V: REGIONAL AND COUNTRY EXPERIENCES, AFRICA REGION

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Herewith, abstracts on regional and country experiences with measles control and elimination from six regions.

 

Items V through X, like items I through IV, appear in this month’s Journal of Infectious Diseases, also at

http://jid.oxfordjournals.org/content/204/suppl_1.toc

Full text is available to JID subscribers.

 

At two ends of the spectrum, the articles on China and Somalia illustrate the different conditions under which five of WHO’s six regions are moving towards measles elimination. If China is not quite there, where will Somalia be by 2020 if it remains a failed state?

 

Good reading.

 

 

V: REGIONAL AND COUNTRY EXPERIENCES, AFRICA REGION

 

 

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

  1. 1.   Balcha G. Masresha1, Amadou Fall2, Messeret Eshetu3, Steve Sosler4, Mary Alleman2,
  2. 2.   James L. Goodson5, Reggis Katsande1 and Deogratias Nshimirimana1 

+ Author Affiliations

  1. 1.    1Immunisation and Vaccines Development Programme, Regional Office for Africa, World Health Organization, Brazzaville, The Republic of the Congo
  2. 2.    2Immunisation and Vaccines Development Programme, West Africa Inter-Country Support Team, World Health Organization, Ouagadougou, Burkina Faso
  3. 3.    3Immunisation and Vaccines Development Programme, East and South Africa Inter-Country Support Team, World Health Organization, Harare, Zimbabwe
  4. 4.    4Immunisation and Vaccines Development Programme, Central Africa Inter-Country Support Team, World Health Organization, Libreville, Gabon
  5. 5.    5Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia
  6. Correspondence: Balcha G. Masresha, MD, Regional Office for Africa, World Health Organization, Immunisation and Vaccines Development Programme, Boite Postale 6, Brazzaville, The Republic of the Congo (masreshab@zw.afro.who.int).

Abstract

Introduction In 2001, countries in the . African region adopted the measles-associated mortality reduction strategy recommended by the World Health Organization and the United Nations Children's Fund. With support from partners, these strategies were implemented during 2001–2009.

Methods To assess implementation, estimates . of the first dose of measles vaccination through routine services (MCVI) and reported coverage for measles supplemental immunization activities (SIAs) were reviewed. Measles surveillance data were analyzed.

Results During 2001–2009, regional MCV1 . coverage increased from 56% to 69%, and >425 million children received measles vaccination through 125 SIAs. Measles case-based surveillance was established in 40 of 46 countries; the remaining 6 have aggregated case reporting. From 2001 through 2008, reported measles cases decreased by 92%, from 492,116 to 37,010; however, in 2009, cases increased to 83,625.

Conclusions  The implementation of the . recommended strategies led to a marked decrease in measles cases in the region; however, the outbreaks occurring since 2008 indicate suboptimal vaccination coverage. To achieve high MCV1 coverage, provide a second dose through either periodic SIAs or routine services, and to ensure further progress toward attaining the regional measles pre-elimination goal by 2012, a renewed commitment from implementing partners and donors is needed.

http://jid.oxfordjournals.org/content/204/suppl_1/S198.abstract

 

 

Changing Epidemiology of Measles in Africa

  1. 1.   James L. Goodson1, Balcha G. Masresha2, Kathleen Wannemuehler1, Amra Uzicanin1 and

Stephen Cochi1 

+ Author Affiliations

  1. 1.    1Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia
  2. 2.    2Immunisation and Vaccines Development Programme, World Health Organization, Africa Regional Office, Brazzaville, Congo
  3. Correspondence: James L. Goodson, MPH, Global Immunization Division, Centers for Disease Control and Prevention, 1600 Clifton Rd, NE, MS-E05, Atlanta, GA 30333 (jgoodson@cdc.gov).

Abstract

Background. In Africa before the  introduction of measles vaccination, measles primarily affected young children. To describe measles epidemiology in Africa since the start of accelerated measles control activities in 2001, we analyzed regional measles case-based surveillance data for 2002–2009.

Methods. Country-years were grouped by  10-year moving average of routine measles vaccination coverage (aMCV1). Age was log transformed, and pair-wise comparisons of means were made. A χ2 test was used to assess association between coverage and age groups. Cumulative percent curves and percentiles of age, dot plots with Loess curve, and Spearman rank correlation coefficient were calculated.

Results. Of 180,284 suspected cases, 73,009  (41%) were confirmed as measles. Of these, the mean age was 79 months (median, 36 months; interquartile range, 16–96 months) and significantly younger in country-years with <50% aMCV1 than those with 50%–74% aMCV1 (P = .03) and ≥75% (P = .02). With increasing coverage, there was a slight decrease in age in the 10th and 25th and moderate increase in age in the 50th, 75th, and 90th percentiles.

Conclusions. During 2002–2009, the median  age of confirmed measles was 36 months. In countries with ≥50% aMCV1 coverage compared with low-coverage countries, age shifted to older children and young adults; for infants, age decreased slightly with higher coverage.

http://jid.oxfordjournals.org/content/204/suppl_1/S205.abstract

 

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

  1. 1.   Goitom G. Weldegebriel1, Alex Gasasira1, Pauline Harvey1, Balcha Masresha2,

James L. Goodson3, Muhammad A. Pate4, Emmanuel Abanida4 and Ana Chevez1 

+ Author Affiliations

  1. 1.    1World Health Organization, Country Office, Nigeria
  2. 2.    2World Health Organization, African Regional Office, Brazzaville, Congo
  3. 3.    3Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia
  4. 4.    4National Primary Health Care Development Agency, Nigeria
  5. Correspondence: Goitom Weldegebriel, MD, MPH, World Health Organization, Country Office, Abuja, Nigeria (weldegebrielg@ng.afro.who.int).

Abstract

Introduction  From 1990 through 2008, . routine immunization coverage of measles vaccine in Nigeria ranged from 35% to 70%. Nigeria conducted a nationwide measles vaccination campaign in 2 phases during 2005–2006 that targeted children aged 9 months to 14 years; in 2008, a nationwide follow-up campaign that targeted children aged 9 months to 4 years was conducted in 2 phases. Despite these efforts, measles cases continued to occur.

Methods This is a descriptive study that . reviewed the measles immunization coverage data from administrative, World Health Organization, United Nations Children’s Fund, survey, and supplemental immunization activities data. Measles surveillance data were analyzed from case-based surveillance reports.

Results  Confirmed measles cases increased . from 383 in 2006 to 2542 in 2007 and to 9510 in 2008. Of the confirmed cases in 2008, 717 (30%) occurred in children <2 years of age, 1145 (48%) in children 2–4 years of age, and 354 (14%) were in children 5–14 years of age. In 2008, the measles case fatality rate was 1.2%.

Conclusions Suboptimal routine coverage and . the wide interval between the catch-up and follow-up campaigns likely led to an accumulation of children susceptible to measles.

http://jid.oxfordjournals.org/content/204/suppl_1/S226.abstract

 

Progress in Measles Mortality Reduction in Ethiopia, 2002–2009

  1. 1.   Kassahun Mitiku1,  Tesfaye Bedada1, Balcha G. Masresha4, Wondimagegn Kegne1,

Fatoumata Nafo-Traoré1, Neghist Tesfaye2 and Asnakew Yigzaw3 

+ Author Affiliations

  1. 1.    1World Health Organization, Country Office, Addis Ababa
  2. 2.    2Federal Ministry of Health
  3. 3.    3The Clinton Foundation Health Initiative, Ethiopia
  4. 4.    4World Health Organization, African Regional Office, Congo
  5. Correspondence: Kassahun Mitiku, MD, MPH, World Health Organization, Country Office, Addis Ababa, Ethiopia (kasahunm@et.afro.who.int).

Abstract

Background. In 2002, Ethiopia adopted the  African regional accelerated measles control strategies to reduce measles mortality. Routine measles vaccination is provided for infants at 9 months of age. A second opportunity for measles vaccination through supplementary immunization activities (SIAs) started in 2002, targeting children aged 6 months–14 years; periodic follow-up SIAs were conducted, targeting children aged 6–59 months from 2005 through 2009.

Methods. The administrative coverage data  for routine measles vaccination and the respective World Health Organization–United Nations Children's Fund vaccination coverage estimates, as well as administrative coverage during measles SIAs and the measles case-based surveillance data from 2004 through 2009, were reviewed and analyzed.

Results.The administrative coverage with  routine measles vaccination increased from 37% in 2000 to 76% in 2009. The SIAs coverage was 92% for the catch-up SIAs, 88% for the first follow-up SIAs, and 92% for the second follow-up SIAs. Measles case-based surveillance met the targets set for the 2 main performance indicators during 2005–2009.

Conclusions. Following the adoption of the  measles control strategies, a reduction in the number of reported measles cases and measles outbreaks was documented. However, measles outbreaks continued to occur in Ethiopia, mainly because of suboptimal measles vaccination coverage.

http://jid.oxfordjournals.org/content/204/suppl_1/S232.abstract

 

 

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

  1. 1.   Kassahun Mitiku1, Tesfaye Bedada1, Balcha Masresha4, Wendemagegn Kegne1,

Fatoumata Nafo-Traoré1, Neghist Tesfaye2 and Berhane Beyene3 

+ Author Affiliations

  1. 1.    1World Health Organization, Country Office
  2. 2.    2Federal Ministry of Health
  3. 3.    3Ethiopian Health and Nutrition Research Institute, Addis Ababa, Ethiopia
  4. 4.    4World Health Organization, African Regional Office, Brazzaville, Congo
  5. Correspondence: Kassahun Mitiku, MD, MPH, World Health Organization, Country Office, Addis Ababa, Ethiopia (kasahunm@et.afro.who.int).

Abstract

Background. Rubella is usually a mild rash  illness. However, when a woman contracts rubella early in pregnancy, serious consequences may occur, including birth defects known as congenital rubella syndrome (CRS). Information is limited on the epidemiology of rubella and CRS in Ethiopia.

Method. Rubella cases reported through the  measles case-based surveillance system during 2004–2009 were analyzed.

Results. A total of 8212 samples were tested  for rubella immunoglobulin (Ig) M, and 992 (12.1%) of these specimens had test results that were positive for rubella IgM. The age distribution of patients with rubella-positive cases ranged from 3 months to 44 years. The majority (94.7%) of the cases were in individuals <15 years of age. The proportion of positive specimens from urban areas (19.4%) was higher than that from rural areas (11.6%).

Conclusions. Rubella is endemic in Ethiopia  and mainly occurs among children and young adolescents. To better understand the burden of rubella and CRS, and to develop a national strategy for rubella control in Ethiopia, CRS surveillance will need to be established, and appropriate studies need to be conducted.

http://jid.oxfordjournals.org/content/204/suppl_1/S239.abstract

 

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

  1. 1.   Francisco J. Luquero1, Heloise Pham-Orsetti1, D. A. T. Cummings1,  Philippe E. Ngaunji2,

Marcelino Nimpa3, Florence Fermon4,  Ndong Ngoe2,  Stephen Sosler5, Peter Strebel6 and

Rebecca F. Grais1 

+ Author Affiliations

  1. 1.    1Epicentre, Paris, France
  2. 2.    2Division of Operational Research, Ministry of Health, Cameroon
  3. 3.    3Expanded Programme of Immunization, Ministry of Health, Cameroon
  4. 4.    4Médecins Sans Frontières, Paris, France
  5. 5.    5Inter-country Support Team for Central Africa, World Health Organization, Libreville, Gabon
  6. 6.    6Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
  7. Correspondence: Francisco J. Luquero, MD, MPH, Epicentre, 8 rue Saint Sabin, 75011, Paris, France (fluquero@epicentre.msf.org).

Abstract

Background. A measles outbreak occurred in  Maroua, Cameroon, from January 2008 to April 2009. In accordance with recent World Health Organization guidelines, an outbreak-response immunization (ORI) was conducted in January 2009. The aim of this study was to investigate the causes of the epidemic in order to guide vaccination strategies.

Methods. We performed a stratified household-based survey using cluster sampling to determine measles vaccination coverage in children aged 9 months to 15 years. We defined 3 strata based on measles incidence. Next, we performed a case–control study to measure vaccine effectiveness (VE). Cases were obtained from health center registries. Controls were selected among respondents to the coverage survey.

Results. The vaccination-coverage survey included 2963 children in total. The overall routine vaccination coverage was 74.1% (95% confidence interval [CI]: 70.0%–78.3%). Measles incidence was inversely proportional to routine vaccination coverage, with high incidence associated with coverage of 71% and low incidence associated with coverage of 84%. The overall VE was 94% (95% CI, 86.7%–97.4%). After the ORI in January 2009, the coverage was >90% in all strata and measles incidence declined rapidly.

Discussion.  Our results confirm that  insufficient vaccination coverage was the main reason for this epidemic. The ORI conducted in January 2009 contributed both to control the epidemic and to increase the vaccination coverage to desirable levels.

http://jid.oxfordjournals.org/content/204/suppl_1/S243.abstract

 

 

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

  1. 1.   James L. Goodson1,  Steve Sosler2, Omer Pasi1, Ticha Johnson3, Marie Kobella4,

Martin E. Monono5 and Amra Uzicanin1 

+ Author Affiliations

  1. 1.    1Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia
  2. 2.    2World Health Organization, Central Africa Inter-Country Support Team, Gabon
  3. 3.    3World Health Organization
  4. 4.    4Expanded Programme on Immunization
  5. 5.    5Family Health Department, Ministry of Health, Cameroon
  6. Correspondence: Omer Pasi, MD, MPH, Global Immunization Div, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Mailstop E05, Atlanta, GA 30333 (opasi@cdc.gov).

Abstract

A large measles outbreak occurred in Maroua, Cameroon during October 2008–April 2009; a nine-day outbreak response immunization (ORI) campaign was initiated 15 weeks after the start of the outbreak during high transmission season. To assess the impact of ORI, we described changes to case counts and characteristics before and after ORI, and the reporting efficiency of measles cases to the surveillance system. A sharp decrease in cases occurred from 555 cases during the period before ORI to 162 cases during the period after ORI; reporting efficiency was 79.5% before ORI and 93.0% after ORI. These findings highlight the potential benefits of rapid implementation of recommended ORI strategies during measles outbreaks in Africa.

http://jid.oxfordjournals.org/content/204/suppl_1/S252.abstract

 

 

 

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

  1. 1.   David E. Sugerman1,  Amadou Fall2,  Marie-Thérèse Guigui3, Michael N'dolie4,

Terry Balogun4, Alie Wurie5 and James L. Goodson1 

+ Author Affiliations

  1. 1.    1Centers for Disease Control and Prevention, Global Immunization Division, Atlanta, Georgia
  2. 2.    2World Health Organization, Inter-Country Support Team for West Africa, Ouagadougou, Burkina Faso
  3. 3.    3UNICEF, Health Specialist for Measles, Yellow Fever, and Health Emergencies, Regional Office for West and Central Africa, Dakar, Senegal
  4. 4.    4Expanded Programme on Immunization, World Health Organization
  5. 5.    5Ministry of Health and Sanitation, Expanded Programme on Immunization, Freetown, Sierra Leone
  6. Reprints or correspondence: David E. Sugerman, MD, MPH, Global Immunization Division, Centers for Disease Control and Prevention, 1600 Clifton Rd, NE; MS-E05, Atlanta, GA 30333 (ggi4@cdc.gov).

Abstract

Background. Large-scale measles outbreaks  occurred throughout Africa from 2008-2010. In Sierra Leone, in November 2009, preceding a measles supplemental immunization activity (SIA), the largest measles outbreak in a decade started.

Methods. We analyzed data from the national  measles case-based surveillance system, developed a susceptibility profile of the population, and calculated vaccine effectiveness (VE) among children 12-59 months of age.

Results. From November 1, 2009 to July 13,  2010, 1,094 confirmed cases, including 9 deaths, were reported; 716 (66%) were <5 years of age. B3 genotype was identified. Measles attack rates per 100,000 population were highest among infants aged 6–8 months (56.4) and in Bo district (49.4). Districts with higher estimated SIA coverage tended to have lower attack rates (Spearman Correlation Coefficient = −0.63), p = 0.07. Among 473 cases with information on vaccination status, 222 (47%) were unvaccinated; estimated VE was 74%. The 2009 measles SIA led to 165,000 fewer estimated susceptible individuals.

Conclusions. The 2009 measles SIA reduced  the overall magnitude of the outbreak, though routine and SIA coverage was insufficient to prevent it entirely. Maintaining high coverage through routine services and SIAs in all districts and conducting follow-up SIAs prior to the end of the low transmission season may prevent future outbreaks.

http://jid.oxfordjournals.org/content/204/suppl_1/S260.abstract