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Goshu Muluneh A, Woldemariam Merid M, Tigabu B, Getie Ferede M, Molla Kassa G, Animut Y. Less than one-fifth of Ethiopian children were vaccinated for measles second dose; evidence from the Ethiopian mini demographic and health survey 2019. Vaccine X 2022; 12:100217. [PMID: 36148266 PMCID: PMC9486014 DOI: 10.1016/j.jvacx.2022.100217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 09/02/2022] [Accepted: 09/06/2022] [Indexed: 11/27/2022] Open
Abstract
Ethiopia introduced the measles second dose vaccine from the routine expanded immunization program in 2018. Shreds of evidence are scarce on the measles second dose vaccination coverage and its associated factors in Ethiopia. We aimed to assess the measles second dose vaccination coverage and associated factors in Ethiopia using the recent Ethiopian Mini Demographic and Health Survey (EMDHS) 2019 data. An in-depth secondary data analysis was conducted based on the Ethiopian mini demographic and health survey 2019 data; which was a cross-sectional survey targeted on key indicators of maternal and child health. A weighted sample of 965 children was included in the analysis. A multi-level mixed effect logistics regression model was fitted. Adjusted Odds Ratio (AOR) with 95 %CI was reported for statistically significant variables. The measles second dose coverage was 12.36 % (95 %CI = 10.89, 15.44). Not vaccinated for the third dose of pentavalent vaccine (Penta 3) (AOR = 0.60, 95 %CI: 0.37, 0.95), age of the child [13 to 23 months (AOR = 2.14, 95 %CI: 1.05, 4.36), 24 to 36 months (AOR = 2.58, 95 %CI: 1.32, 5.05)], household head educational status [no education (AOR = 0.51,95 %CI: 0.26, 0.99), primary (AOR = 0.44, 95 %CI: 0.23, 0.85)], and living in south nation, nationalities and peoples region (SNNPR) (AOR = 2.83,95 %CI: 1.12, 7.11) were significantly associated with measles second dose vaccination coverage. Measles second dose vaccination coverage was low in Ethiopia. Age of the child, being vaccinated for the Penta 3, educational status of the household head, and region of residence were significant determinants of measles second dose vaccination coverage.
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Sodjinou VD, Mengouo MN, Douba A, Tanifum P, Yapi MD, Kuzanwa KR, Otomba JS, Masresha B. Epidemiological characteristics of a protracted and widespread measles outbreak in the Democratic Republic of Congo, 2018 - 2020. Pan Afr Med J 2022; 42:282. [PMID: 36405650 PMCID: PMC9636736 DOI: 10.11604/pamj.2022.42.282.34410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 07/06/2022] [Indexed: 12/26/2022] Open
Abstract
Introduction measles is a highly contagious viral disease. Since 2011, the Democratic Republic of Congo (DR Congo) has had the first dose measles vaccination coverage of less than 80% according to the World Health Organization - United Nations International Children's Emergency Fund (WHO-UNICEF) coverage estimates, and measles mass vaccination coverage of less than the required coverage level of 95% by survey. Starting in August 2018, the country experienced an increase in measles case reports which continued through to early 2020. Epidemiological aspects of the outbreak are described in this article. Methods we analysed aggregate weekly passive surveillance data from the DR Congo for the years 2018 - 2020 to understand the trends of occurrence of suspected measles cases. We also analysed the measles case-based surveillance database to understand the epidemiological characteristics of confirmed cases of measles and rubella during the same period of time. Results a total of 458,156 suspected measles cases and 8,127 deaths were reported between 1st January 2018 and 31st December 2020, with the majority of cases and deaths reported in 2019. Only 2.9% of these cases were reported through the case-based surveillance system, with 31,639 cases being confirmed as measles by the laboratory, by epidemiological linkage and on clinical compatibility. Children less than 5 years of age were most affected with a cumulative incidence of 960 cases per 1,000,000 inhabitants. Only 41% of the confirmed cases were vaccinated. Maindombe and Tshopo provinces had the highest cumulative incidence levels. There was a distinct geographic progression of the outbreak between provinces during the course of the three years. A total of 1760 lab confirmed rubella cases were confirmed in various provinces among the cases investigated with blood specimens, 93% of whom were less than 15 years of age. Conclusion the recent gaps in vaccination coverage, the age pattern of confirmed cases and the lack of vaccination history in the majority of cases is suggestive of failure to vaccinate as the likely cause of this large and protracted outbreak. Efforts to improve vaccination coverage and the measles surveillance system are needed in order to prevent the occurrence of future outbreaks and to avert measles-related deaths.
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Affiliation(s)
| | - Marcellin Nimpa Mengouo
- World Health Organization Country Office for Democratic Republic of Congo, Kinshasa, the Democratic Republic of the Congo
| | - Alfred Douba
- Public Health Department, Felix Houphouet Boigny University, Abidjan-Cocody, Cote d'Ivoire
| | - Patricia Tanifum
- World Health Organization Intercountry Team for Central Africa, Libreville, Gabon
| | - Moise Desire Yapi
- World Health Organization Country Office for Democratic Republic of Congo, Kinshasa, the Democratic Republic of the Congo
| | - Kanyiga Robert Kuzanwa
- World Health Organization Country Office for Democratic Republic of Congo, Kinshasa, the Democratic Republic of the Congo
| | - John Samuel Otomba
- World Health Organization Country Office for Democratic Republic of Congo, Kinshasa, the Democratic Republic of the Congo
| | - Balcha Masresha
- World Health Organization Regional Office for Africa, Brazzaville, Congo,,Corresponding author: Balcha Masresha, World Health Organization Regional Office for Africa, Brazzaville, Congo.
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Tegegne AA, Maleghemi S, Anyuon AN, Zeleke FA, Legge GA, Ferede MA, Manyanga PD, Paul VG, Mutebi NM, Ticha JM, Kilo OTD, Ndenzako F, Pascal M, Olu OO. The sensitivity of acute flaccid paralysis surveillance - the case of South Sudan: retrospective secondary analysis of AFP surveillance data 2014-2019. Pan Afr Med J 2022; 42:12. [PMID: 36158926 PMCID: PMC9475052 DOI: 10.11604/pamj.supp.2022.42.1.33965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 05/30/2022] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION South Sudan has made quite impressive progress in interrupting wild poliovirus and maintaining a polio-free status since the last case was reported in 2009. South Sudan introduced different complementary strategies to enhance acute flaccid paralysis (AFP) surveillance. Hence, the objective of this study is to evaluate the sensitivity of the surveillance system using the WHO recommended surveillance standard and highlight the progress and challenges over the years. METHODS we conducted a retrospective, descriptive, quantitative study design and used the available secondary AFP surveillance database. RESULTS the overall non-polio AFP rate was 6.2/100,000 children under 15 years old in the study period. The stool adequacy was maintained well above the certification level of surveillance. The two main surveillance performance indicators were met at the national level throughout the study period. In contrast, only five out of ten states persistently attained and maintained the two main surveillance performance indicators throughout the study period, while in 2019 all states achieved except for Jonglei state. During the analysis period, no wild poliovirus was isolated except two circulating Vaccine Derived Poliovirus Type 2 (cVDPV2) cases in 2014 and one Immunodeficiency Vaccine Derived Poliovirus Type 2 (iVDPV2) case in 2015. However, on average, three cases were classified as polio compatible with each year of the study. CONCLUSION South Sudan met the two key surveillance performance indicators and had a sensitive AFP surveillance system during the period studied. We recommend intensifying surveillance activities in the former conflict-affected states and counties to maintain polio-free status.
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Affiliation(s)
- Ayesheshem Ademe Tegegne
- World Health Organization Country Office, Juba, South Sudan,,Corresponding author Ayesheshem Ademe Tegegne, World Health Organization Country Office, Juba, South Sudan.
| | | | | | | | | | | | - Peter Daudi Manyanga
- World Health Organization Inter-Country Support Team for Eastern and Southern African Countries, Harare, Zimbabwe
| | | | | | | | | | | | - Mkanda Pascal
- World Health Organization African Region, Brazzaville, Congo
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Sowe A, Njie M, Sowe D, Fofana S, Ceesay L, Camara Y, Tesfaye B, Bah S, Bah AK, Baldeh AK, Dampha BD, Baldeh SN, Touray A. Epidemiology of measles cases, vaccine effectiveness, and performance towards measles elimination in The Gambia. PLoS One 2021; 16:e0258961. [PMID: 34673828 PMCID: PMC8530347 DOI: 10.1371/journal.pone.0258961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 10/10/2021] [Indexed: 11/18/2022] Open
Abstract
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.
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Affiliation(s)
- Alieu Sowe
- WHO Country Office, Nairobi, Kenya
- * E-mail:
| | - Mbye Njie
- Expanded Program on Immunisation, Ministry of Health, Banjul, The Gambia
| | - Dawda Sowe
- Expanded Program on Immunisation, Ministry of Health, Banjul, The Gambia
| | - Sidat Fofana
- Expanded Program on Immunisation, Ministry of Health, Banjul, The Gambia
| | - Lamin Ceesay
- Expanded Program on Immunisation, Ministry of Health, Banjul, The Gambia
| | | | | | - Samba Bah
- Expanded Program on Immunisation, Ministry of Health, Banjul, The Gambia
| | - Alieu K. Bah
- World Bank Country Office, Cape Point, Bakau, The Gambia
| | - Abdoulie K. Baldeh
- School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Bakary D. Dampha
- Department of Global Public Health, Karolinska Institutet, Solna, Sweden
| | - Samba N. Baldeh
- Expanded Program on Immunisation, Ministry of Health, Banjul, The Gambia
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Ori PU, Adebowale A, Umeokonkwo CD, Osigwe U, Balogun MS. Descriptive epidemiology of measles cases in Bauchi State, 2013-2018. BMC Public Health 2021; 21:1311. [PMID: 34225675 PMCID: PMC8256615 DOI: 10.1186/s12889-021-11063-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 05/14/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Measles accounts for high morbidity and mortality in children, especially in developing countries. In 2017, about 11,190 measles cases were recorded in Nigeria, including Bauchi State. The aim of this study was to describe the trend and burden of measles in Bauchi State, Nigeria. METHOD We analyzed secondary data of measles cases extracted from the Measles Surveillance data system in Bauchi State from January 2013 to June 2018. The variables extracted included age, sex, doses of vaccination, case location and outcome. Data were analyzed using descriptive statistics, logistic regression, and multiplicative time series model (α = 0.05). RESULTS A total of 4935 suspected measles cases with an average annual incidence rate of 15.3 per 100,000 population and 57 deaths (Case Fatality Rate, CFR: 1.15%) were reported. Among the reported cases, 294 (6%;) were laboratory-confirmed, while clinically compatible and epi-linked cases were 402 (8%) and 3879 (70%), respectively. Of the 4935 measles cases, 2576 (52%) were males, 440 (9%) were under 1 year of age, and 3289 (67%) were between 1 and 4 years. The average annual incidence rate among the 1-4 year age-group was 70.3 per 100,000 population. The incidence rate was lowest in 2018 with 2.1 per 100,000 and highest in 2015 with 26.2 per 100,000 population. The measles cases variation index per quarter was highest in quarter 1 (198.86), followed by quarter 2 (62.21) and least in quarter 4 (10.37) of every year. Only 889 (18%) of the measles cases received at least one dose of measles vaccine, 2701 (54.7%) had no history of measles vaccination while 1346 (27.3%) had unknown vaccination status. The fatality of measles in Bauchi State were significantly associated with being under 5 years (AOR = 5.58; 95%CI: 2.19-14.22) and not having at least a dose of MCV (OR = 7.14; 95%CI: 3.70-14.29). CONCLUSION Measles burden remains high in Bauchi State despite a decrease in its incidence over the study years. Most of the cases occurred in the first quarter of every year. Improved routine measles surveillance for prompt case management could reduce the burden of the disease in Bauchi State.
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Affiliation(s)
| | - Ayo Adebowale
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, University of Ibadan, Ibadan, Nigeria
| | - Chukwuma David Umeokonkwo
- Nigerian Field Epidemiology and Laboratory and Training Programme, Abuja, Nigeria
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State Nigeria
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Yitbarek K, Tilahun T, Debela T, Abdena D, Girma T. Measles epidemiology and vaccination coverage in Oromia Region, Ethiopia: Evidence from surveillance, 2011-2018. Vaccine 2021; 39:4351-4358. [PMID: 34147294 DOI: 10.1016/j.vaccine.2021.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 05/15/2021] [Accepted: 06/07/2021] [Indexed: 11/18/2022]
Abstract
Despite a reported high coverage of measles-containing vaccine (MCV), low-income countries including, Ethiopia, have sustained high measles transmission with frequent outbreaks. We investigated the distribution of measles infection and vaccination in Oromia Regional State, Ethiopia. According to the World Health Organization (WHO) and the Ethiopian measles case classification guidelines, measles cases were classified as laboratory-confirmed, clinically compatible, and epidemiologically linked. We derived measles vaccination coverage estimates using reported measles vaccine efficacy and, the proportion of measles cases vaccinated with measles vaccine at least once from the surveillance data. We calculated measles effective reproduction number (Re) in the region. Almost twenty-five thousand measles cases were reported through the surveillance system, with more than 50% of the suspected and confirmed measles cases reported in 2015. Measles had sustained and high transmission rate with uneven distribution among the zones. Children between 1 and 4 years of age and MCV unvaccinated individuals were the most affected groups. In all the zones, the average surveillance-estimated MCV coverage among both infants and under-five children was significantly lower than the WHO recommended minimum 90% threshold herd-immunity. With this level of vaccination coverage, an infected case can transmit to more than four individuals. Nevertheless, the administrative coverage reports for the concurrent period were consistently above 90%. The estimated MCV coverage across the Oromia region was well below the recommended herd-immunity threshold. It partly explains the apparent mismatch of sustained measles transmission and outbreaks despite the very high administrative coverage estimates. Oromia regional health bureau, in collaboration with key stakeholders, should make a concerted effort to increase the effective-coverage of MCV to at least 90%. Additionally, multiple-dose MCV has to be scaled-up and accompanied with appropriate geographic and age targeting using evidence from surveillance data. Immediate programmatic action is needed to improve the quality of measles surveillance.
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Affiliation(s)
- Kiddus Yitbarek
- Department of Health Policy and Management, Jimma University, Jimma, Ethiopia.
| | - Tizta Tilahun
- Fenot Project, Harvard T.H. Chan School of Public Health, Department of Global Health and Population, Addis Ababa, Ethiopia; College of Medicine and Health Sciences, Bahir Dar University, Ethiopia
| | | | - Dereje Abdena
- Oromia Regional Health Bureau, Addis Ababa, Ethiopia
| | - Tsinuel Girma
- Fenot Project, Harvard T.H. Chan School of Public Health, Department of Global Health and Population, Addis Ababa, Ethiopia
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Mburu CN, Ojal J, Chebet R, Akech D, Karia B, Tuju J, Sigilai A, Abbas K, Jit M, Funk S, Smits G, van Gageldonk PGM, van der Klis FRM, Tabu C, Nokes DJ, Scott J, Flasche S, Adetifa I. The importance of supplementary immunisation activities to prevent measles outbreaks during the COVID-19 pandemic in Kenya. BMC Med 2021; 19:35. [PMID: 33531015 PMCID: PMC7854026 DOI: 10.1186/s12916-021-01906-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 01/11/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has disrupted routine measles immunisation and supplementary immunisation activities (SIAs) in most countries including Kenya. We assessed the risk of measles outbreaks during the pandemic in Kenya as a case study for the African Region. METHODS Combining measles serological data, local contact patterns, and vaccination coverage into a cohort model, we predicted the age-adjusted population immunity in Kenya and estimated the probability of outbreaks when contact-reducing COVID-19 interventions are lifted. We considered various scenarios for reduced measles vaccination coverage from April 2020. RESULTS In February 2020, when a scheduled SIA was postponed, population immunity was close to the herd immunity threshold and the probability of a large outbreak was 34% (8-54). As the COVID-19 contact restrictions are nearly fully eased, from December 2020, the probability of a large measles outbreak will increase to 38% (19-54), 46% (30-59), and 54% (43-64) assuming a 15%, 50%, and 100% reduction in measles vaccination coverage. By December 2021, this risk increases further to 43% (25-56), 54% (43-63), and 67% (59-72) for the same coverage scenarios respectively. However, the increased risk of a measles outbreak following the lifting of all restrictions can be overcome by conducting a SIA with ≥ 95% coverage in under-fives. CONCLUSION While contact restrictions sufficient for SAR-CoV-2 control temporarily reduce measles transmissibility and the risk of an outbreak from a measles immunity gap, this risk rises rapidly once these restrictions are lifted. Implementing delayed SIAs will be critical for prevention of measles outbreaks given the roll-back of contact restrictions in Kenya.
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Affiliation(s)
- C N Mburu
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya.
- Department of Infectious Diseases Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.
| | - J Ojal
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Department of Infectious Diseases Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - R Chebet
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - D Akech
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - B Karia
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - J Tuju
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - A Sigilai
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - K Abbas
- Department of Infectious Diseases Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - M Jit
- Department of Infectious Diseases Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - S Funk
- Department of Infectious Diseases Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - G Smits
- Department of Immunosurveillance, Centre for Infectious Diseases Control, National Institute of Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - P G M van Gageldonk
- Department of Immunosurveillance, Centre for Infectious Diseases Control, National Institute of Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - F R M van der Klis
- Department of Immunosurveillance, Centre for Infectious Diseases Control, National Institute of Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - C Tabu
- National Vaccine and Immunisation Programme, Ministry of Health, Nairobi, Kenya
| | - D J Nokes
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- School of Life Sciences and Zeeman Institute for Systems Biology and Infectious Disease Epidemiology Research (SBIDER), University of Warwick, Coventry, UK
| | - Jag Scott
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Department of Infectious Diseases Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - S Flasche
- Department of Infectious Diseases Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Imo Adetifa
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya.
- Department of Infectious Diseases Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.
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Cutts FT, Ferrari MJ, Krause LK, Tatem AJ, Mosser JF. Vaccination strategies for measles control and elimination: time to strengthen local initiatives. BMC Med 2021; 19:2. [PMID: 33397366 PMCID: PMC7781821 DOI: 10.1186/s12916-020-01843-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 11/05/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Through a combination of strong routine immunization (RI), strategic supplemental immunization activities (SIA) and robust surveillance, numerous countries have been able to approach or achieve measles elimination. The fragility of these achievements has been shown, however, by the resurgence of measles since 2016. We describe trends in routine measles vaccine coverage at national and district level, SIA performance and demographic changes in the three regions with the highest measles burden. FINDINGS WHO-UNICEF estimates of immunization coverage show that global coverage of the first dose of measles vaccine has stabilized at 85% from 2015 to 19. In 2000, 17 countries in the WHO African and Eastern Mediterranean regions had measles vaccine coverage below 50%, and although all increased coverage by 2019, at a median of 60%, it remained far below levels needed for elimination. Geospatial estimates show many low coverage districts across Africa and much of the Eastern Mediterranean and southeast Asian regions. A large proportion of children unvaccinated for MCV live in conflict-affected areas with remote rural areas and some urban areas also at risk. Countries with low RI coverage use SIAs frequently, yet the ideal timing and target age range for SIAs vary within countries, and the impact of SIAs has often been mitigated by delays or disruptions. SIAs have not been sufficient to achieve or sustain measles elimination in the countries with weakest routine systems. Demographic changes also affect measles transmission, and their variation between and within countries should be incorporated into strategic planning. CONCLUSIONS Rebuilding services after the COVID-19 pandemic provides a need and an opportunity to increase community engagement in planning and monitoring services. A broader suite of interventions is needed beyond SIAs. Improved methods for tracking coverage at the individual and community level are needed together with enhanced surveillance. Decision-making needs to be decentralized to develop locally-driven, sustainable strategies for measles control and elimination.
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Affiliation(s)
- F T Cutts
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.
| | - M J Ferrari
- Center for Infectious Disease Dynamics, Pennsylvania State University, University Park, PA, USA
| | - L K Krause
- Vaccine Delivery, Global Development, The Bill & Melinda Gates Foundation, Seattle, WA, USA
| | - A J Tatem
- WorldPop, Department of Geography and Environmental Science, University of Southampton, Highfield, Southampton, SO17 1BJ, UK
| | - J F Mosser
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, 98121, USA
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Lee BY, Brown ST, Haidari LA, Clark S, Abimbola T, Pallas SE, Wallace AS, Mitgang EA, Leonard J, Bartsch SM, Yemeke TT, Zenkov E, Ozawa S. Economic value of vaccinating geographically hard-to-reach populations with measles vaccine: A modeling application in Kenya. Vaccine 2019; 37:2377-2386. [PMID: 30922700 PMCID: PMC6487493 DOI: 10.1016/j.vaccine.2019.03.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 03/01/2019] [Accepted: 03/06/2019] [Indexed: 01/18/2023]
Abstract
BACKGROUND Since special efforts are necessary to vaccinate people living far from fixed vaccination posts, decision makers are interested in knowing the economic value of such efforts. METHODS Using our immunization geospatial information system platform and a measles compartment model, we quantified the health and economic value of a 2-dose measles immunization outreach strategy for children <24 months of age in Kenya who are geographically hard-to-reach (i.e., those living outside a specified catchment radius from fixed vaccination posts, which served as a proxy for access to services). FINDINGS When geographically hard-to-reach children were not vaccinated, there were 1427 total measles cases from 2016 to 2020, resulting in $9.5 million ($3.1-$18.1 million) in direct medical costs and productivity losses and 7504 (3338-12,903) disability-adjusted life years (DALYs). The outreach strategy cost $76 ($23-$142)/DALY averted (compared to no outreach) when 25% of geographically hard-to-reach children received MCV1, $122 ($40-$226)/DALY averted when 50% received MCV1, and $274 ($123-$478)/DALY averted when 100% received MCV1. CONCLUSION Outreach vaccination among geographically hard-to-reach populations was highly cost-effective in a wide variety of scenarios, offering support for investment in an effective outreach vaccination strategy.
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Affiliation(s)
- Bruce Y Lee
- Public Health Computational and Operations Research (PHICOR), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States; Global Obesity Prevention Center (GOPC), Johns Hopkins University, Baltimore, MD, United States.
| | - Shawn T Brown
- Pittsburgh Supercomputing Center (PSC), Carnegie Mellon University, Pittsburgh, PA, United States; McGill Centre for Integrative Neuroscience, McGill Neurological Institute, McGill University, Montreal, Canada
| | - Leila A Haidari
- Pittsburgh Supercomputing Center (PSC), Carnegie Mellon University, Pittsburgh, PA, United States
| | - Samantha Clark
- The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, University of Washington, Seattle, WA, United States
| | - Taiwo Abimbola
- Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States
| | - Sarah E Pallas
- Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States
| | - Aaron S Wallace
- Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States
| | - Elizabeth A Mitgang
- Public Health Computational and Operations Research (PHICOR), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States; Global Obesity Prevention Center (GOPC), Johns Hopkins University, Baltimore, MD, United States
| | - Jim Leonard
- Pittsburgh Supercomputing Center (PSC), Carnegie Mellon University, Pittsburgh, PA, United States
| | - Sarah M Bartsch
- Public Health Computational and Operations Research (PHICOR), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States; Global Obesity Prevention Center (GOPC), Johns Hopkins University, Baltimore, MD, United States
| | - Tatenda T Yemeke
- Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina - Chapel Hill, Chapel Hill, NC, United States
| | - Eli Zenkov
- Pittsburgh Supercomputing Center (PSC), Carnegie Mellon University, Pittsburgh, PA, United States
| | - Sachiko Ozawa
- Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina - Chapel Hill, Chapel Hill, NC, United States; Department of Maternal and Child Health, UNC Gillings School of Global Public Health, University of North Carolina - Chapel Hill, Chapel Hill, NC, United States
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