1
|
Melis T, Mose A, Fikadu Y, Haile K, Habte A, Jofiro G. Predictors for low coverage of uptake of second dose of measles vaccine among children in sub-Saharan Africa, 2023: a systematic review and meta-analysis. J Pharm Policy Pract 2023; 17:2285507. [PMID: 38205190 PMCID: PMC10775641 DOI: 10.1080/20523211.2023.2285507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024] Open
Abstract
Background Measles became a public health important disease in sub-Saharan Africa. World Health Organization recommended measles-containing vaccine dose 2 (MCV2) through routine service delivery. This study aims to determine coverage of second-dose measles vaccination uptake and its predictors among children aged 24-35 months in sub-Saharan Africa. Methods and materials We conducted an extensive search of literature as indicated in the guideline of reporting systematic review and meta-analysis (PRISMA). The databases used were PubMed, Google Scholar, and HINARI literature. Results The overall uptake of the second dose of measles vaccine uptake was 41% (95% CI: 28.90-53.47). Caregiver's awareness of the importance of the second dose of measles (2.51, 95% CI 1.77, 3.25), educational status of mothers (1.30, 95% CI 1.16, 1.45), distance from vaccination site (1.22, 95% CI 1.12, 1.32), and attending four and above ANC visit (2.72, 95% CI 2.29, 3.15) were determinants for second dose measles vaccine uptake. Conclusion Coverage of the second dose of measles uptake in Sub-Saharan Africa was low (41%) which is lower than the recommendation from WHO. Therefore policymakers and stakeholders should increase mother's awareness. Also, special strategies should be developed for those who are far from the vaccination site. Abbreviation and acronyms ANC: Ante Natal Care; JBI: Joanna Briggs Institute; MCV1: Measles containing vaccine dose 1; MCV2: Measles containing vaccine dose 2; WHO: World Health Organization.
Collapse
Affiliation(s)
- Tamirat Melis
- Department of Public Health, College of Medicine and Health Science, Wolkite University, Wolkite, Ethiopia
| | - Ayenew Mose
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Australia
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Australia
- Department of Midwifery, College of Medicine and Health Science, Wolkite University, Wolkite, Ethiopia
| | - Yohannes Fikadu
- Department of Midwifery, College of Medicine and Health Science, Wolkite University, Wolkite, Ethiopia
| | - Kassahun Haile
- Department of medical laboratory, College of Medicine and Health Science, Wolkite University, Wolkite, Ethiopia
| | - Aklilu Habte
- Department of Public Health, College of Medicine and Health Science, Wachamo University, Hosanna, Ethiopia
| | - Gemechu Jofiro
- Department of Nurse, College of Medicine and Health Science, Arsi University, Asela, Ethiopia
| |
Collapse
|
2
|
Chilot D, Belay DG, Shitu K, Gela YY, Getnet M, Mulat B, Muluneh AG, Merid MW, Bitew DA, Alem AZ. Measles second dose vaccine utilization and associated factors among children aged 24–35 months in Sub-Saharan Africa, a multi-level analysis from recent DHS surveys. BMC Public Health 2022; 22:2070. [PMID: 36371164 PMCID: PMC9655865 DOI: 10.1186/s12889-022-14478-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 10/27/2022] [Indexed: 11/13/2022] Open
Abstract
Background Although a safe and effective vaccine is available, measles remains an important cause of mortality and morbidity among young children in Sub-Saharan Africa (SSA). The WHO and UNICEF recommended measles-containing vaccine dose 2 (MCV2) in addition to measles-containing vaccine dose 1 (MCV1) through routine services strategies. Many factors could contribute to the routine dose of MCV2 coverage remaining far below targets in many countries of this region. This study aimed to assess the prevalence of MCV2 utilization among children aged 24–35 months and analyze factors associated with it by using recent nationally representative surveys of SSA countries. Methods Secondary data analysis was done based on recent Demographic and Health Surveys (DHS) data from eight Sub-Saharan African countries. In this region, only eight countries have a record of routine doses of measles-containing vaccine dose 2 in their DHS dataset. The multilevel binary logistic regression model was fitted to identify significantly associated factors. Variables were extracted from each of the eight country’s KR files. Adjusted Odds Ratios (AOR) with a 95% Confidence Interval (CI) and p-value ≤ 0.05 in the multivariable model were used to declare significant factors associated with measles-containing vaccine dose 2 utilization. Result The pooled prevalence of MCV2 utilization in SSA was 44.77% (95% CI: 27.10–62.43%). In the multilevel analysis, mothers aged 25–34 years [AOR = 1.15,95% CI (1.05–1.26), mothers aged 35 years and above [AOR = 1.26, 95% CI (1.14–1.41)], maternal secondary education and above [AOR = 1.27, 95% CI (1.13–1.43)], not big problem to access health facilities [AOR = 1.21, 95% CI (1.12–1.31)], four and above ANC visit [AOR = 2.75, 95% CI (2.35–3.24)], PNC visit [AOR = 1.13, 95% CI (1.04–1.23)], health facility delivery [AOR = 2.24, 95% CI (2.04–2.46)], were positively associated with MCV2 utilization. In contrast, multiple twin [AOR = 0.70, 95% CI (0.53–0.95)], rural residence [AOR = 0.69, 95% CI (0.57–0.82)] and high community poverty [AOR = 0.66, 95% CI (0.54–0.80)] were found to be negatively associated with MCV2 utilization. Conclusions and recommendations Measles-containing vaccine doses 2 utilization in Sub-Saharan Africa was relatively low. Individual-level factors and community-level factors were significantly associated with low measles-containing vaccine dose 2 utilization. The MCV2 utilization could be improved through public health intervention by targeting rural residents, children of uneducated mothers, economically poor women, and other significant factors this study revealed.
Collapse
|
3
|
Sanyaolu A, Okorie C, Marinkovic A, Ayodele O, Abbasi AF, Prakash S, Gosse J, Younis S, Mangat J, Chan H. Measles Outbreak in Unvaccinated and Partially Vaccinated Children and Adults in the United States and Canada (2018-2019): A Narrative Review of Cases. INQUIRY: The Journal of Health Care Organization, Provision, and Financing 2020; 56:46958019894098. [PMID: 31823676 PMCID: PMC6906342 DOI: 10.1177/0046958019894098] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Since 2018 and currently in 2019, the United States and Canada experienced a
rapidly spreading measles virus outbreak. The developing outbreak may be due to
a lack of vaccination, an inadequate dosage of measles (MMR) vaccine, clusters
of intentionally under-vaccinated children, imported measles from global travel,
and from those who are immunocompromised or have other life-threatening
diseases. The infection originated mainly from travelers who acquired measles
abroad and has thus led to a major outbreak and health concern not only in the
United States and Canada but also in other parts of the world. According to
World Health Organization, from January 2019 through September 2019, 1234 cases
of measles have been reported in the United States and 91 reported cases in
Canada, while in 2018, 372 and 28 cases were reported in the United States and
Canada, respectively. A potential driving factor to the increased cases maybe
because fewer children have been vaccinated over the last number of years in
both countries. This article is a narrative review of cases discussing the
measles outbreak among partially vaccinated and unvaccinated children and adults
in the United States and Canada in 2018 and 2019.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Jessica Gosse
- All Saints University, Kingstown, Saint Vincent, and the Grenadines
| | - Sadaf Younis
- All Saints University, Kingstown, Saint Vincent, and the Grenadines
| | - Jasmine Mangat
- All Saints University, Kingstown, Saint Vincent, and the Grenadines
| | - Henry Chan
- Medical University of the Americas, Charlestown, Saint Kitts, and Nevis
| |
Collapse
|
4
|
Mekki M, Eley B, Hardie D, Wilmshurst JM. Subacute sclerosing panencephalitis: clinical phenotype, epidemiology, and preventive interventions. Dev Med Child Neurol 2019; 61:1139-1144. [PMID: 30680706 DOI: 10.1111/dmcn.14166] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/07/2018] [Indexed: 11/28/2022]
Abstract
Subacute sclerosing panencephalitis (SSPE) is a preventable condition reported in 6.5 to 11 per 100 000 cases of measles, and highest in children who contracted measles infection when they were less than 5 years of age. Children residing in areas with poor vaccination coverage and high prevalence of human immunodeficiency virus are at increased risk of developing SSPE. SSPE is life-threatening in most affected children. This report documents current data relating to the clinical phenotype, epidemiology, and understanding of SSPE, inclusive of preventive interventions. While improvements in disease progression with immunomodulation may occur, overall there is no cure. Most therapies focus on supportive needs. Seizures and abnormal movements may respond to carbamazepine. Many countries advocate policies to enhance vaccination coverage. Effective preventive health care programmes, assurance of parental perceptions, and crisis support for unprecedented events obstructing effective primary health care are needed. Until measles is eradicated worldwide, children in all regions remain at risk. WHAT THIS PAPER ADDS: Measles contracted under 5 years of age has highest risk of developing subacute sclerosing panencephalitis (SSPE). Children with, or exposed to, human immunodeficiency virus infection, who contract measles may be at increased risk of SSPE.
Collapse
Affiliation(s)
- Mohammed Mekki
- Paediatric Neurology Division, Department of Paediatrics and Child Health, Neuroscience Institute, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Brian Eley
- Paediatric Infectious Diseases Unit, Department of Paediatrics and Child Health, Faculty of Health Sciences, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Diana Hardie
- Division of Medical Virology, Department of Clinical Laboratory Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,National Health Laboratory Service, Cape Town, South Africa
| | - Jo M Wilmshurst
- Paediatric Neurology Division, Department of Paediatrics and Child Health, Neuroscience Institute, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| |
Collapse
|
5
|
True Measles Cases Undetected by Reverse Transcription-PCR (RT-PCR): Effect of Genetic Variability on Assay Sensitivity Needs To Be Regularly Surveyed. J Clin Microbiol 2019; 57:JCM.00341-19. [PMID: 31167845 DOI: 10.1128/jcm.00341-19] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
6
|
Choisy M, Trinh ST, Nguyen TND, Nguyen TH, Mai QL, Pham QT, Tran ND, Dang DA, Horby PW, Boni MF, Bryant J, Lewycka SO, Nadjm B, Van Doorn HR, Wertheim HFL. Sero-Prevalence Surveillance to Predict Vaccine-Preventable Disease Outbreaks; A Lesson from the 2014 Measles Epidemic in Northern Vietnam. Open Forum Infect Dis 2019; 6:ofz030. [PMID: 30863786 PMCID: PMC6405937 DOI: 10.1093/ofid/ofz030] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 01/08/2019] [Accepted: 01/17/2019] [Indexed: 11/30/2022] Open
Abstract
Background During the first half of 2014, a severe outbreak of measles occurred in northern Vietnam, causing 15 033 confirmed cases and 146 deaths. Methods To evaluate the population-level seroprevalence of protection against measles in the period before the outbreak, we made use of an existing age-stratified serum bank, collected over the year before the outbreak, between November 2012 and December 2013, from 4 sites across the country (Hanoi, Hue, Dak Lak, and Ho Chi Minh City). Data from the UNICEF’s Multiple Indicator Clustered Surveys (MICS), carried out in Vietnam during the first quarter of 2014, were used to assess the vaccine coverage in 6 ecological regions of Vietnam. Results Results revealed a large discrepancy between levels of protection, as estimated from the serology and vaccine coverage estimated by UNICEF’s MICS. Variation in seroprevalence across locations and age groups corresponded with reported numbers of measles cases, most of which were among the 0–2-year-old age group and in the northern part of the country. Conclusions Our study presents a strong case in favor of a serosurveillance sentinel network that could be used to proactively tune vaccination policies and other public health interventions.
Collapse
Affiliation(s)
- Marc Choisy
- Oxford University Clinical Research Unit, Wellcome Trust Asia Programme, Hanoi, Vietnam.,MIVEGEC (UMR CNRS, IRD & University of Montpellier), Montpellier, France
| | - Son Tung Trinh
- Oxford University Clinical Research Unit, Wellcome Trust Asia Programme, Hanoi, Vietnam
| | - Thi Ngoc Diep Nguyen
- Oxford University Clinical Research Unit, Wellcome Trust Asia Programme, Hanoi, Vietnam
| | | | - Quynh Le Mai
- National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Quang Thai Pham
- National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Nhu Duong Tran
- National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Duc Anh Dang
- National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Peter W Horby
- Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Maciej F Boni
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Vietnam.,Center for Infectious Disease Dynamics, Department of Biology, Pennsylvania State University, State College, Pennsylvania
| | - Juliet Bryant
- Oxford University Clinical Research Unit, Wellcome Trust Asia Programme, Hanoi, Vietnam
| | - Sonia O Lewycka
- Oxford University Clinical Research Unit, Wellcome Trust Asia Programme, Hanoi, Vietnam
| | - Behzad Nadjm
- Oxford University Clinical Research Unit, Wellcome Trust Asia Programme, Hanoi, Vietnam
| | - H Rogier Van Doorn
- Oxford University Clinical Research Unit, Wellcome Trust Asia Programme, Hanoi, Vietnam
| | - Heiman F L Wertheim
- Oxford University Clinical Research Unit, Wellcome Trust Asia Programme, Hanoi, Vietnam.,Department of Medical Microbiology and Radboudumc Center for Infectious Diseases, Radboudumc, Nijmegen, the Netherlands
| |
Collapse
|
7
|
Takahashi S, Metcalf CJE, Ferrari MJ, Tatem AJ, Lessler J. The geography of measles vaccination in the African Great Lakes region. Nat Commun 2017; 8:15585. [PMID: 28541287 PMCID: PMC5458501 DOI: 10.1038/ncomms15585] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 04/07/2017] [Indexed: 11/09/2022] Open
Abstract
Expanded access to measles vaccination was among the most successful public health interventions of recent decades. All WHO regions currently target measles elimination by 2020, yet continued measles circulation makes that goal seem elusive. Using Demographic and Health Surveys with generalized additive models, we quantify spatial patterns of measles vaccination in ten contiguous countries in the African Great Lakes region between 2009-2014. Seven countries have 'coldspots' where vaccine coverage is below the WHO target of 80%. Over 14 million children under 5 years of age live in coldspots across the region, and a total of 8-12 million children are unvaccinated. Spatial patterns of vaccination do not map directly onto sub-national administrative units and transnational coldspots exist. Clustering of low vaccination areas may allow for pockets of susceptibility that sustain circulation despite high overall coverage. Targeting at-risk areas and transnational coordination are likely required to eliminate measles in the region.
Collapse
Affiliation(s)
- Saki Takahashi
- Department of Ecology and Evolutionary Biology, Princeton University, Princeton, New Jersey 08544, USA
| | - C. Jessica E. Metcalf
- Department of Ecology and Evolutionary Biology, Princeton University, Princeton, New Jersey 08544, USA
- Woodrow Wilson School of Public and International Affairs, Princeton University, Princeton, New Jersey 08544, USA
| | - Matthew J. Ferrari
- Center for Infectious Disease Dynamics, The Pennsylvania State University, State College, Pennsylvania 16802, USA
| | - Andrew J. Tatem
- WorldPop, Department of Geography and Environment, University of Southampton, Southampton SO17 1BJ, UK
- Flowminder Foundation, Stockholm SE-11355, Sweden
| | - Justin Lessler
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205, USA
| |
Collapse
|
8
|
Sood A, Mitra M, Joshi HA, Nayak US, Siddaiah P, Babu TR, Mahapatro S, Sanmukhani J, Gupta G, Mittal R, Glueck R. Immunogenicity and safety of a novel MMR vaccine (live, freeze-dried) containing the Edmonston-Zagreb measles strain, the Hoshino mumps strain, and the RA 27/3 rubella strain: Results of a randomized, comparative, active controlled phase III clinical trial. Hum Vaccin Immunother 2017; 13:1523-1530. [PMID: 28362563 PMCID: PMC5512778 DOI: 10.1080/21645515.2017.1302629] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
This phase III clinical trial was conducted to evaluate the immunogenicity and safety of the single-dose and multi-dose formulations of a novel MMR vaccine (live, freeze-dried) developed by M/s Cadila Healthcare Limited, India (Cadila MMR vaccine), containing the Hoshino mumps strain, compared to that of an existing MMR vaccine (live, freeze-dried) developed by M/s Serum Institute of India Limited, India (Serum MMR vaccine). These two vaccines have similar measles and rubella strains, but different mumps strains (Hoshino in Cadila MMR vaccine, and L-Zagreb in Serum MMR vaccine). Three hundred and twenty-eight subjects of either sex, aged 15–18 months, were randomized in a 2:1 ratio to receive either the Cadila or Serum MMR vaccine. Immunogenicity assessments (IgG antibodies against measles, mumps, and rubella viruses) were done at baseline and 42 d after vaccination. Solicited (local and systemic) and unsolicited adverse events were recorded for up to 42 d following vaccination. The Cadila MMR vaccine was found to be non-inferior to the Serum MMR vaccine in terms of end-of-study proportion of subjects seropositive for anti-measles antibodies (100.0% in both groups), anti-mumps antibodies (94.5% vs. 94.0%), and anti-rubella antibodies (95.5% vs. 91.0%). Both vaccines were well tolerated by all study participants; the most common adverse event reported in both groups was fever, followed by rash. The results of this phase III clinical trial show that the novel Cadila MMR vaccine is non-inferior to the Serum MMR vaccine.
Collapse
Affiliation(s)
- Ashwani Sood
- a Department of Paediatrics , Indira Gandhi Medical College Shimla , Himachal Pradesh , India
| | - Monjori Mitra
- b Institute of Child Health , Kolkata , West Bengal , India
| | - Himanshu Arvind Joshi
- c Department of Paediatrics , GMERS Medical College and General Hospital, Sola , Ahmedabad , Gujarat , India
| | - Uma Siddhartha Nayak
- d Department of Pediatrics , GMERS Medical College & General Hospital, Gotri , Vadodara , Gujarat , India
| | - Prashanth Siddaiah
- e Department of Pediatrics , Mysore Medical College and Research Institute and Associated Hospitals , Mysore , Karnataka , India
| | - T Ramesh Babu
- f Department of Pediatrics , Gandhi General Hospital, Musheerabad , Secunderabad , Telangana , India
| | - Samarendra Mahapatro
- g Department of Pediatrics , Hi-Tech Medical College & Hospital, Health Park , Pandara , Bhubaneswar , India
| | - Jayesh Sanmukhani
- h Department of Clinical Research and Regulatory Affairs , Cadila Healthcare Limited , India
| | - Gaurav Gupta
- i Department of Virology and Biotechnology , Vaccine Technology Centre, Cadila Healthcare Limited , India
| | - Ravindra Mittal
- j Department of Clinical Research and Regulatory Affairs , Cadila Healthcare Limited , India
| | - Reinhard Glueck
- k Vaccine Technology Centre , Cadila Healthcare Limited , India
| |
Collapse
|
9
|
Adhikari BB, Goodson JL, Chu SY, Rota PA, Meltzer MI. Assessing the Potential Cost-Effectiveness of Microneedle Patches in Childhood Measles Vaccination Programs: The Case for Further Research and Development. Drugs R D 2016; 16:327-338. [PMID: 27696306 PMCID: PMC5114202 DOI: 10.1007/s40268-016-0144-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE Currently available measles vaccines are administered by subcutaneous injections and require reconstitution with a diluent and a cold chain, which is resource intensive and challenging to maintain. To overcome these challenges and potentially increase vaccination coverage, microneedle patches are being developed to deliver the measles vaccine. This study compares the cost-effectiveness of using microneedle patches with traditional vaccine delivery by syringe-and-needle (subcutaneous vaccination) in children's measles vaccination programs. METHODS We built a simple spreadsheet model to compute the vaccination costs for using microneedle patch and syringe-and-needle technologies. We assumed that microneedle vaccines will be, compared with current vaccines, more heat stable and require less expensive cool chains when used in the field. We used historical data on the incidence of measles among communities with low measles vaccination rates. RESULTS The cost of microneedle vaccination was estimated at US$0.95 (range US$0.71-US$1.18) for the first dose, compared with US$1.65 (range US$1.24-US$2.06) for the first dose delivered by subcutaneous vaccination. At 95 % vaccination coverage, microneedle patch vaccination was estimated to cost US$1.66 per measles case averted (range US$1.24-US$2.07) compared with an estimated cost of US$2.64 per case averted (range US$1.98-US$3.30) using subcutaneous vaccination. CONCLUSIONS Use of microneedle patches may reduce costs; however, the cost-effectiveness of patches would depend on the vaccine recipients' acceptability and vaccine effectiveness of the patches relative to the existing conventional vaccine-delivery method. This study emphasizes the need to continue research and development of this vaccine-delivery method that could boost measles elimination efforts through improved access to vaccines and increased vaccination coverage.
Collapse
Affiliation(s)
- Bishwa B Adhikari
- Division of Preparedness and Emerging Infections, Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases, 1600 Clifton Road NE, MS-C18, Atlanta, GA, 30333, USA.
| | - James L Goodson
- Global Immunization Division, Centers for Disease Control and Prevention, Center for Global Health, Atlanta, GA, USA
| | - Susan Y Chu
- Global Immunization Division, Centers for Disease Control and Prevention, Center for Global Health, Atlanta, GA, USA
| | - Paul A Rota
- Division of Viral Diseases, Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Atlanta, GA, USA
| | - Martin I Meltzer
- Division of Preparedness and Emerging Infections, Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases, 1600 Clifton Road NE, MS-C18, Atlanta, GA, 30333, USA
| |
Collapse
|
10
|
On-time Measles and Pneumococcal Vaccination of Shanghai Children: The Impact of Individual-level and Neighborhood-level Factors. Pediatr Infect Dis J 2016; 35:e311-7. [PMID: 27294307 DOI: 10.1097/inf.0000000000001267] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Measles-containing vaccines (MCVs) and pneumococcal conjugate vaccines (PCVs) can prevent a large proportion of infant deaths and are recommended by international organizations for inclusion in pediatric immunization schedules. In China, MCV but not PCV is publically funded and access to vaccination may be limited among nonlocals, who are rural migrants to cities. In this study, we estimate the proportion of Shanghai children with on-time MCV and PCV administration, compare vaccination in nonlocals versus locals and assess the impact of township-level characteristics on vaccination outcomes. METHODS Data from children in the Shanghai Immunization Program Information System were linked to township-level data from the 2010 China Census. We used generalized estimating equations with logistic regression models to assess the impact of residency and township-level predictors on on-time MCV and PCV administration. RESULTS Nonlocals had lower vaccination levels than locals. Compared with locals, nonlocals had 0.50 times the odds of MCV dose 1 by 9 months [95% confidence interval (CI): 0.47, 0.53], 0.42 times the odds of MCV dose 2 by 24 months (95% CI: 0.39, 0.45), 0.37 times the odds of PCV by 9 months of age (95% CI: 0.33, 0.42) and 0.41 times the odds of PCV by 24 months of age (95% CI: 0.37, 0.45). Overall, children had less on-time MCV and PCV administration in nonlocal-majority than local-majority townships. CONCLUSIONS Late vaccination negatively impacts disease control efforts in Shanghai. Nonlocals, particularly those living in nonlocal-majority townships, should especially be targeted for vaccination in order to improve disease control efforts in Shanghai.
Collapse
|
11
|
Driessen J, Olson ZD, Jamison DT, Verguet S. Comparing the health and social protection effects of measles vaccination strategies in Ethiopia: An extended cost-effectiveness analysis. Soc Sci Med 2015; 139:115-22. [DOI: 10.1016/j.socscimed.2015.06.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
12
|
Transport networks and inequities in vaccination: remoteness shapes measles vaccine coverage and prospects for elimination across Africa. Epidemiol Infect 2014; 143:1457-66. [PMID: 25119237 PMCID: PMC4411642 DOI: 10.1017/s0950268814001988] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Measles vaccination is estimated to have averted 13·8 million deaths between 2000 and 2012. Persisting heterogeneity in coverage is a major contributor to continued measles mortality, and a barrier to measles elimination and introduction of rubella-containing vaccine. Our objective is to identify determinants of inequities in coverage, and how vaccine delivery must change to achieve elimination goals, which is a focus of the WHO Decade of Vaccines. We combined estimates of travel time to the nearest urban centre (⩾50 000 people) with vaccination data from Demographic Health Surveys to assess how remoteness affects coverage in 26 African countries. Building on a statistical mapping of coverage against age and geographical isolation, we quantified how modifying the rate and age range of vaccine delivery affects national coverage. Our scenario analysis considers increasing the rate of delivery of routine vaccination, increasing the target age range of routine vaccination, and enhanced delivery to remote areas. Geographical isolation plays a key role in defining vaccine inequity, with greater inequity in countries with lower measles vaccine coverage. Eliminating geographical inequities alone will not achieve thresholds for herd immunity, indicating that changes in delivery rate or age range of routine vaccination will be required. Measles vaccine coverage remains far below targets for herd immunity in many countries on the African continent and is likely to be inadequate for achieving rubella elimination. The impact of strategies such as increasing the upper age range eligible for routine vaccination should be considered.
Collapse
|
13
|
Whittaker MA, Dean AJ, Chancellor A. Advocating for malaria elimination - learning from the successes of other infectious disease elimination programmes. Malar J 2014; 13:221. [PMID: 24902848 PMCID: PMC4057589 DOI: 10.1186/1475-2875-13-221] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 06/01/2014] [Indexed: 11/10/2022] Open
Abstract
Malaria elimination is back on the agenda, but it remains challenging for countries to make the transition from effective control to elimination. Many other infectious diseases have been targeted by globally-coordinated elimination advocacy campaigns, and advocacy has been considered an essential component of the success of other disease elimination programmes. What can the malaria community learn from these successes? A review of infectious disease elimination programmes to identify successful elements of advocacy for disease elimination was undertaken. Key elements are: (i) a global elimination plan, supported by international health bodies; (ii) thorough costings and tools to support the business case; (iii) an approach that is positioned within a development framework; (iv) core elimination advocacy messages; (v) provision of advocacy tools for partners (vi) extensive and effective community engagement; and (vii) strong partnerships. These features provide insights into 'what works' in global elimination advocacy. Advocacy is a powerful tool to support the long-term political and financial commitment necessary for malaria elimination. The global malaria community needs to work together, to ensure that the early steps towards the end goal of malaria elimination are taken.
Collapse
Affiliation(s)
- Maxine A Whittaker
- School of Population Health, The University of Queensland, Herston, Australia
| | - Angela J Dean
- School of Population Health, The University of Queensland, Herston, Australia
| | - Arna Chancellor
- School of Population Health, The University of Queensland, Herston, Australia
| |
Collapse
|
14
|
|
15
|
Omonijo AG, Matzarakis A, Oguntoke O, Adeofun CO. Effect of thermal environment on the temporal, spatial and seasonal occurrence of measles in Ondo state, Nigeria. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2012; 56:873-885. [PMID: 21928098 DOI: 10.1007/s00484-011-0492-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2011] [Revised: 08/23/2011] [Accepted: 08/24/2011] [Indexed: 05/31/2023]
Abstract
We investigated the temporal and spatial dynamics, as well as the seasonal occurrence of measles in Ondo state, Nigeria, to better understand the role of the thermal environment in the occurrence of the childhood killer disease measles, which ranks among the top ten leading causes of child deaths worldwide. The linkages between measles and atmospheric environmental factors were examined by correlating human-biometeorological parameters in the study area with reported clinical cases of measles for the period 1998-2008. We also applied stepwise regression analysis in order to determine the human-biometeorological parameters that lead to statistical changes in reported clinical cases of measles. We found that high reported cases of measles are associated with the least populated areas, where rearing and cohabitation of livestock/domestic animals within human communities are common. There was a significant correlation (P < 0.01) between monthly cases of measles and human-biometeorological parameters except wind speed and vapour pressure. High transmission of measles occurred in the months of January to May during the dry season when human thermal comfort indices are very high. This highlights the importance of the thermal environment in disease demographics since it accounted for more than 40% variation in measles transmission within the study period.
Collapse
|
16
|
Bharti N, Broutin H, Grais RF, Ferrari MJ, Djibo A, Tatem AJ, Grenfell BT. Spatial dynamics of meningococcal meningitis in Niger: observed patterns in comparison with measles. Epidemiol Infect 2012; 140:1356-65. [PMID: 22009033 PMCID: PMC3846174 DOI: 10.1017/s0950268811002032] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Throughout the African meningitis belt, meningococcal meningitis outbreaks occur only during the dry season. Measles in Niger exhibits similar seasonality, where increased population density during the dry season probably escalates measles transmission. Because meningococcal meningitis and measles are both directly transmitted, we propose that host aggregation also impacts the transmission of meningococcal meningitis. Although climate affects broad meningococcal meningitis seasonality, we focus on the less examined role of human density at a finer spatial scale. By analysing spatial patterns of suspected cases of meningococcal meningitis, we show fewer absences of suspected cases in districts along primary roads, similar to measles fadeouts in the same Nigerien metapopulation. We further show that, following periods during no suspected cases, districts with high reappearance rates of meningococcal meningitis also have high measles reintroduction rates. Despite many biological and epidemiological differences, similar seasonal and spatial patterns emerge from the dynamics of both diseases. This analysis enhances our understanding of spatial patterns and disease transmission and suggests hotspots for infection and potential target areas for meningococcal meningitis surveillance and intervention.
Collapse
Affiliation(s)
- N Bharti
- Department of Ecology and Evolutionary Biology, Woodrow Wilson School of Public and International Affairs, Princeton University, NJ, USA.
| | | | | | | | | | | | | |
Collapse
|
17
|
Employing Live Microbes for Vaccine Delivery. DEVELOPMENT OF NOVEL VACCINES 2012. [PMCID: PMC7123214 DOI: 10.1007/978-3-7091-0709-6_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/29/2022]
|
18
|
Zhuo J, Geng W, Hoekstra EJ, Zhong G, Liang X, Zhang J. Impact of supplementary immunization activities in measles-endemic areas: a case study from Guangxi, China. J Infect Dis 2011; 204 Suppl 1:S455-62. [PMID: 21666199 DOI: 10.1093/infdis/jir063] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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.
Collapse
Affiliation(s)
- Jiatong Zhuo
- Division of Immunization Service, Guangxi Zhuang Autonomous Region Center for Disease Control and Prevention, Nanning, Guangxi, China
| | | | | | | | | | | |
Collapse
|
19
|
Goodson JL, Sosler S, Pasi O, Johnson T, Kobella M, Monono ME, Uzicanin A. Impact of a Measles Outbreak Response Immunization Campaign: Maroua, Cameroon, 2009. J Infect Dis 2011; 204 Suppl 1:S252-9. [DOI: 10.1093/infdis/jir151] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
20
|
Fadnes LT, Jackson D, Engebretsen IMS, Zembe W, Sanders D, Sommerfelt H, Tylleskär T. Vaccination coverage and timeliness in three South African areas: a prospective study. BMC Public Health 2011; 11:404. [PMID: 21619642 PMCID: PMC3126743 DOI: 10.1186/1471-2458-11-404] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2011] [Accepted: 05/27/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Timely vaccination is important to induce adequate protective immunity. We measured vaccination timeliness and vaccination coverage in three geographical areas in South Africa. METHODS This study used vaccination information from a community-based cluster-randomized trial promoting exclusive breastfeeding in three South African sites (Paarl in the Western Cape Province, and Umlazi and Rietvlei in KwaZulu-Natal) between 2006 and 2008. Five interview visits were carried out between birth and up to 2 years of age (median follow-up time 18 months), and 1137 children were included in the analysis. We used Kaplan-Meier time-to-event analysis to describe vaccination coverage and timeliness in line with the Expanded Program on Immunization for the first eight vaccines. This included Bacillus Calmette-Guérin (BCG), four oral polio vaccines and 3 doses of the pentavalent vaccine which protects against diphtheria, pertussis, tetanus, hepatitis B and Haemophilus influenzae type B. RESULTS The proportion receiving all these eight recommended vaccines were 94% in Paarl (95% confidence interval [CI] 91-96), 62% in Rietvlei (95%CI 54-68) and 88% in Umlazi (95%CI 84-91). Slightly fewer children received all vaccines within the recommended time periods. The situation was worst for the last pentavalent- and oral polio vaccines. The hazard ratio for incomplete vaccination was 7.2 (95%CI 4.7-11) for Rietvlei compared to Paarl. CONCLUSIONS There were large differences between the different South African sites in terms of vaccination coverage and timeliness, with the poorer areas of Rietvlei performing worse than the better-off areas in Paarl. The vaccination coverage was lower for the vaccines given at an older age. There is a need for continued efforts to improve vaccination coverage and timeliness, in particular in rural areas. TRIAL REGISTRATION NUMBER ClinicalTrials.gov: NCT00397150.
Collapse
Affiliation(s)
- Lars T Fadnes
- Centre for International Health, University of Bergen, Norway
| | - Debra Jackson
- School of Public Health, University of Western Cape, South Africa
| | | | | | | | - Halvor Sommerfelt
- Centre for International Health, University of Bergen, Norway
- Division of Infectious Disease Control, Norwegian Institute of Public Health, Norway
| | | |
Collapse
|
21
|
Fadnes LT, Nankabirwa V, Sommerfelt H, Tylleskär T, Tumwine JK, Engebretsen IMS. Is vaccination coverage a good indicator of age-appropriate vaccination? A prospective study from Uganda. Vaccine 2011; 29:3564-70. [PMID: 21402043 DOI: 10.1016/j.vaccine.2011.02.093] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2010] [Revised: 02/25/2011] [Accepted: 02/25/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND Timely vaccination is important to protect children from common infectious diseases. We assessed vaccination timeliness and vaccination coverage as well as coverage of vitamin A supplementation in a Ugandan setting. METHODS AND FINDINGS This study used vaccination information gathered during a cluster-randomized trial promoting exclusive breastfeeding in Eastern Uganda between 2006 and 2008 (ClinicalTrials.gov no. NCT00397150). Five visits were carried out from birth up to 2 years of age (median follow-up time 1.5 years), and 765 children were included in the analysis. We used Kaplan-Meier time-to-event analysis to describe vaccination coverage and timeliness. Vaccination coverage at the end of follow-up was above 90% for all vaccines assessed individually that were part of the Expanded Program on Immunization (EPI), except for the measles vaccine which had 80% coverage (95%CI 76-83). In total, 75% (95%CI 71-79) had received all the recommended vaccines at the end of follow-up. Timely vaccination according to the recommendations of the Ugandan EPI was less common, ranging from 56% for the measles vaccine (95%CI 54-57) to 89% for the Bacillus Calmette-Guérin (BCG) vaccine (95%CI 86-91). Only 18% of the children received all vaccines within the recommended time ranges (95%CI 15-22). The children of mothers with higher education had more timely vaccination. The coverage for vitamin A supplementation at end of follow-up was 84% (95%CI 81-87). CONCLUSIONS Vaccination coverage was reasonably high, but often not timely. Many children were unprotected for several months despite being vaccinated at the end of follow-up. There is a need for continued efforts to optimise vaccination timeliness.
Collapse
Affiliation(s)
- Lars T Fadnes
- Centre for International Health, University of Bergen, 5018 Bergen, Norway.
| | | | | | | | | | | | | |
Collapse
|
22
|
Bharti N, Djibo A, Ferrari MJ, Grais RF, Tatem AJ, McCabe CA, Bjornstad ON, Grenfell BT. Measles hotspots and epidemiological connectivity. Epidemiol Infect 2010; 138:1308-16. [PMID: 20096146 PMCID: PMC4756478 DOI: 10.1017/s0950268809991385] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Though largely controlled in developed countries, measles remains a major global public health issue. Regional and local transmission patterns are rooted in human mixing behaviour across spatial scales. Identifying spatial interactions that contribute to recurring epidemics helps define and predict outbreak patterns. Using spatially explicit reported cases from measles outbreaks in Niger, we explored how regional variations in movement and contact patterns relate to patterns of measles incidence. Because we expected to see lower rates of re-introductions in small, compared to large, populations, we measured the population-size corrected proportion of weeks with zero cases across districts to understand relative rates of measles re-introductions. We found that critical elements of spatial disease dynamics in Niger are agricultural seasonality, transnational contact clusters, and roads networks that facilitate host movement and connectivity. These results highlight the need to understand local patterns of seasonality, demographic characteristics, and spatial heterogeneities to inform vaccination policy.
Collapse
Affiliation(s)
- N Bharti
- Penn State University, Biology Department and Center for Infectious Disease Dynamics, University Park, PA, USA.
| | | | | | | | | | | | | | | |
Collapse
|
23
|
Szusz EK, Garrison LP, Bauch CT. A review of data needed to parameterize a dynamic model of measles in developing countries. BMC Res Notes 2010; 3:75. [PMID: 20233414 PMCID: PMC2848058 DOI: 10.1186/1756-0500-3-75] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2010] [Accepted: 03/16/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Dynamic models of infection transmission can project future disease burden within a population. Few dynamic measles models have been developed for low-income countries, where measles disease burden is highest. Our objective was to review the literature on measles epidemiology in low-income countries, with a particular focus on data that are needed to parameterize dynamic models. METHODS We included age-stratified case reporting and seroprevalence studies with fair to good sample sizes for mostly urban African and Indian populations. We emphasized studies conducted before widespread immunization. We summarized age-stratified attack rates and seroprevalence profiles across these populations. Using the study data, we fitted a "representative" seroprevalence profile for African and Indian settings. We also used a catalytic model to estimate the age-dependent force of infection for individual African and Indian studies where seroprevalence was surveyed. We used these data to quantify the effects of population density on the basic reproductive number R0. RESULTS The peak attack rate usually occurred at age 1 year in Africa, and 1 to 2 years in India, which is earlier than in developed countries before mass vaccination. Approximately 60% of children were seropositive for measles antibody by age 2 in Africa and India, according to the representative seroprevalence profiles. A statistically significant decline in the force of infection with age was found in 4 of 6 Indian seroprevalence studies, but not in 2 African studies. This implies that the classic threshold result describing the critical proportion immune (pc) required to eradicate an infectious disease, pc = 1-1/R0, may overestimate the required proportion immune to eradicate measles in some developing country populations. A possible, though not statistically significant, positive relation between population density and R0 for various Indian and African populations was also found. These populations also showed a similar pattern of waning of maternal antibodies. Attack rates in rural Indian populations show little dependence on vaccine coverage or population density compared to urban Indian populations. Estimated R0 values varied widely across populations which has further implications for measles elimination. CONCLUSIONS It is possible to develop a broadly informative dynamic model of measles transmission in low-income country settings based on existing literature, though it may be difficult to develop a model that is closely tailored to any given country. Greater efforts to collect data specific to low-income countries would aid in control efforts by allowing highly population-specific models to be developed.
Collapse
Affiliation(s)
- Emily K Szusz
- Department of Mathematics and Statistics, University of Guelph, Guelph, Canada.
| | | | | |
Collapse
|
24
|
Goodson JL, Wiesen E, Perry RT, Mach O, Kitambi M, Kibona M, Luman ET, Cairns KL. Impact of measles outbreak response vaccination campaign in Dar es Salaam, Tanzania. Vaccine 2009; 27:5870-4. [DOI: 10.1016/j.vaccine.2009.07.057] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2009] [Revised: 07/16/2009] [Accepted: 07/18/2009] [Indexed: 10/20/2022]
|
25
|
Sonibare MA, Moody JO, Adesanya EO. Use of medicinal plants for the treatment of measles in Nigeria. JOURNAL OF ETHNOPHARMACOLOGY 2009; 122:268-72. [PMID: 19168120 DOI: 10.1016/j.jep.2009.01.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2008] [Revised: 12/18/2008] [Accepted: 01/04/2009] [Indexed: 05/10/2023]
Abstract
AIM OF THE STUDY The present study was an ethnobotanical survey of three Local Government areas of the Ijebu area of Ogun State in southwest Nigeria for plants used in the treatment of measles. MATERIALS AND METHODS Unstructured interviews were conducted among both urban and rural dwellers of three major groups of Ijebu people inhabiting the area (Ijebu North, Ijebu northeast and Ijebu Ode Local Governments). RESULTS A total of 20 respondents constituted by herbalists, herbsellers and old people that have privileged information on the plants used in the treatment of measles among children were encountered during the survey. Twenty-three plant species belonging to 18 Angiosperm families were said to possess curative properties for the cure of measles among the local populace. Amongst the most frequently used plants are Elytraria marginata Vahl, Peperomia pellucida (L.) Humb., Bonpl. & Kunth, Vernonia amygdalina Del., Momordica charantia L., Newbouldia laevis (P. Beauv.) Seem. ex Bureau, and Ocimum gratissimum L. CONCLUSION The most frequently mentioned family is Cucurbitaceae. The mode of preparation and recommended dosages are enumerated in this paper. The results of the study call for an urgent need of the introduction of a strategy for the conservation of indigenous medicinal plants in the area.
Collapse
Affiliation(s)
- M A Sonibare
- Department of Pharmacognosy, Faculty of Pharmacy, University of Ibadan, Ibadan, Nigeria.
| | | | | |
Collapse
|
26
|
Wolfson LJ, Grais RF, Luquero FJ, Birmingham ME, Strebel PM. Estimates of measles case fatality ratios: a comprehensive review of community-based studies. Int J Epidemiol 2009; 38:192-205. [DOI: 10.1093/ije/dyn224] [Citation(s) in RCA: 138] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
27
|
Ferrari MJ, Grais RF, Bharti N, Conlan AJK, Bjørnstad ON, Wolfson LJ, Guerin PJ, Djibo A, Grenfell BT. The dynamics of measles in sub-Saharan Africa. Nature 2008; 451:679-84. [PMID: 18256664 DOI: 10.1038/nature06509] [Citation(s) in RCA: 222] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2007] [Accepted: 12/04/2007] [Indexed: 11/09/2022]
Abstract
Although vaccination has almost eliminated measles in parts of the world, the disease remains a major killer in some high birth rate countries of the Sahel. On the basis of measles dynamics for industrialized countries, high birth rate regions should experience regular annual epidemics. Here, however, we show that measles epidemics in Niger are highly episodic, particularly in the capital Niamey. Models demonstrate that this variability arises from powerful seasonality in transmission-generating high amplitude epidemics-within the chaotic domain of deterministic dynamics. In practice, this leads to frequent stochastic fadeouts, interspersed with irregular, large epidemics. A metapopulation model illustrates how increased vaccine coverage, but still below the local elimination threshold, could lead to increasingly variable major outbreaks in highly seasonally forced contexts. Such erratic dynamics emphasize the importance both of control strategies that address build-up of susceptible individuals and efforts to mitigate the impact of large outbreaks when they occur.
Collapse
Affiliation(s)
- Matthew J Ferrari
- Center for Infectious Disease Dynamics, The Pennsylvania State University, University Park, Pennsylvania 16802, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
28
|
|
29
|
Durrheim DN, Kelly H, Ferson MJ, Featherstone D. Remaining measles challenges in Australia. Med J Aust 2007; 187:181-4. [PMID: 17680748 DOI: 10.5694/j.1326-5377.2007.tb01182.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2007] [Accepted: 05/01/2007] [Indexed: 11/17/2022]
Abstract
Measles is now rare in Australia, and cases can usually be linked to its importation from endemic countries. To prevent measles outbreaks in Australia, high vaccination coverage with two doses of vaccine must be sustained. All medical practitioners should consider a diagnosis of measles in a patient of any age who presents with fever and a non-vesiculating, non-itchy rash. If measles is suspected clinically, public health authorities should be immediately notified, so that testing and management of patients can be discussed and contact tracing initiated. When a patient is suspected of having measles, testing of a serum sample for measles-specific IgM and IgG antibodies should be requested urgently. Pathology laboratories should have effective protocols for immediately reporting positive measles-specific IgM antibody tests, or other results indicative of measles, to public health authorities.
Collapse
Affiliation(s)
- David N Durrheim
- Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, NSW, Australia.
| | | | | | | |
Collapse
|
30
|
Wolfson LJ, Strebel PM, Gacic-Dobo M, Hoekstra EJ, McFarland JW, Hersh BS. Has the 2005 measles mortality reduction goal been achieved? A natural history modelling study. Lancet 2007; 369:191-200. [PMID: 17240285 DOI: 10.1016/s0140-6736(07)60107-x] [Citation(s) in RCA: 182] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND In 2002, the UN General Assembly Special Session on Children adopted a goal to reduce deaths owing to measles by half by the end of 2005, compared with 1999 estimates. We describe efforts and progress made towards this goal. METHODS We assessed trends in immunisation against measles on the basis of national implementation of the WHO/UNICEF comprehensive strategy for measles mortality reduction, and the provision of a second opportunity for measles immunisation. We used a natural history model to evaluate trends in mortality due to measles. RESULTS Between 1999 and 2005, according to our model mortality owing to measles was reduced by 60%, from an estimated 873,000 deaths (uncertainty bounds 634,000-1,140,000) in 1999 to 345,000 deaths (247,000-458,000) in 2005. The largest percentage reduction in estimated measles mortality during this period was in the western Pacific region (81%), followed by Africa (75%) and the eastern Mediterranean region (62%). Africa achieved the largest total reduction, contributing 72% of the global reduction in measles mortality. Nearly 7.5 million deaths from measles were prevented through immunisation between 1999 and 2005, with supplemental immunisation activities and improved routine immunisation accounting for 2.3 million of these prevented deaths. INTERPRETATION The achievement of the 2005 global measles mortality reduction goal is evidence of what can be accomplished for child survival in countries with high childhood mortality when safe, cost-effective, and affordable interventions are backed by country-level political commitment and an effective international partnership.
Collapse
Affiliation(s)
- Lara J Wolfson
- Initiative for Vaccine Research, WHO, 20 Avenue Appia, CH-1211 Geneva 27, Switzerland.
| | | | | | | | | | | |
Collapse
|
31
|
Grais RF, Dubray C, Gerstl S, Guthmann JP, Djibo A, Nargaye KD, Coker J, Alberti KP, Cochet A, Ihekweazu C, Nathan N, Payne L, Porten K, Sauvageot D, Schimmer B, Fermon F, Burny ME, Hersh BS, Guerin PJ. Unacceptably high mortality related to measles epidemics in Niger, Nigeria, and Chad. PLoS Med 2007; 4:e16. [PMID: 17199407 PMCID: PMC1761051 DOI: 10.1371/journal.pmed.0040016] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2006] [Accepted: 11/14/2006] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Despite the comprehensive World Health Organization (WHO)/United Nations Children's Fund (UNICEF) measles mortality-reduction strategy and the Measles Initiative, a partnership of international organizations supporting measles mortality reduction in Africa, certain high-burden countries continue to face recurrent epidemics. To our knowledge, few recent studies have documented measles mortality in sub-Saharan Africa. The objective of our study was to investigate measles mortality in three recent epidemics in Niamey (Niger), N'Djamena (Chad), and Adamawa State (Nigeria). METHODS AND FINDINGS We conducted three exhaustive household retrospective mortality surveys in one neighbourhood of each of the three affected areas: Boukoki, Niamey, Niger (April 2004, n = 26,795); Moursal, N'Djamena, Chad (June 2005, n = 21,812); and Dong District, Adamawa State, Nigeria (April 2005, n = 16,249), where n is the total surveyed population in each of the respective areas. Study populations included all persons resident for at least 2 wk prior to the study, a duration encompassing the measles incubation period. Heads of households provided information on measles cases, clinical outcomes up to 30 d after rash onset, and health-seeking behaviour during the epidemic. Measles cases and deaths were ascertained using standard WHO surveillance-case definitions. Our main outcome measures were measles attack rates (ARs) and case fatality ratios (CFRs) by age group, and descriptions of measles complications and health-seeking behaviour. Measles ARs were the highest in children under 5 y old (under 5 y): 17.1% in Boukoki, 17.2% in Moursal, and 24.3% in Dong District. CFRs in under 5-y-olds were 4.6%, 4.0%, and 10.8% in Boukoki, Moursal, and Dong District, respectively. In all sites, more than half of measles cases in children aged under 5 y experienced acute respiratory infection and/or diarrhoea in the 30 d following rash onset. Of measles cases, it was reported that 85.7% (979/1,142) of patients visited a health-care facility within 30 d after rash onset in Boukoki, 73.5% (519/706) in Moursal, and 52.8% (603/1,142) in Dong District. CONCLUSIONS Children in these countries still face unacceptably high mortality from a completely preventable disease. While the successes of measles mortality-reduction strategies and progress observed in measles control in other countries of the region are laudable and evident, they should not overshadow the need for intensive efforts in countries that have just begun implementation of the WHO/UNICEF comprehensive strategy.
Collapse
|
32
|
Muller CP, Kremer JR, Best JM, Dourado I, Triki H, Reef S. Reducing global disease burden of measles and rubella: Report of the WHO Steering Committee on research related to measles and rubella vaccines and vaccination, 2005. Vaccine 2007; 25:1-9. [PMID: 17262908 DOI: 10.1016/j.vaccine.2006.07.039] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The WHO Steering Committee reviewed and evaluated the progress towards global control of measles and rubella and provided guidelines for future research activities concerning both diseases during its meeting in New Delhi, in April 2005. Global measles vaccination coverage increased from 71% in 1999 to 76% in 2004 and indigenous transmission was interrupted or kept at very low levels in many countries. However, Africa and Southeast Asia continue to experience endemic transmission and high mortality rates, despite a global mortality reduction of 39% between 1999 and 2003. On the basis of reports from countries with continued indigenous measles virus transmission, future control strategies as well as advantages and potential drawbacks of global measles eradication were discussed. Similarly the burden of rubella and congenital rubella syndrome (CRS) as well as the cost-effectiveness of rubella vaccination was assessed using different methods in several countries without vaccination programs. As measles and rubella viruses continue to circulate surveillance and control strategies need further optimization. RT-PCR was considered as an alternative method for laboratory diagnosis of CRS. The value of dried blood spots and oral fluid as alternative samples for measles and rubella IgG and IgM detection and genotype determination was evaluated. However further validation of these methods in different settings is required before their routine use can be recommended.
Collapse
Affiliation(s)
- Claude P Muller
- Institute of Immunology and WHO Collaborative Center for Measles and WHO European Regional Reference Laboratory for Measles and Rubella, Laboratoire National de Santé, Luxemburg.
| | | | | | | | | | | |
Collapse
|
33
|
Mohan A, Murhekar MV, Wairgkar NS, Hutin YJ, Gupte MD. Measles transmission following the tsunami in a population with a high one-dose vaccination coverage, Tamil Nadu, India 2004-2005. BMC Infect Dis 2006; 6:143. [PMID: 16984629 PMCID: PMC1586205 DOI: 10.1186/1471-2334-6-143] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2006] [Accepted: 09/19/2006] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND On 26 December 2004, a tsunami struck the coast of the state of Tamil Nadu, India, where one-dose measles coverage exceeded 95%. On 29 December, supplemental measles immunization activities targeted children 6 to 60 months of age in affected villages. On 30 December, Cuddalore, a tsunami-affected district in Tamil Nadu reported a cluster of measles cases. We investigated this cluster to estimate the magnitude of the problem and to propose recommendations for control. METHODS We received notification of WHO-defined measles cases through stimulated passive surveillance. We collected information regarding date of onset, age, sex, vaccination status and residence. We collected samples for IgM antibodies and genotype studies. We modeled the accumulation of susceptible individuals over the time on the basis of vaccination coverage, vaccine efficacy and birth rate. RESULTS We identified 101 measles cases and detected IgM antibodies against measles virus in eight of 11 sera. Cases were reported from tsunami-affected (n = 71) and unaffected villages (n = 30) with attack rates of 1.3 and 1.7 per 1000, respectively. 42% of cases in tsunami-affected villages had an onset date within 14 days of the tsunami. The median ages of case-patients in tsunami-affected and un-affected areas were 54 months and 60 months respectively (p = 0.471). 36% of cases from tsunami-affected areas were above 60 months of age. Phylogenetic analyses indicated that the sequences of virus belonged to genotype D8 that circulated in Tamil Nadu. CONCLUSION Measles virus circulated in Cuddalore district following the tsunami, although there was no association between the two events. Transmission despite high one-dose vaccination coverage pointed to the limitations of this vaccination strategy. A second opportunity for measles immunization may help reducing measles mortality and morbidity in such areas. Children from 6 month to 14 years of age must be targeted for supplemental immunization during complex emergencies.
Collapse
Affiliation(s)
- Arumugam Mohan
- Field Epidemiology Training Programme, National Institute of Epidemiology (ICMR), Chennai, India
- Directorate of Public Health and Preventive Medicine, Govt. of Tamil Nadu, Chennai, India
| | - Manoj V Murhekar
- Field Epidemiology Training Programme, National Institute of Epidemiology (ICMR), Chennai, India
| | | | - Yvan J Hutin
- Field Epidemiology Training Programme, National Institute of Epidemiology (ICMR), Chennai, India
| | - Mohan D Gupte
- Field Epidemiology Training Programme, National Institute of Epidemiology (ICMR), Chennai, India
| |
Collapse
|
34
|
Grais RF, Ferrari MJ, Dubray C, Bjørnstad ON, Grenfell BT, Djibo A, Fermon F, Guerin PJ. Estimating transmission intensity for a measles epidemic in Niamey, Niger: lessons for intervention. Trans R Soc Trop Med Hyg 2006; 100:867-73. [PMID: 16540134 DOI: 10.1016/j.trstmh.2005.10.014] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2005] [Revised: 10/17/2005] [Accepted: 10/18/2005] [Indexed: 10/24/2022] Open
Abstract
The objective of this study is to estimate the effective reproductive ratio for the 2003-2004 measles epidemic in Niamey, Niger. Using the results of a retrospective and prospective study of reported cases within Niamey during the 2003-2004 epidemic, we estimate the basic reproductive ratio, effective reproductive ratio (RE) and minimal vaccination coverage necessary to avert future epidemics using a recent method allowing for estimation based on the epidemic case series. We provide these estimates for geographic areas within Niamey, thereby identifying neighbourhoods at high risk. The estimated citywide RE was 2.8, considerably lower than previous estimates, which may help explain the long duration of the epidemic. Transmission intensity varied during the course of the epidemic and within different neighbourhoods (RE range: 1.4-4.7). Our results indicate that vaccination coverage in currently susceptible children should be increased by at least 67% (vaccine efficacy 90%) to produce a citywide vaccine coverage of 90%. This research highlights the importance of local differences in vaccination coverage on the potential impact of epidemic control measures. The spatial-temporal spread of the epidemic from district to district in Niamey over 30 weeks suggests that targeted interventions within the city could have an impact.
Collapse
Affiliation(s)
- R F Grais
- Epicentre, 8 rue Saint Sabin, 75011 Paris, France.
| | | | | | | | | | | | | | | |
Collapse
|
35
|
Chowdhury F, Khan AI, Hossain MI, Malek MA, Faruque ASG, Ahmed T, Salam MA. Young children non-immunized against measles: characteristics and programmatic implications. Acta Paediatr 2006; 95:44-9. [PMID: 16373295 DOI: 10.1080/08035250500286987] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
AIM To examine the presenting characteristics, including nutritional status, of young children without measles immunization and to suggest appropriate public health measures to improve immunization status. METHODS In this retrospective case-control analysis, we studied 4075 children aged 12-23 mo of either sex, who attended ICDDR,B's Dhaka hospital during 1994-2003. Cases included children who reported to this facility without receiving measles vaccine, and the control children were those who received the vaccine. RESULTS 3181 of 4075 (78%) children, including 1227 (39%) girls and 1954 (61%) boys, received measles immunization. The proportion of vaccinated children increased from 74% in 1997 to 82% in 2001. Some non-specific effects of measles immunization were observed. Fifty-one per cent of the children without measles immunization were stunted, 76% were underweight, and 48% were wasted. The non-immunized children were twice as likely to be stunted, underweight, and wasted than the immunized children; they were more often dehydrated (some or severe dehydration) (28% vs 22%, p<0.001), required longer duration (>72 h) of hospitalization (15% vs 10%, p<0.001), did not receive vitamin A capsule in the previous 6 mo (56% vs 36%, p<0.001), and had more frequent abnormal lung auscultation indicative of acute lower respiratory tract infections (8% vs 5%, p<0.001). Female children, illiterate mother, lack of vitamin A supplementation, and history of measles were significantly associated with non-immunization against measles after controlling for co-variables. Results were similar when different nutritional indicators (underweight, stunting, or wasting) were added separately to logistic regression models. CONCLUSION Intervention strategies to enhance immunization coverage in infants should target illiterate mothers and their children, particularly the females and malnourished ones, provide them with measles immunization and vitamin A capsule, and encourage their periodic follow-up visits as part of a preventive nutritional programme.
Collapse
Affiliation(s)
- F Chowdhury
- Clinical Sciences Division, ICDDR,B: Centre for Health and Population Research, GPO Box 128, Dhaka 1000, Bangladesh
| | | | | | | | | | | | | |
Collapse
|
36
|
Alexander ME, Moghadas SM, Rohani P, Summers AR. Modelling the effect of a booster vaccination on disease epidemiology. J Math Biol 2005; 52:290-306. [PMID: 16283412 DOI: 10.1007/s00285-005-0356-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2005] [Revised: 07/29/2005] [Indexed: 10/25/2022]
Abstract
Despite the effectiveness of vaccines in dramatically decreasing the number of new infectious cases and severity of illnesses, imperfect vaccines may not completely prevent infection. This is because the immunity afforded by these vaccines is not complete and may wane with time, leading to resurgence and epidemic outbreaks notwithstanding high levels of primary vaccination. To prevent an endemic spread of disease, and achieve eradication, several countries have introduced booster vaccination programs. The question of whether this strategy could eventually provide the conditions for global eradication is addressed here by developing a seasonally-forced mathematical model. The analysis of the model provides the threshold condition for disease control in terms of four major parameters: coverage of the primary vaccine; efficacy of the vaccine; waning rate; and the rate of booster administration. The results show that if the vaccine provides only temporary immunity, then the infection typically cannot be eradicated by a single vaccination episode. Furthermore, having a booster program does not necessarily guarantee the control of a disease, though the level of epidemicity may be reduced. In addition, these findings strongly suggest that the high coverage of primary vaccination remains crucial to the success of a booster strategy. Simulations using estimated parameters for measles illustrate model predictions.
Collapse
Affiliation(s)
- M E Alexander
- Institute for Biodiagnostics, National Research Council Canada, R3B 1Y6, Winnipeg, Manitoba, Canada.
| | | | | | | |
Collapse
|
37
|
Howe RC, Dhiman N, Ovsyannikova IG, Poland GA. Induction of CD4 T cell proliferation and in vitro Th1-like cytokine responses to measles virus. Clin Exp Immunol 2005; 140:333-42. [PMID: 15807859 PMCID: PMC1809354 DOI: 10.1111/j.1365-2249.2005.02766.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Mechanisms that lead to induction of life-long immunity to measles virus (MV) are poorly understood. In the present study, we have assessed the activation, proliferation and cytokine secreting function of peripheral blood T cells from MV immune individuals. Expression of cell blastogenesis markers, such as increased forward light scatter and CD38 expression, peaked 5-7 days after infection of peripheral blood mononuclear cells (PBMC) with the live attenuated Edmonston strain of MV. Subset analysis revealed that both CD3- and CD3+ cells expressed activation markers but that the CD3+ T cells predominated late in the culture period corresponding to maximal proliferation and cell recovery. The majority of CD3+ T cells consisted of CD4+CD8- cells. IFN-gamma and IL-4 production similarly showed optimal production late in culture. Depletion of CD4 cells prior to culture and MV stimulation completely abrogated both IFN-gamma and IL-4 production, whereas depletion of CD8 cells did not diminish production, suggesting that CD4+CD8- T cells were principally involved in production of these cytokines. Finally, optimal IFN-gamma production was elicited at high MV doses and IL-4 at much lower doses. These results suggest that among MV immune individuals, in vitro responses to measles are dominated by CD4+ T cells that, depending on antigen dose, primarily produce a Th1-like and, to a lesser extent, a Th1/Th2-mixed pattern of cytokine release.
Collapse
Affiliation(s)
- R C Howe
- Mayo Vaccine Research Group, Mayo Clinic, 200 First Street, SW, Rochester, MN 55905, USA
| | | | | | | |
Collapse
|
38
|
Howe RC, Ovsyannikova IG, Pinsky NA, Poland GA. Identification of Th0 cells responding to measles virus. Hum Immunol 2005; 66:104-15. [PMID: 15694995 DOI: 10.1016/j.humimm.2004.10.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2004] [Revised: 10/12/2004] [Accepted: 10/15/2004] [Indexed: 10/25/2022]
Abstract
Mechanisms involved in the induction of immunity to measles virus (MV) are not well understood. In the present study, we assessed proliferation, interferon (IFN)-gamma, and interleukin (IL)-4 production of MV-specific T cells after secondary in vitro stimulation of peripheral blood mononuclear cells (PBMCs) from human donors. Such secondary stimulation resulted in responses substantially higher than after primary in vitro exposure. Most study participants produced both IFN-gamma and IL-4 after secondary in vitro stimulation. Patterns of secondary in vitro responses that use genetically disparate antigen-presenting cells were consistent with T-cell recognition restricted to human leukocyte antigen class II molecules. Limiting dilution analyses indicated that precursor frequencies of cytokine secreting and proliferating cells ranged from about 0.001% to 0.1% among fresh PBMCs. Split-well analyses of limiting dilution cultures suggested that virtually all putative T-cell clones produced either IFN-gamma alone or both IFN-gamma and IL-4. Intracytoplasmic flow cytometric analysis of polyclonal MV-specific secondary in vitro responding T cells revealed a similar pattern of cytokine expression. These results suggest that memory T cells responding in vitro to MV generate cells that produce either IFN-gamma alone (and resemble Th1-like cells) or secreted both IFN-gamma and IL-4 (resembling Th0-like cells) in vitro with few cells expressing a Th2-like pattern.
Collapse
Affiliation(s)
- Rawleigh C Howe
- Mayo Vaccine Research Group, Mayo Clinic and Foundation, Rochester, MN 55905, USA
| | | | | | | |
Collapse
|
39
|
Smit SB, Hardie D, Tiemessen CT. Measles virus genotype B2 is not inactive: Evidence of continued circulation in Africa. J Med Virol 2005; 77:550-7. [PMID: 16254960 DOI: 10.1002/jmv.20491] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This study describes two measles outbreaks--one in Cape Town, South Africa in November 2002, and the other in Luanda, Angola in March 2003. The outbreaks were notable because they were caused by closely related genotype B2 viruses. This genotype was first described in an outbreak in Libreville, Gabon in the 1980s and was labeled as inactive by the World Health Organization in 2003 because it had not been detected for over 15 years. As the first three cases in the Cape Town outbreak were Angolan citizens who recently arrived from Angola, it appears likely that the source of the virus was Angola. Molecular analysis of specimens collected during the outbreak in Luanda provided direct evidence for the circulation of genotype B2 measles virus (MV) in Angola. This study clearly demonstrates that there is still active circulation of genotype B2 in Africa, and we propose that its apparent inactivity is merely the result of insufficient virologic/molecular surveillance in the region. These findings highlight the need for expanded molecular surveillance in Africa.
Collapse
Affiliation(s)
- Sheilagh B Smit
- Vaccine-preventable Virus Infections Unit, National Institute for Communicable Diseases (NICD), Johannesburg, South Africa.
| | | | | |
Collapse
|
40
|
Schoen C, Stritzker J, Goebel W, Pilgrim S. Bacteria as DNA vaccine carriers for genetic immunization. Int J Med Microbiol 2004; 294:319-35. [PMID: 15532991 DOI: 10.1016/j.ijmm.2004.03.001] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Genetic immunization with plasmid DNA vaccines has proven to be a promising tool in conferring protective immunity in various experimental animal models of infectious diseases or tumors. Recent research focuses on the use of bacteria, in particular enteroinvasive species, as effective carriers for DNA vaccines. Attenuated strains of Shigella flexneri, Salmonella spp., Yersinia enterocolitica or Listeria monocytogenes have shown to be attractive candidates to target DNA vaccines to immunological inductive sites at mucosal surfaces. This review summarizes recent progress in bacteria-mediated delivery of plasmid DNA vaccines in the field of infectious diseases and cancer.
Collapse
Affiliation(s)
- Christoph Schoen
- Department of Microbiology, Biocenter of the University, D-97074 Würzburg, Germany
| | | | | | | |
Collapse
|
41
|
Meissner HC, Strebel PM, Orenstein WA. Measles vaccines and the potential for worldwide eradication of measles. Pediatrics 2004; 114:1065-9. [PMID: 15466106 DOI: 10.1542/peds.2004-0440] [Citation(s) in RCA: 88] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The annual number of reported measles cases in the United States has declined from between 3 million and 4 million in the prevaccine era to <100 cases in association with the highest recorded immunization rates in history. Because of continued importation of measles into the United States, young children who are not vaccinated appropriately may experience more than a 60-fold increase in risk of disease. Unsubstantiated claims suggesting an association between measles vaccine and neurologic disorders have led to reduced vaccine use and a resurgence of measles in countries where immunization rates have declined below the level needed to maintain herd immunity. To address the possibility of worldwide control of measles, efforts to ensure high immunization rates among people in both developed and developing countries must be sustained.
Collapse
Affiliation(s)
- H Cody Meissner
- Division of Pediatric Infectious Disease, Tufts-New England Medical Center, University School of Medicine, 750 Washington St, Boston, MA 02111, USA.
| | | | | |
Collapse
|
42
|
Morgan OWC. Following in the footsteps of smallpox: can we achieve the global eradication of measles? BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2004; 4:1. [PMID: 15102333 PMCID: PMC387835 DOI: 10.1186/1472-698x-4-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2003] [Accepted: 03/17/2004] [Indexed: 11/10/2022]
Abstract
BACKGROUND: Although an effective measles vaccine has been available for almost 40 years, in 2000 there were about 30 million measles infections worldwide and 777,000 measles-related deaths. The history of smallpox suggests that achieving measles eradication depends on several factors; the biological characteristics of the organism; vaccine technology; surveillance and laboratory identification; effective delivery of vaccination programmes and international commitment to eradication. DISCUSSION: Like smallpox, measles virus has several biological characteristics that favour eradication. Humans are the only reservoir for the virus, which causes a visible illness and infection leading to life-long immunity. As the measles virus has only one genetic serotype which is relatively stable over time, the same basic vaccine can be used world-wide. Vaccination provides protection against measles infection for at least 15 years, although efficacy may be reduced due to host factors such as nutritional status. Measles vaccination may also confer other non-specific health benefits leading to reduced mortality. Accurate laboratory identification of measles cases enables enhanced surveillance to support elimination programmes. The "catch-up, keep-up, follow-up" vaccination programme implemented in the Americas has shown that measles elimination is possible using existing technologies. On 17th October 2003 the "Cape Town Measles Declaration" by the World Health Organisation and the United Nations Childrens Fund called on governments to intensify efforts to reduce measles mortality by supporting universal vaccination coverage and the development of more effective vaccination. SUMMARY: Although more difficult than for smallpox, recent experience in the Americas suggests that measles eradication is technically feasible. Growing international support to deliver these programmes means that measles, like smallpox, may very well become a curiosity of history.
Collapse
Affiliation(s)
- Oliver WC Morgan
- Health Protection Agency, North West London Health Protection Unit, London, UK.
| |
Collapse
|