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X: MEASLES ELIMINATION IN WESTERN PACIFIC REGION
Progress and Challenges for Measles Elimination by 2012 in the Western Pacific Region
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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
Lei Cao1, Ning Wen1, Wenbo Xu3, Xiaofeng Liang1, Weizhong Yang4 and
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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
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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
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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
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
+ Author Affiliations
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
+ Author Affiliations
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
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
10. 10Korea Centers for Disease Control and Prevention, Chungcheongbuk-do, Republic of Korea
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