X: MEASLES ELIMINATION IN WESTERN PACIFIC REGION

Tuesday, 28th of June 2011

 

X: MEASLES ELIMINATION IN WESTERN PACIFIC REGION

 

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

1. 1.   David H. Sniadack, Jorge Mendoza-Aldana, Youngmee Jee, Benjamin Bayutas and

Kayla Mae Lorenzo-Mariano

+ Author Affiliations

1. 1.    Expanded Programme on Immunization Unit, Division of Combating Communicable Diseases, World Health Organization Regional Office of the Western Pacific, Manila, Philippines
2. Correspondence: David H. Sniadack, MD, WHO Regional Office of the Western Pacific, PO Box 2932 (United Nations Avenue), 1000 Manila Philippines (sniadackd@wpro.who.int).

Abstract

Background. The 37 countries and areas of the World Health Organization (WHO) Western Pacific Region have targeted measles for elimination by 2012.

Methods. We reviewed routine and supplementary immunization coverage based on 2010 WHO/United Nation’s Children’s Fund (UNICEF) estimates and Joint Reporting Forms and epidemiologic and laboratory data submitted by the countries and areas.

Results. In 2009, 21 of 37 countries and areas had ≥90% coverage with a first dose of measles vaccine; 32 countries and areas provided 2 routine doses of measles vaccine with 94% weighted average coverage among those reporting. From 1996 to 2009, 235 million persons received measles vaccine during 94 immunization campaigns in 30 countries and areas. As of 2009, 2.8 suspected cases per 100,000 population were discarded as nonmeasles; however, only 43% of second level administrative units reported at least 1 discarded case per 100,000. Adequate specimen collection rate was 71%. Measles incidence was 34 per million population in 2009, a 58% decrease compared with 2008 and the lowest ever reported. As many as 25 countries and areas already may have eliminated measles.

Conclusions.  Achieving the 2012 measles elimination goal is feasible provided political and financial commitments are increased at every level to further improve routine and supplementary immunization activity (SIA) coverage and surveillance in every district.

 

http://jid.oxfordjournals.org/content/204/suppl_1/S439.abstract

 

 

 

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

1. 1.   Chao Ma1,a,  Zhijie An1,2,a,  Lixin Hao1, K. Lisa Cairns2, Yan Zhang3,  Jing Ma1,

Lei Cao1, Ning Wen1, Wenbo Xu3, Xiaofeng Liang1, Weizhong Yang4 and

Huiming Luo1

+ Author Affiliations

1. 1.    ¹National Immunization Program, Chinese Center for Disease Control and Prevention
2. 2.    ²Expanded Program on Immunization, World Health Organization Office in China
3. 3.    ³Institutes for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention
4. 4.    ⁴Chinese Center for Disease Control and Prevention, Beijing, China
5. Correspondence: Huiming Luo, MB, National Immunization Program, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Beijing, China (hmluo@vip.sina.com).

Abstract

In 2006, China set a goal of measles elimination by 2012. To describe progress toward this goal, we reviewed relevant policies and strategies and analyzed national data for 2000–2009. In response to implementation of these strategies, including increased routine measles vaccination coverage and province-specific supplementary immunization activities (SIAs), reported measles incidence decreased to a historically low level of 39.5 cases per million in 2009. A synchronized nationwide SIA was scheduled in 2010 to further decrease susceptibility to measles. However, reaching and maintaining measles elimination will require strong political commitment and efforts for strengthening surveillance, increasing 2-dose vaccine coverage to >95%, stricter enforcement of the requirement to check immunization status at school entry, and careful attention to measles susceptibility in those aged ≥15 years.

http://jid.oxfordjournals.org/content/204/suppl_1/S447.abstract

 

 

 

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

1. 1.   Jiatong Zhuo1, Wenkui Geng2, Edward J. Hoekstra3, Ge Zhong1,  Xiaofeng Liang4 and

Jian Zhang5

+ Author Affiliations

1. 1.    ¹Division of Immunization Service, Guangxi Zhuang Autonomous Region Center for Disease Control and Prevention
2. 2.    ²Department of Research and Education Management, Guangxi Zhuang Autonomous Region Bureau of Public Health, Nanning, Guangxi
3. 3.    ³Health Section, Program Division, Global Measles Program and Health Emergencies, United Nations Children's Fund, New York
4. 4.    ⁴Center of Expanded Program of Immunization, China Centers for Disease Control and Prevention, Beijing, China
5. 5.    ⁵Division of Epidemiology, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro
6. Correspondence: Jian Zhang, MD, DrPH, Jiann-Ping Hsu College of Public Health, Georgia Southern University, PO Box 8015, Statesboro, GA (jianzhang@georgiasouthern.edu).

Abstract

Because of limited resources, each year during the period from 1999 through 2007, only about one-quarter of the 111 counties in Guangxi province were selected by means of risk assessment to participate in Supplementary Immunization Activities (SIAs), targeting children aged 8 months to 14 years during 1999–2003 and 8 months to 10 years during 2004–2007. Approximately 2 million doses of measles vaccines were administrated each year during SIAs. Estimated from the National Notifiable Diseases Surveillance System, with a reliable internal consistency over years, the average annual incidences of measles before SIAs (1993–1998), during the first phase (1999–2003), and during the second phase (2004–2007) were 16.05, 9.10, and 2.46 cases per 100,000, respectively. The overall provincewide annual incidence decreased by 84.67%, from 12.12 cases per 100,000 in 2000 to 2.10 cases per 100,000 in 2007. The percentage of counties with annual incidence ≥10 cases per 100,000 decreased from 55% in 1993 to <1% in 2007. Compared with the pre-SIA period, the greatest decrease in annual incidence was 83.93% for the 10–14.9-year-old group and the smallest decrease was 46.16% for children <1 year old. The multiple-year SIAs targeting children in selected high-risk counties were effective in controlling measles in mountainous, impoverished, and multiethnic measles-endemic areas.

 

http://jid.oxfordjournals.org/content/204/suppl_1/S455.abstract

 

 

 

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

1. 1.   Jiatong Zhuo1, Edward J. Hoekstra2, Ge Zhong1,  Wei Liu1, Zhigang Zheng1 and

Jian Zhang3

+ Author Affiliations

1. 1.    ¹Division of Immunization Service, Guangxi Zhuang Autonomous Region Center for Disease Control and Prevention, Nanning, Guangxi, China
2. 2.    ²Health Section, Programme Division, Global Measles Program and Health Emergencies, United Nations Children's Fund, New York
3. 3.    ³Division of Epidemiology, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro
4. Correspondence: Jian Zhang, MD, DrPH, Jiann-Ping Hsu College of Public Health, Georgia Southern University, PO Box 8015, Statesboro, GA (jianzhang@georgiasouthern.edu).

Abstract

The major challenge for measles elimination is to harness sufficient political will to provide the necessary financial and human resources. This is particularly relevant for local governments (at county and township levels in China) and communities that generally have not accepted measles as a serious health burden and thus have not made its prevention a high priority. An effort has been made to use surveillance data to harness political will and overcome or mitigate the shortage of resources in the impoverished province of Guangxi, one of China's 31 administrative divisions. A comprehensive information system collecting data pertaining to Expanded Program on Immunization (EPI-info) was refined to align with China's political system and translate international and national commitments into sustainable local actions. The EPI-info has proved an effective tool in identifying high-risk areas, strengthening routine immunization services, conducting mass measles immunization campaigns, and catalyzing capacity building at both county and local community levels. We outline the principles and operational features of the EPI-info and the rationale and steps taken to refine it.

 

http://jid.oxfordjournals.org/content/204/suppl_1/S463.abstract

 

 

Measles Outbreak on a College Campus Transmitted Through Internet Cafés

1. 1.   Yan Jin1,2,a,  Huilai Ma1,a, Lijie Zhang1, Hua He2,  Mahemuti Yisimaer2,

Min Chen2, Baoling Rui2, Bateer Axigeburen2, Jinggong Hao2,  Meiying Sun2,

Feng Gao2, Wei Chen2, Abudureyimu Abudukelimu2, Jinglin Chen2, Qiong Li3,

Mei Shen3, Yanping Shi3, Zurexi Hezati3, Tiejun Li3, Haiying Chen3, Juan Chen3 and

Bao-Ping Zhu1

+ Author Affiliations

1. 1.    ¹Chinese Field Epidemiology Training Program, Chinese Center for Disease Control and Prevention, Beijing
2. 2.    ²Urumqi Center for Disease Control and Prevention
3. 3.    ³Tianshan Center for Disease Control and Prevention, Urumqi, Xinjiang, China
4. Correspondence: Lijie Zhang, PhD, 27 Nanwei Rd, Chinese Center for Disease Control and Prevention, Beijing 100050, China (zhang_li_jie@hotmail.com).

Abstract

Background. During March 2008, a college in  Urumqi, capital of Xinjiang Uygur Autonomous Region in China, reported a measles outbreak, amid a city-wide outbreak involving >2700 cases.

Methods. Suspected case patients were  defined as patients with onset of fever (≥38°) and rash between 7 March and 30 April 2008. Probable case patients were defined as suspected case patients with >3 days of rash or known exposure to someone with laboratory-confirmed measles. Confirmed case patients were defined as suspected or probable case patients with Koplik spots or positive titer for immunoglobulin M antibody. We conducted a case-control investigation to identify risk factors for transmission.

Results. We identified 162 suspected (attack rate, 1.9%), 99 probable, and 62 confirmed case patients. The epidemic curve indicated a point source initially, followed by person-to-person transmission. Approximately 63% of 90 probable case patients and 27% of 150 asymptomatic student controls randomly selected among classmates of student case patients visited internet cafés during the exposure period (odds ratio [OR], 4.5; 95% confidence interval [CI], 2.6–8.0); 66% of case patients and 45% of student controls reported close contact with a measles case patient (OR, 2.3; 95% CI, 1.3–3.9). In stratified analysis, visiting internet cafés (OR, 4.0; 95% CI, 1.5–11) remained significantly associated with disease, but contact with case patients (OR, 1.9; 95% CI, .79–4.4) became nonsignificant.

Conclusions. This measles outbreak was transmitted in internet cafés, followed by secondary transmission. Chinese universities should require proof of immunity or 2 doses of measles vaccine at college entry.

 

http://jid.oxfordjournals.org/content/204/suppl_1/S471.abstract

 

 

Epidemiology of a Measles Epidemic in Vietnam 2008–2010

1. 1.   David H. Sniadack1,  Jorge Mendoza-Aldana1,  Dang Thi Thanh Huyen2, Trieu Thi Thanh Van3, Nguyen Van Cuong2,  Jean Marc Olive4, Kohei Toda4 and Nguyen Tran Hien2

+ Author Affiliations

1. 1.    ¹Expanded Programme on Immunization Unit, Division of Combating Communicable Diseases, Regional Office of the Western Pacific, World Health Organization, Manila, Philippines
2. 2.    ²National Expanded Programme on Immunization
3. 3.    ³National Measles Laboratory, National Institute of Hygiene and Epidemiology, Vietnam Ministry of Health
4. 4.    ⁴World Health Organization Country Office for Vietnam, Hanoi
5. Correspondence: David H. Sniadack, MD, MPH, WHO Regional Office of the Western Pacific, PO Box 2932 (United Nations Ave), 1000 Manila, Philippines (sniadackd@wpro.who.int).

Abstract

Background. Vietnam conducted a measles catch-up supplementary immunization activity (SIA) during 2002–2003 that targeted children 9 months–10 years of age, followed by subnational SIAs targeting persons up to 20 years of age during 2004 and 2007–2008. A measles epidemic began among young adults in October 2008 in the northern region, spread nationwide during early 2009, and continued during 2010.

Methods. We reviewed national epidemiologic  and laboratory surveillance data. Measles cases were defined and classified according to World Health Organization recommendations.

Results. From October 2008 through January  2010, 7948 confirmed measles cases were reported from 60 of 63 provinces, an incidence of 93 cases per million population. Incidence was 328 cases per million population among children age 1–4 years, 318 cases per million population among infants, and 271 cases per million population among persons aged 20–24 years. Few cases were reported among persons 7–17 or >27 years of age. Median age of cases trended downward over time in all regions.

Conclusions. The 2002–2003 measles SIA protected its targeted age group, but this epidemic was not prevented by follow-up subnational SIAs in selected provinces during 2007–2008. Transmission began among young adults and was sustained among children. The outcome of Vietnam's 2010 SIA targeting children only and change in routine schedule may influence elimination strategies for other countries.

 

http://jid.oxfordjournals.org/content/204/suppl_1/S476.abstract

 

 

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

1. 1.   Won Suk Choi1, David H. Sniadack2,  Youngmee Jee2, Un-Yeong Go3,Jae Sung So4,

Heeyeon Cho5, Geun-Ryang Bae5, Dong Han Lee6, Kisoon Kim7, Hee Sook Yoon7,

Yoon Seok Chung8, Chun Kang8, Hyekyung Park9, Ok Park10 and Jong Koo Lee10

+ Author Affiliations

1. 1.    ¹Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
2. 2.    ²Expanded Programme on Immunization, World Health Organization Western Pacific Regional Office, Manila, The Philippines
3. 3.    ³Global Influenza Program, World Health Organization, Geneva, Switzerland
4. 4.    ⁴Jungnangu Public Health Center, Seoul, Republic of Korea; Divisions of
5. 5.    ⁵Vaccine Preventable Disease Control and National Immunization Program
6. 6.    ⁶Public Health Crisis Response
7. 7.    ⁷Respiratory Viruses
8. 8.    ⁸Influenza Viruses
9. 9.    ⁹Biobank for Health Sciences

10.  ¹⁰Korea Centers for Disease Control and Prevention, Chungcheongbuk-do, Republic of Korea

1. Correspondence: Jong Koo Lee, MD, PhD, Korea Centers for Disease Control and Prevention, Osong Health Technology Administration Complex, 187 Osongsaengmyeong2(i)-ro, Gangoe-myon, Cheongwon-gun, Chungcheongbuk-do, 363-951, Republic of Korea (docmohw@mohw.go.kr).

Abstract

Background. From 2002 through 2006, Republic of Korea conducted extensive measles elimination activities and declared elimination in 2006. An outbreak of measles involving 180 confirmed cases occurred during 2007.

Methods. An outbreak investigation was performed and enhanced surveillance was implemented. Detailed case investigations and laboratory testing included serologic and molecular diagnostic methods. Cases were classified according to World Health Organization and national guidelines.

Results.During 2007, 451 suspected cases were reported and 180 (40%) cases were confirmed as measles during epidemiologic weeks 14–42. Incidence during the outbreak was 3.7 cases per million persons, excluding imported cases. Most confirmed cases were reported from Seoul; 137 (76%) cases were among children <24 months old, 124 (69%) case patients had no history of measles vaccination, and 81 (45%) case patients resulted from nosocomial transmission in 6 hospitals. Community members, patients, and health care workers all contributed to measles virus transmission. Limited outbreak control measures were implemented; high population immunity likely accounted for the self-limited transmission during this outbreak.

Conclusions. Limited outbreaks of measles,  in which nosocomial transmission can play an important role, may occur after countries have declared elimination. Timely and opportunistic vaccination may help prevent such outbreaks; high-quality surveillance is critical for their detection.

 

http://jid.oxfordjournals.org/content/204/suppl_1/S483.abstract