Epidemiological analysis of measles and evaluation of measles surveillance system performance in Iraq, 2005-2010

Ghana’s progress towards measles elimination: Surveillance data analysis, Greater Accra Region, 2015 – 2019

Introduction

Although measles is targeted for global elimination by 2020, an estimated 869,770 measles cases and 207,500 deaths occurred in 2019. Ghana adopted the World Health Organization measles elimination strategies, however, evidence of a systematic, comprehensive analysis of data tracking progress towards elimination is sparse. We analyzed measles data to describe its epidemiology, surveillance, and vaccination coverage performances in the Greater Accra Region.

Methods

We reviewed and conducted a descriptive analysis of measles surveillance, laboratory, and vaccination data for 2015 to 2019 obtained from the regional health directorate and National public health reference laboratory. Case patients’ demographic and clinical variables were analyzed into frequencies, proportions, and rates. We used WHO measles elimination performance targets; at least one suspected measles case reported per 100,000 population, 80% of suspected measles cases investigated with adequate blood samples, measles incidence <1/1,000,000 population, 95% routine vaccination coverage and during SIAs as benchmarks.

Results

Of 930 suspected measles cases reported, 605(65.1%) were tested. Males accounted for 356(58.8%); 141(23.3%), 342(56.5%), and 122(20.2%), were children <1, 1–4, and ≥5 years old respectively. Of those tested, 10(1.65%) were measles IgM confirmed, of which 7(70.0%) had received at least one dose of measles vaccine. Annualized measles reporting rate ranged from 1.8 to 6.4 per 100,000 population from 2015 to 2019. District specimen collection rate was 100%, and measles incidence was between 0 – 0.6 per million population in the period 2015–2019. Measles vaccination coverage increased from 73.5% in 2016 to 102% in 2019 with 75% of districts achieving 95% coverage in 2019.

Conclusion

The measles case-based surveillance system and vaccination program in the Greater Accra region showed an increasing level of performance towards Ghana’s elimination status. However, performance in laboratory testing of blood specimens was suboptimal. Authorities of Ghana’s health system should strengthen laboratory capacity for prompt diagnosis of measles.

Pediatric Infectious Diseases Encountered During Wartime-Part 1: Experiences and Lessons Learned From Armed Conflict in the Modern Era

PURPOSE OF REVIEW

Armed conflicts occur globally, with some regions experiencing heightened instability for many years. A better understanding of the infectious disease impact on children in armed conflict will allow aid organizations to anticipate and mitigate the most serious problems.

RECENT FINDINGS

Armed conflicts are estimated to have caused approximately 30 million civilian deaths during the past 27 years, with two-thirds occurring in women and children. Children are extremely vulnerable to the mass population displacements, experiencing a combined loss of safety, nutrition, shelter, hygiene, and health care. Under these circumstances, the emergence and prevalence of multiple infectious diseases can result in heightened morbidity and mortality long after active conflict ceases.

SUMMARY

Factors leading to increased infectious diseases in populations in crisis due to armed conflict and lessons learned from recent outbreaks are discussed in detail. Acute respiratory infections, diphtheria, measles, varicella, and cholera are a few of the more common infectious diseases that take advantage of populations displaced or disrupted by conflict. Key issues include the ability of countries or non-governmental organizations (NGOs) to keep up with basic childhood immunizations, and how rapidly disease outbreaks are recognized and addressed with disease-specific interventions.

Epidemiology of measles cases, vaccine effectiveness, and performance towards measles elimination in The Gambia

Introduction

In 2011, member states of the World Health Organization (WHO) Africa Regional Office (AFRO) resolved to eliminate Measles by 2020. Our study aims to assess The Gambia’s progress towards the set AFRO measles elimination target and highlight surveillance and immunisation gaps to better inform future measles prevention strategies.

Material and methods

A retrospective review of measles surveillance data for the period 2011–2019, was extracted from The Gambia case-based measles surveillance database. WHO—UNICEF national coverage estimates were used for estimating national level MCV coverage. Measles post campaign coverage survey coverage estimates were used to estimate national measles campaign coverage.

Results

One hundred and twenty-five of the 863 reported suspected cases were laboratory confirmed as measles cases. More than half (53.6%) of the confirmed cases have unknown vaccination status, 24% of cases were vaccinated, 52.8% of cases occurred among males, and 72.8% cases were among urban residents. The incidence of measles cases per million population was lowest (0) in 2011–2012 and highest in 2015 and 2016 (31 and 23 respectively). The indicator for surveillance sensitivity was met in all years except in 2016 and 2019. Children aged 5–9 years (Incidence Rate Ratio—IRR = 0.6) and residents of Central River region (IRR = 0.21) had lower measles risk whilst unvaccinated (Adjusted IRR = 5.95) and those with unknown vaccination status (IRR 2.21) had higher measles risk. Vaccine effectiveness was 89.5%.

Conclusion

The Gambia’s quest to attain measles elimination status by 2020 has registered significant success but it is unlikely that all target indicators will be met. Vaccination has been very effective in preventing cases. There is variation in measles risk by health region, and it will be important to take it into account when designing prevention and control strategies. The quality of case investigations should be improved to enhance the quality of surveillance for decision making.

Risk Factors of Measles Outbreak Among Students of Mizan-Tepi University, Tepi Campus, Southwest Ethiopia

Background

Measles is a serious respiratory disease that is spread easily through coughing and sneezing of the measles virus for which humans are the only reservoir. Even though prevention and elimination strategies had been implemented, the outbreaks of measles infection quietly occur in different parts of the world. As of November 2019 a suspected measles outbreak was reported from Tepi campus student’s clinic. We investigated the outbreak to determine its possible sources, control measures and identify associated risk factors among students of Mizan-Tepi University.

Methods

A facility based unmatched case-control study was conducted. An interviewer administered questionnaire was used to collect the data. Data were cleaned and entered to Epi-info7 and analyzed using SPSS-20. A logistic regression analysis was conducted to identify risk factors associated with measles outbreak at a p-value ≤0.05.

Results

A total of 40 measles cases were reported during the investigation. The probable source of the outbreak was an index case who had a travel history to a district with the measles epidemic. Five samples were collected for confirmation of the diagnosis. No measles-related deaths were reported. The major risk factors for measles infection in Mizan-Tepi University were being unvaccinated [AOR = 5.21, 95% CI (1.938, 12.058)], being female [AOR = 4.21, 95% CI (1.426, 11.182)], age group of 18–20 [AOR = 0.123, 95% CI (0.041, 0.37)] and having a contact history [AOR = 0.149, 95% CI (0.041, 0.544)].

Conclusion

The findings of the present investigation indicated that being unvaccinated and having a contact history with confirmed or suspected cases increased the risk of measles infection. Reduction in the level of protective antibodies over time may accelerate transmission of measles in the campus. Strengthening case-based surveillance and supplemental measles vaccination are imperative.

The epidemiology of 32 selected communicable diseases in Iraq, 2004-2016

BACKGROUND

The 2003 invasion of Iraq significantly undermined population health. However, there is a lack of understanding of how it undermined communicable disease control. This study was performed to assess the incidence trends of 32 communicable diseases in post-conflict Iraq.

METHODS

Reported incidence data for 32 communicable diseases (2004-2016) were collected from routine reports sent to the Iraqi Ministry of Health by primary health centers, and general and tertiary hospitals. Incidence (per 100 000) was defined as the number of reported incident cases divided by the population size. Joinpoint regression was used to examine the incidence trends and average annual percentage change (AAPC) for each disease, and the overall incidence rate across the period.

RESULTS

Communicable diseases increased significantly during the peak years of the war, especially during the US troop surge period (2007-2009). As US troops withdrew (after 2011), overall communicable diseases decreased. The incidence rate of nearly half of the 32 diseases decreased significantly, while the incidence rate of five increased significantly (hepatitis A, varicella, viral meningitis, cutaneous leishmaniasis, extrapulmonary tuberculosis).

CONCLUSIONS

The early foundational strength of Iraq's health system may help explain why infectious disease failed to overwhelm the population following the invasion. Iraq's federal government could exercise its legal authority to manage threats to public health security by expanding the disease surveillance system.

Trend of vaccine preventable diseases in Iraq in time of conflict

Introduction

Iraq has passed through a series of successive conflicts, economic sanction and violence. The overall health sector in Iraq has been plunged and the services are facing a continuous shortage in vaccines, medicines and other supplies, and access of people to the basic health services being more impaired. The objective of this study was to portray the trend of vaccine preventable diseases in Iraq during the past 17 years to provide baseline information for disease burden estimation.

Methods

This study was built on collection and treatment of morbidity data related to vaccine preventable diseases (tuberculosis, poliomyelitis, measles, mumps, rubella, diphtheria, tetanus, pertussis, and hepatitis B) that were registered by the Department of Health Statistics during the years (2000-2016). The incidence rates were plotted on a timeline to define the trend of each disease. Data were also categorized by gender and age groups (less than five years, 5 to 15 years and 15 years and more).

Results

Diphtheria, rubella, and tuberculosis showed a slowly down going trend of incidence while mumps demonstrated a peak at 2016. Hepatitis B showed an up going trend of incidence while measles showed a secular trend every 4-5 years.

Conclusion

Vaccine preventable diseases are still causing outbreaks; precipitated by fluctuation of vaccine coverage. Tuberculosis has been reemerged after a relatively long period of control.

Modelling spatio-temporal patterns of disease for spatially misaligned data: An application on measles incidence data in Namibia from 2005-2014

Background

Making inferences about measles distribution patterns at small area level is vital for more focal targeted intervention. However, in statistical literature, the analysis of originally collected data on one resolution with the purpose to make inferences on a different level of spatial resolution is referred to as the misalignment problem. In Namibia the measles data were available in aggregated format at regional level for the period 2005 to 2014. This leads to a spatial misalignment problem if the purpose is to make decisions at constituency level. Moreover, although data on risk covariates of measles could be obtained at constituency level, they were not available each year between 2005 and 2014. Thus, assuming that covariates were constant through the study period would induce measurement errors which might have effects on the analysis results. This paper presents a spatio-temporal model through a multi-step approach in order to deal with misalignment and measurement error.

Methods

For the period 2005–2014, measles data from the Ministry of Health and Social Services (MoHSS) were analysed in two steps. First, a multi-step approach was applied to correct spatial misalignment in the data. Second, a classical measurement error model was fitted to account for measurement errors. The time effects were specified using a nonparametric formulation for the linear trend through first order random walk. An interaction between area and time was modelled through type I and type II interaction structures.

Results

The study showed that there was high variation in measles risk across constituencies and as well as over the study period (2005–2014). Furthermore, the risk of measles was found to be associated with (i) the number of people aged between 0 and 24 years, (ii) the percentages of women aged 15–49 with an educational level more than secondary, (iii) the percentages of children age 12–23 months who received measles vaccine, (iv) the percentages of malnourished children under 5 years, and (vi) the measles cases for each previous year.

Conclusion

The study showed some of the determinants of measles risk and revealed areas at high risk through disease mapping. Additionally, the study showed a non-linear temporal distribution of measles risk over the study period. Finally, it was shown that ignoring the measurement errors may yield misleading results. It was recommended that group and geographically targeted intervention, prevention and control strategies can be tailored on the basis these findings.

Poor quality data challenges conclusion and decision making: timely analysis of measles confirmed and suspected cases line list in Southern Nations Nationalities and People's Region, Ethiopia

BACKGROUND

Measles is one of the leading causes of death among young children even though a safe and cost-effective vaccine is available. Timely analysis of measles surveillance data is crucial for epidemic control and can show disease control program status. Therefore, this study aimed to show vaccination status and delay in seeking health care using surveillance data.

METHODS

A retrospective study was carried out in Southern Nations Nationalities and People's Region (SNNPR), Ethiopia. We reviewed 2132 records from measles surveillance line list data from July 2013 to January 2014. Descriptive statistics were performed using SPSS 20 for Windows.

RESULTS

From a total of 2132 confirmed and suspected measles cases, 1319 (61.9%), had at least one dose of measles containing vaccine; the rest 398 (18.7%) and 415 (19.5%) were unvaccinated and had unknown status respectively. About two fifth, 846 (39.7%), cases visited health facilities within 48 h of onset of clinical signs/symptoms with a median of 2.0 days, IQR (1.0, 3.0).

CONCLUSION

Majority of the measles cases were vaccinated with at least one dose of measles containing vaccine and vaccination data or vaccine potency at lower level was unclear. Delay in seeking healthcare was noted as only about two fifth of cases visited health facilities within 48 h of clinical manifestation. Vaccination and surveillance data quality and factors associated with delay in seeking health care should be investigated.

Re-Emerging Vaccine-Preventable Diseases in War-Affected Peoples of the Eastern Mediterranean Region-An Update

For the past few decades, the Eastern Mediterranean Region has been one area of the world profoundly shaped by war and political instability. On-going conflict and destruction have left the region struggling with innumerable health concerns that have claimed the lives of many. Wars, and the chaos they leave behind, often provide the optimal conditions for the growth and re-emergence of communicable diseases. In this article, we highlight a few of the major re-emerging vaccine preventable diseases in four countries of the Eastern Mediterranean Region that are currently affected by war leading to a migration crisis: Iraq, South Sudan, Syria, and Yemen. We will also describe the impact these infections have had on patients, societies, and national health care services. This article also describes the efforts, both local and international, which have been made to address these crises, as well as future endeavors that can be done to contain and control further devastation left by these diseases.

The epidemiological and serological characteristics of measles in Dongguan, China, 2005-2014

This study examined the epidemiological and serological characteristics of measles in Dongguan, China. From 2005 to 2014, a total of 8,224 measles cases were reported in Dongguan, 33.5% of which were aged <1 y and 30.6% >14 y. From 2005 to 2014, the proportion of the <1 y measles cases increased year by year from 24.3% to 47.9%. Of the cases aged ≥8 months (n = 6,768 cases), only 11.6% had been immunized with at least one dose of measles vaccine. Of the 2,213 cases who had never been immunized with measles vaccine, immigrants accounted for 82.4%. 52.4% of the measles cases were diagnosed with pneumonia, and 12 cases died from respiratory failure. Seroprevalence rate in women and their newborns was 86.0% and 82.5%, respectively. Measurement of serum measles antibody levels for infants aged less than 8 months indicated that seroprevalence rate dramatically declined from 97.3% at birth to 9.3% and 13.2% at 6- and 7- month old. The existence of a sufficient pool of unvaccinated people (especially immigrants) and decreased level of passively transferred measles antibodies in infants from vaccinated mothers contributed to the sustained transmission observed in Dongguan. In addition to high routine vaccination coverage, new strategies and innovations for measles vaccination are needed to eliminate measles.

The epidemiological and clinical characteristics of measles in Wenzhou, China, 2000-2010

This study examined the epidemiological and clinical characteristics of measles in Wenzhou, China. From 2000 to 2010, a total of 13271 measles cases were reported in Wenzhou, with epidemics occurring every 3-4 years. Forty-five per cent of the cases were aged <1 year and 27.2% were aged >14 years. Of 2262 hospitalized measles cases, 66.3% were diagnosed with pneumonia, and three cases died from respiratory failure. The number of measles cases of infants requiring hospitalization increased from birth to age 8 months and declined thereafter. Measurement of serum measles antibody levels in normal infants indicates that over 80% of infants in Wenzhou may be susceptible to measles by age 6 months. The existence of a sufficient pool of unvaccinated children and the decreased level of passively transferred measles antibodies in infants from vaccinated mothers contributed to the sustained transmission observed in Wenzhou.