by the American Red Cross, the Centers for Disease Control and Prevention, UNICEF, the United Nations Foundation, and the World Health Organization).

Methods. We used published data to assess the effect of measles mortality reduction on overall and disease-specific global mortality rates among children aged <5 years by reviewing the results from studies with the best estimates on causes of deaths in children aged 0–59 months.

Results. The estimated measles-related mortality among children aged <5 years worldwide decreased from 872,000 deaths in 1990 to 556,000 in 2001 (36% reduction) and to 118,000 in 2008 (86% reduction). All-cause mortality in this age group decreased from >12 million in 1990 to 10.6 million in 2001 (13% reduction) and to 8.8 million in 2008 (28% reduction). Measles accounted for about 7% of deaths in this age group in 1990 and 1% in 2008, equal to 23% of the global reduction in all-cause mortality in this age group from 1990 to 2008.

Conclusions. Aggressive efforts to prevent measles have led to this remarkable reduction in measles deaths. The current funding gap and insufficient political commitment for measles control jeopardizes these achievements and presents a substantial risk to achieving MDG4.

• ·         © The Author 2011. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com

 

•  COMPARING MEASLES WITH PREVIOUS ERADICATION PROGRAMS: ENABLING AND CONSTRAINING FACTORS

 

1. 1.       Robert Keegan1,
2. 2.       Alya Dabbagh2,
3. 3.       Peter M. Strebel2 and
4. 4.       Stephen L. Cochi3

+ Author Affiliations

1. 1.       ¹Independent consultant, Atlanta, Georgia
2. 2.       ²Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
3. 3.       ³Global Immunization Division, Centers for Disease Control and Prevention, Department of Health and Human Services, Atlanta, Georgia
4. Correspondence: Peter M. Strebel, MBChB, MPH, IVB/EPI, World Health Organization, 20 Ave Appia, CH-1211 Geneva 27, Switzerland (strebelp@who.int).

Abstract

Background. Five major disease eradication initiatives were initiated during the second half of the 20th century. The enabling and constraining factors—political, social, economic, and other—for these previous and current eradication programs can inform decision making regarding a proposed measles eradication initiative.

Methods. We reviewed the literature on the yaws, malaria, smallpox, guinea worm, and polio eradication programs and compared enabling and constraining factors for each of these programs with the same factors as they relate to a possible measles eradication initiative.

Results. A potential measles eradication program would enjoy distinct advantages in comparison with earlier eradication programs, including strong political and societal support, economic analyses demonstrating a high level of cost-effectiveness, and a rigorous upfront process, compared with previous eradication initiatives, that has validated the feasibility of achieving measles eradication. However, increasing population density, urbanization, and wars/civil conflicts will pose serious challenges.

Conclusions. Measles eradication will be very challenging but probably not as difficult to achieve as polio eradication. Measles eradication should be undertaken only if the commitments and resources will be adequate to meet the political, social, economic, and technical challenges.

• ·         © The Author 2011. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com

 

• OUTBREAK RESPONSE IMMUNIZATION

 

 Should Outbreak Response Immunization Be Recommended for Measles Outbreaks in Middle- and Low-Income Countries? An Update

1. 1.      K. Lisa Cairns1,
2. 2.      Robert T. Perry1,
3. 3.      Tove K. Ryman1,
4. 4.      Robin K. Nandy2 and
5. 5.      Rebecca F. Grais3

+ Author Affiliations

1. 1.      ¹Global Immunization Division, US Centers for Disease Control and Prevention, Atlanta, Georgia
2. 2.      ²UNICEF, New York, New York
3. 3.      ³Epicentre, Paris, France
4. Correspondence: K. Lisa Cairns, MD, MPH, MS E-05, 1600 Clifton Rd, Atlanta, GA 30306 (kfc4@cdc.gov).

Abstract below; free full text to JID subscribers

 

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.

• ·         © Published by Oxford University Press on behalf of the Infectious Diseases Society of America 2011. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com

 

• GLOBAL ERADICATION OF MEASLES: AN EPIDEMIOLOGIC AND ECONOMIC EVALUATION

 

1. 1.      Ann Levin1,
2. 2.      Colleen Burgess2,
3. 3.      Louis P. Garrison Jr.3,
4. 4.      Chris Bauch4,
5. 5.      Joseph Babigumira3,
6. 6.      Emily Simons5 and
7. 7.      Alya Dabbagh5

+ Author Affiliations

1. 1.      ¹Independent Consultant, Bethesda, Maryland
2. 2.      ²MathEcology, Phoenix, Arizona
3. 3.      ³Department of Pharmacy, University of Washington, Seattle
4. 4.      ⁴Department of Mathematics and Statistics, University of Guelph, Ontario, Canada
5. 5.      ⁵World Health Organization, Geneva, Switzerland
6. Correspondence: Ann Levin, PhD, 6414 Hollins Dr, Bethesda, MD 20817 (annlevin@verizon.net).

Abstract

Background. Measles remains an important cause of morbidity and mortality in children in developing countries. Due to the success of the measles mortality reduction and elimination efforts thus far, the WHO has raised the question of whether global eradication of measles is economically feasible.

Methods. The cost-effectiveness of various measles mortality reduction and eradication scenarios was evaluated vis-à-vis the current mortality reduction goal in six countries and globally. Data collection on costs of measles vaccination were conducted in six countries in four regions: Bangladesh, Brazil, Colombia, Ethiopia, Tajikistan, and Uganda. The number of measles cases and deaths were projected from 2010 to 2050 using a dynamic, age-structured compartmental model. The incremental cost-effectiveness ratios were then calculated for each scenario vis a vis the baseline.

Results. Measles eradication by 2020 was the found to be the most cost-effective scenario, both in the six countries and globally. Eradicating measles by 2020 is projected to cost an additional discounted $7.8 billion and avert a discounted 346 million DALYs between 2010 and 2050.

Conclusions. In conclusion, the study found that, compared to the baseline, reaching measles eradication by 2020 would be the most cost-effective measles mortality reduction scenario, both for the six countries and on a global basis.

 

• © The Author 2011. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com

Expand+

• MEASLES CONTROL AND ELIMINATION IN SOMALIA: THE GOOD, THE BAD, AND THE UGLY

 

1. 1.       Raoul Kamadjeu1,
2. 2.       Kebede Assegid1,
3. 3.       Boubker Naouri3,
4. 4.       Imran Raza Mirza2,
5. 5.       Abdurazak Hirsi4,
6. 6.       Abdurahman Mohammed5,
7. 7.       Mohammed Omer6,
8. 8.       Abdi Hassan Dualle6 and
9. 9.       Abraham Mulugeta1

+ Author Affiliations

1. 1.       ¹World Health Organization, Polio Eradication Program/Expanded Program on Immunization, Somalia Liaison office
2. 2.       ²UNICEF Somalia, Accelerated Child Survival and Development, Health Unit, Nairobi, Kenya
3. 3.       ³World Health Organizations, Vaccine Preventable Diseases and Immunization, Eastern Mediterranean Office, Cairo, Egypt
4. 4.       ⁴Ministry of Health, Expanded Program on Immunization Unit, Puntland
5. 5.       ⁵Ministry of Health and Labor, Expanded Program on Immunization Unit, Somaliland
6. 6.       ⁶World Health Organization, Somalia Field Offices in Mogadishu and Hargeisa, Somalia
7. Correspondence: Assegid Kebede, MD, MPH, World Health Organization, Expanded Program on Immunization, Somalia Liaison office in Nairobi, Warwick Center, Nairobi, Kenya, PO BOX 63565-00619 (kebedea@nbo.emro.who.int).

Abstract

Despite enormous challenges, Somalia has been successfully implementing accelerated measles control activities since 2005. Through innovative strategies and with the support of local and international partners, the country has shown potentials of implementing measles mortality reduction activities in complex emergencies. Measles incidence has been reduced by >80% after the measles catch-up campaigns of 2005–2007, and national reported measles routine immunization coverage with first dose measles containing vaccine has reached 59% for the first time in 2009. However, the near collapse of the health care system and the ongoing insecurity continue to hamper the implementation of recommended measles control and elimination strategies in some parts of the country, making these achievements fragile. Somalia exemplifies the challenges in meeting measles elimination goals in the World Health Organization Eastern Mediterranean region. As the region is entering its 2010 measles elimination goals, it appears necessary to establish realistic and flexible interim goals for measles control in Somalia that will take into consideration the specificities of the country. Maintaining flexibility in conducting field operations, securing financial resources, multiplying opportunities for measles vaccination, and improving disease monitoring systems will remain vital to sustain and improve current achievements.

• ·         © The Author 2011. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com