VII: REGIONAL AND COUNTRY EXPERIENCES WITH MEASLES ELIMINATION, MIDEAST

Tuesday, 28th of June 2011 Print

 

 

VII: REGIONAL AND COUNTRY EXPERIENCES, MIDEAST

 

Progress Toward Measles Elimination in the Eastern Mediterranean Region

  1. 1.   Boubker Naouri1,  Hinda Ahmed1,  Raef Bekhit1, Nadia Teleb1, Ezzeddine Mohsni2 and

James P. Alexander Jr.3 

+ Author Affiliations

  1. 1.    1Vaccine Preventable Diseases and Immunization
  2. 2.    2Disease Surveillance, Eradication and Elimination, Regional Office for the Eastern Mediterranean, World Health Organization, Cairo, Egypt
  3. 3.    3Global Immunization Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
  4. Correspondence: James P. Alexander, Jr, MD, Centers for Disease Control and Prevention, 1600 Clifton Rd, NE, Mailstop E-05, Atlanta, Georgia 30333 (axj1@cdc.gov).

Abstract

Since 1997, when the goal of interrupting measles transmission by 2010 was adopted, substantial progress has been made toward the elimination of measles in the Eastern Mediterranean Region (EMR). For the 22 EMR member countries, routine coverage with the first dose of a measles-containing vaccine (MCV) increased from 70% in 1997 to 82% in 2009. All 22 countries conducted measles catch-up vaccination campaigns during 1994–2009, and most conducted follow-up campaigns as needed. Of the 22 EMR countries, 19 have established case-based surveillance for measles with laboratory confirmation. Reported measles cases decreased by 86% during 1998–2008, and estimated measles mortality decreased by 93% during 2000–2008, accounting for 17% of global measles mortality reduction during that period. Despite these successes, several significant challenges remain, and the EMR will not be able to achieve measles elimination by the end of 2010. Achieving and maintaining high population immunity with 2 doses of MCV, improving sensitive case-based surveillance, identifying and vaccinating high-risk subpopulation groups, and appropriately responding to outbreaks are key steps needed to achieve the goal.

http://jid.oxfordjournals.org/content/204/suppl_1/S289.abstract

 

 

 

Toward Measles Elimination in Bahrain—A Middle East Country Experience

  1. 1.   Jaleela S. Jawad1, Adel S. Al-Sayyad2,  Fathiya Sataih1, Boubker Naouri3 and

James P. Alexander Jr4 

+ Author Affiliations

  1. 1.    1Immunization Unit
  2. 2.    2Communicable Diseases Control Unit, Public Health Directorate, Ministry of Health, Manama, Bahrain
  3. 3.    3Vaccine Preventable Diseases and Immunization, Regional Office for the Eastern Mediterranean, World Health Organization, Cairo, Egypt
  4. 4.    4Global Immunization Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
  5. Correspondence: James P. Alexander Jr, MD, Centers for Disease Control and Prevention, 1600 Clifton Road, N.E. Mailstop E-05, Atlanta, Georgia, 30333 (axj1@cdc.gov).

Abstract

Measles was a leading cause of infant and child morbidity and mortality in Bahrain before the introduction of measles vaccine in 1974. With the establishment of the Expanded Program on Immunization (EPI) in 1981 and the introduction of a second dose of measles vaccine in 1985, coverage for first and second doses of measles vaccine increased to 94% by 1997 and has been sustained >97% since 2001. Measles, mumps, and rubella (MMR) immunization campaigns targeting 12-year-old students were conducted annually during 1998–2006 and achieved coverage of >95%. As a result, the incidence of measles in Bahrain has declined markedly over the past 4 decades, to 2.7 cases per million persons in 2009. Recent confirmed measles cases have occurred sporadically, in undervaccinated children or in infants too young or adults too old to receive measles vaccine. Bahrain has made significant progress toward measles elimination by sustaining high immunization coverage and strengthening case-based measles surveillance activities. Further success will depend on improved identification and immunization of undervaccinated expatriate workers and their families.

http://jid.oxfordjournals.org/content/204/suppl_1/S299.abstract

 

 

 

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

  1. 1.   Seyed Mohsen Zahraei1, Mohamad M. Gouya1,  Talat Mokhtari Azad2, Rambod Soltanshahi1, Azam Sabouri1, Boubker Naouri3 and James P. Alexander Jr4 

+ Author Affiliations

  1. 1.    1Vaccine Preventable Diseases Department, Center for Communicable Diseases Control, Ministry of Health and Medical Education
  2. 2.    2National Reference Laboratory for Measles and Rubella, Tehran University of Medical Sciences, Tehran, Iran
  3. 3.    3Vaccine Preventable Diseases and Immunization, Regional Office for the Eastern Mediterranean, World Health Organization, Cairo, Egypt
  4. 4.    4Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia
  5. Correspondence: James P. Alexander Jr, MD, 1600 Clifton Rd, NE, Mailstop E-05, Centers for Disease Control and Prevention, Atlanta, GA 30333 (axj1@cdc.gov).

Abstract

Measles is still one of the most common infectious killers of children in the world, especially in developing countries. In Iran, during the prevaccine era, 150,000–500,000 cases of measles were reported annually, with a death rate of 10%–15%. After the establishment of Expanded Program on Immunization program in 1984, vaccination rates for the first and second doses of measles vaccine increased to >90% by the mid-1990s, and the number of measles cases decreased to 2652 in 1996. In response to increased numbers of cases in older age groups during 1996–2002, a nationwide measles-rubella vaccination campaign was conducted in 2003, and 33,100,000 persons (99%) aged 5–25 years were vaccinated. During 2004–2009, 221 laboratory-confirmed measles cases (<1 case per million population) were detected, primarily in rural areas and among migrant groups who traveled to or came from high-incidence countries. High routine immunization coverage, low disease incidence, and surveillance system data suggest that interruption of endemic virus transmission might have already been achieved in Iran, but challenges remain and continued efforts are needed to sustain this accomplishment.

http://jid.oxfordjournals.org/content/204/suppl_1/S305.abstract

 

 

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

  1. 1.   Raoul Kamadjeu1,  Kebede Assegid1, Boubker Naouri3, Imran Raza Mirza2,

Abdurazak Hirsi4, Abdurahman Mohammed5, Mohammed Omer6,

Abdi Hassan Dualle6 and 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.

http://jid.oxfordjournals.org/content/204/suppl_1/S312.abstract

 

 

Progress Toward Measles and Rubella Elimination in Egypt

  1. 1.   N. El Sayed1, N. Kandeel2, I. Barakat1, I. Moussa1, J. P. Alexander Jr3, B. Naouri4 and

S. E. Reef3 

+ Author Affiliations

  1. 1.    1Family Planning and Primary Health Care
  2. 2.    2Endemic Diseases and Central Laboratories
  3. 3.    3Centers for Disease Control and Prevention, Atlanta, Georgia
  4. 4.    4Regional Office for the Eastern Mediterranean, World Health Organization, Cairo, Egypt
  5. Correspondence: Susan E. Reef, MD, Centers for Disease Control and Prevention, 1600 Clifton Rd, NE, Mailstop E-05, Atlanta, Georgia 30333 (ser2@cdc.gov).

Abstract

Measles and rubella were common infectious diseases in Egypt during the prevaccine era. Monovalent measles vaccine was introduced in 1977, and measles vaccination coverage increased from <50% to >90% from 1980 to 1999; however, measles outbreaks continued to occur at 2- to 4-year intervals during this period. After the introduction of a second routine dose of measles vaccine as a combined measles-mumps-rubella (MMR) vaccine in 1999 and the implementation of measles immunization campaigns targeting 6- to 16-year-old children during 2000–2003, reported measles cases dramatically decreased by 2003. In 2002, Egypt established a goal to eliminate measles and rubella and to prevent congenital rubella syndrome (CRS) by 2010. Large-scale rubella and measles outbreaks in 2005–2007, however, led to a revision of the plan of action to achieve the 2010 goals. A nation-wide measles–rubella immunization campaign, targeting children, adolescents, and young adults 2–20 years old, was conducted in 2 phases during 2008–2009 and achieved coverage >95%. With the decrease to record low levels of cases of measles and rubella in 2009 and 2010, Egypt should achieve measles and rubella elimination in the near future, but high coverage(>95%) with 2 doses of measles–rubella vaccine needs to be maintained, measles–rubella surveillance strengthened, and CRS surveillance developed.

http://jid.oxfordjournals.org/content/204/suppl_1/S318.abstract

 

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