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IX: UPDATES FROM SOUTH EAST ASIA REGION
South-East Asia Regional Update on Measles Mortality Reduction and Elimination, 2003–2008
Nalini Ramamurty1, Madhava Ram Balakrishnan1 and Simarjit Singh1
+ Author Affiliations
Abstract
In 2005, the World Health Assembly endorsed a global goal of 90% reduction in measles mortality from 2000 to 2010. Substantial progress has been made toward achieving this goal in countries of the South-East Asia Region (SEAR). More than 120 million children received a second dose of measles-containing vaccine during supplemental immunization activities conducted from 2000 to 2008; routine first-dose measles-containing vaccine coverage increased from 63% in 2000 to 75% by 2008; and measles surveillance is supported in all countries by the Measles-Rubella Laboratory Network. Overall, the estimated number of measles deaths decreased by 46% from 2000 to 2008, and all countries with the exception of India have already achieved the 90% mortality reduction target. Sustained political and financial commitment from SEAR countries is needed to achieve regional measles mortality reduction and elimination.
http://jid.oxfordjournals.org/content/204/suppl_1/S396.abstract
Molecular Epidemiology of Measles in India, 2005–2010
Naseem Shaikh1, Laxman Hungund1, R. S. Tomar1, D. Biswas2, K. Yadav2,
J. Mahanta2, V. N. R. Das3, Prasanna Yergolkar4, P. Gunasekaran5,
D. Raja5, R. Jadi1, Nalini Ramamurty6, A. C. Mishra1 and MeaslesNetIndia collaboratorsa
+ Author Affiliations
Abstract
Measles is a childhood disease that causes great morbidity and mortality in India and worldwide. Because measles surveillance in India is in its infancy, there is a paucity of countrywide data on circulating Measles virus genotypes. This study was conducted in 21 of 28 States and 2 of 7 Union Territories of India by MeaslesNetIndia, a national network of 27 centers and sentinel practitioners. MeaslesNetIndia investigated 52 measles outbreaks in geographically representative areas from 2005 through June 2010. All outbreaks were serologically confirmed by detection of antimeasles virus immunoglobulin M (IgM) antibodies in serum or oral fluid samples. Molecular studies, using World Health Organization (WHO)–recommended protocols obtained 203 N-gene, 40 H-gene, and 4 M-gene sequences during this period. Measles genotypes D4, D7, and D8 were found to be circulating in various parts of India during the study period. Further phylogenetic analysis revealed 4 lineages of Indian D8 genotypes: D8a, D8b, D8c, and D8d.
This study generated a large, countrywide sequence database that can form the baseline for future molecular studies on measles virus transmission pathways in India. This study has created support and capabilities for countrywide measles molecular surveillance that must be carried forward
http://jid.oxfordjournals.org/content/204/suppl_1/S403.abstract
Stability of the Age Distribution of Measles Cases Over Time During Outbreaks in Bangladesh, 2004–2006
Ondrej Mach1, Arun Thapa2, Patrick O'Connor2, Jayantha Linayage2,
Serguei Diorditsa3, ASM Mainul Hasan3, Sharif Uzzaman3 and Md. Abdul Jalil Mondal4
+ Author Affiliations
Abstract
Despite recommendations from WHO to conduct measles outbreak response vaccination campaigns based on the age distribution of cases at the beginning of an outbreak, few data exist to specifically examine whether the age distribution of cases remains constant over time in a measles outbreak. This analysis explores this question with use of measles outbreak surveillance data from Bangladesh from the period 2004–2006. Pearson χ2 tests were conducted of age distributions over 2 periods during 41 large laboratory-confirmed measles outbreaks. Statistically significant changes in age distribution over time were observed in 24% of the outbreaks. No single pattern was detected in the shifts in age distribution; however, an increase in the proportion of cases occurring among infants <9 months of age was evident in 6 outbreaks. These findings suggest a need to consider the possibility of a shift in the age distribution over time when planning an outbreak response vaccination campaign.
http://jid.oxfordjournals.org/content/204/suppl_1/S414.abstract
The Heterogeneity of Measles Epidemiology in India: Implications for Improving Control Measures
Vidya Ramachandran, Asit K. Biswas, Prasun K. Das, Surender N. Gupta,
Dipankar Maji, Harish Chandra Singh Martolia, Armugam Mohan and
+ Author Affiliations
Abstract
Background. Measles vaccination coverage varies in India. Trainees of the Field Epidemiology Training Programme (FETP) investigated 8 outbreaks from 2004 through 2006 in Himachal Pradesh, Uttaranchal, Tamil Nadu, and West Bengal. We reviewed these outbreaks to contribute to the description of the epidemiology of measles and propose recommendations for control.
Methods. FETP trainees searched for measles cases through stimulated passive surveillance or door-to-door case search; estimated attack rates, case fatality, and the median age of case patients; interviewed mothers about vaccination status of their children; and collected serum samples for immunoglobulin M serological testing whenever possible. For 3 outbreaks, the trainees estimated the vaccine efficacy for children >12 months of age through cohort studies.
Results. Six of the 8 outbreaks were serologically confirmed. Compared with outbreaks in other states, outbreaks in states with vaccination coverage of >90% had a higher median age among case patients and a lower median attack rate. Six deaths (case fatality rate, 1.5%) occurred during the 5 outbreaks for which vitamin A was not used. The vaccine efficacy was 84% (95% confidence interval [CI], 74%–91%) in Himachal Pradesh. In West Bengal, it was 66% (95% CI, 44%–80%) in 2005 and 81% (95% CI, 67%–89%) in 2006.
Conclusions. In states with higher coverage, attack rates were lower and case patients were older. Although states with coverage of <90% should increase 1-dose coverage and address coverage in pockets that are poorly reached, a second opportunity for measles vaccination could be considered in states such as Himachal Pradesh and Tamil Nadu. Use of vitamin A for case management needs to be generalized.
http://jid.oxfordjournals.org/content/204/suppl_1/S421.abstract
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
Ramachandran Ramakrishnan1, Asit K. Biswas1,2 and Yvan J. Hutin1,4
+ Author Affiliations
Abstract
Background. Measles is often underreported. We evaluated the sensitivity of the measles surveillance in 2 districts of West Bengal in 2005–2006.
Methods. We sampled households with children . aged <5 years in village clusters selected with probability proportional to size. We searched households door to door to identify World Health Organization–defined suspected measles cases that had occurred during 12 months in 2004–2005 in Howrah and in 2006 in Purulia. We interviewed mothers about use of health care services during episodes and calculated the proportion of patients seen in the public sector. We reviewed surveillance records at all levels to estimate the proportion of cases seen in public health care facilities that had been reported to the district. We calculated the overall sensitivity of measles surveillance by multiplying these 2 proportions.
Results. In Howrah, we identified 240 cases of measles. Of these, 8 (3.3% [95% confidence interval {CI}, 1.5%–6.5%]) had been seen in public facilities and recorded. Of 980 cases identified in 448 public facilities in the periphery, 962 (98%) had been transmitted to the district (overall sensitivity of surveillance, 3.2%). In Purulia, we identified 167 measles cases. Of these, 39 (23.4% [95% CI, = 17.2%–30.5%]) had been seen in public facilities and recorded. Of 418 cases identified in public facilities in the periphery, 414 (99%) had been transmitted to the district (overall sensitivity of surveillance, 23.1%).
Conclusions. Measles surveillance captured a minority of measles cases, but cases captured were transmitted well to the district. Surveillance must engage the private sector. Health education focusing on vitamin A treatment for measles might provide an incentive to seek care, which could increase the sensitivity of surveillance.
http://jid.oxfordjournals.org/content/204/suppl_1/S427.abstract
Developing Rubella Vaccination Policy in Nepal—Results From Rubella Surveillance and Seroprevalence and Congenital Rubella Syndrome Studies
Yuddha Dhoj Sapkota3, Abhijeet Anand4, Thomas Taylor4, Ondrej Mach4,
Susan Reef4, Sirima Pattamadilok5, Jayantha Liyanage6, Patrick O'Connor6,
Tika Sedai7, Sagar Ram Bhandary7, Jeffrey Partridge7,a and William Schluter7
+ Author Affiliations
Abstract
Background. The Government of Nepal is interested in preventing congenital rubella syndrome (CRS). Surveillance data were analyzed and studies conducted to assess the burden of rubella and CRS and aid in developing a rubella vaccination strategy.
Methods. (1) Analysis of rubella cases reported through measles surveillance, 2004 - 2009; (2) in 2008, rubella seroprevalence among women 15 to 39 years of age was evaluated; and (3) in 2009, children attending a school for the deaf were examined for ocular defects associated with CRS.
Results. From 2004-2009, there were 3,710 confirmed rubella cases and more than 95% of these cases were less than 15 years of age. Of 2,224 women of childbearing age (WCBA) tested for anti-rubella IgG, 2,020 (90.8%) were seropositive. Using a catalytic infection model, approximately 1,426 infants were born with CRS (192/100,000 live births) in 2008. Among 243 students attending a school for the deaf, 18 (7.4%) met the clinical criteria for CRS.
Conclusions. Rubella and CRS were documented as significant public health problems in Nepal. A comprehensive approach is necessary, including introducing rubella vaccine in the routine program, assuring immunity among WCBA, strengthening routine immunization, integrating rubella surveillance with measles case-based surveillance, and establishing CRS surveillance.
http://jid.oxfordjournals.org/content/204/suppl_1/S433.abstract