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Michael F, Mirambo MM, Misinzo G, Minzi O, Beyanga M, Mujuni D, Kalabamu FS, Nyanda EN, Mwanyika-Sando M, Ndiyo D, Kasonogo R, Ismail A, Bahati A, Hassan F, Kaale E, Chai JJ, Kinyunyi P, Kyesi F, Tinuga F, Mongi D, Salehe A, Muhindi B, Mdachi J, Magodi R, Mwenesi M, Nyaki H, Katembo B, Tenga K, Kasya M, Mwengee W, Mshana SE. Trends of measles in Tanzania: A 5-year review of case-based surveillance data, 2018-2022. Int J Infect Dis 2024; 139:176-182. [PMID: 38122965 PMCID: PMC10784152 DOI: 10.1016/j.ijid.2023.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 12/11/2023] [Accepted: 12/15/2023] [Indexed: 12/23/2023] Open
Abstract
OBJECTIVES Tanzania observed a gradual increase in the number of measles cases since 2019 with a large outbreak recorded during 2022. This study describes the trend of measles in Tanzania over a 5-year period from 2018-2022. METHODS This was a descriptive study conducted using routine measles case-based surveillance system including 195 councils of the United Republic of Tanzania. RESULTS Between 2018 and 2022 there were 12,253 measles cases reported. Out of 10,691 (87.25%) samples tested by enzyme-linked immunosorbent assay, 903 (8.4%) were measles immunoglobulin M positive. The highest number of laboratory-confirmed measles cases was in 2022 (64.8%), followed by 2020 (13.8%), and 2019 (13.5%). Out of 1279 unvaccinated cases, 213 (16.7%) were laboratory-confirmed measles cases compared to 77/723 (10.6%) who were partially vaccinated and 71/1121 (6.3%) who were fully vaccinated (P < 0.001). Children aged between 1-4 years constituted the most confirmed measles cases after laboratory testing, followed by those aged 5-9 years. There was a notable increase in the number of laboratory-confirmed measles cases in children <1 year and 10-14 years during 2022 compared to previous years. The vaccination coverage of the first dose of measles-containing vaccine (MCV1) was maintained >90% since 2013 while MCV2 increased gradually reaching 88% in 2022. CONCLUSIONS Accumulation of susceptible children to measles due to suboptimal measles vaccination coverage over the years has resulted in an increase in the number of laboratory-confirmed measles cases in Tanzania with more cases recorded during the COVID-19 pandemic. Strengthening surveillance, routine immunization, and targeted strategies are key to achieving the immunity levels required to interrupt measles outbreaks.
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Affiliation(s)
- Fausta Michael
- Immunization and Vaccine Development Program, Ministry of Health, Dodoma, Tanzania
| | - Mariam M Mirambo
- Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Gerald Misinzo
- OR Tambo Africa Research Chair for Viral Epidemics, SACIDS Foundation for One Health, Sokoine University of Agriculture, Morogoro, Tanzania
| | - Omary Minzi
- Department of Clinical Pharmacy and Pharmacology, School of Pharmacy, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Medard Beyanga
- National Public Health Laboratory, Ministry of Health, Dar es Salaam, Tanzania
| | - Delphinus Mujuni
- Immunization and Vaccine Development Program, Ministry of Health, Dodoma, Tanzania
| | - Florence S Kalabamu
- Department of Pediatrics and Child Health, Hubert Kairuki Memorial University, Dar es Salaam, Tanzania
| | - Elias N Nyanda
- Mbeya Medical Research Centre, National Institute for Medical Research, Mbeya, Tanzania
| | | | - Daniel Ndiyo
- Directorate of Regulatory Services, Government Chemist Laboratory Authority, Dodoma, Tanzania
| | - Richard Kasonogo
- Tanzania Medicines and Medical Devices Authority, Ministry of Health, Dodoma, Tanzania
| | - Abbas Ismail
- Department of Mathematics and Statistics, University of Dodoma, Dodoma, Tanzania
| | - Andrew Bahati
- Immunization and Vaccine Development Program, Ministry of Health, Dodoma, Tanzania
| | - Farida Hassan
- Health System, Impact Evaluation and Policy, Ifakara Health Institute, Ifakara, Tanzania
| | - Eliangiringa Kaale
- Pharm R&D Lab and Department of Medicinal Chemistry, School of Pharmacy, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - John J Chai
- District Court of Kwimba, Judiciary of Tanzania, Ngudu, Tanzania
| | - Pricillah Kinyunyi
- Immunization and Vaccine Development Program, Ministry of Health, Dodoma, Tanzania
| | - Furaha Kyesi
- Immunization and Vaccine Development Program, Ministry of Health, Dodoma, Tanzania
| | - Florian Tinuga
- Immunization and Vaccine Development Program, Ministry of Health, Dodoma, Tanzania
| | - Dhamira Mongi
- Immunization and Vaccine Development Program, Ministry of Health, Dodoma, Tanzania
| | - Abdul Salehe
- Immunization and Vaccine Development Program, Ministry of Health, Mnazimmoja, Zanzibar
| | - Bonaventura Muhindi
- Immunization and Vaccine Development Program, Ministry of Health, Dodoma, Tanzania
| | - Joseph Mdachi
- Immunization and Vaccine Development Program, Ministry of Health, Dodoma, Tanzania
| | - Richard Magodi
- Immunization and Vaccine Development Program, Ministry of Health, Dodoma, Tanzania
| | - Mwendwa Mwenesi
- Immunization and Vaccine Development Program, Ministry of Health, Dodoma, Tanzania
| | - Honest Nyaki
- Immunization and Vaccine Development Program, Ministry of Health, Dodoma, Tanzania
| | - Betina Katembo
- National Public Health Laboratory, Ministry of Health, Dar es Salaam, Tanzania
| | - Kelvin Tenga
- National Public Health Laboratory, Ministry of Health, Dar es Salaam, Tanzania
| | - Magdalena Kasya
- National Public Health Laboratory, Ministry of Health, Dar es Salaam, Tanzania
| | | | - Stephen E Mshana
- Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania.
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Musa KM, Oduoye MO, Qazi MS, Zulfiqar K. Measles in the Democratic Republic of the Congo needs urgent attention. Ther Adv Infect Dis 2024; 11:20499361241252534. [PMID: 38751757 PMCID: PMC11095177 DOI: 10.1177/20499361241252534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 04/17/2024] [Indexed: 05/18/2024] Open
Affiliation(s)
| | - Malik Olatunde Oduoye
- Department of Research, The Medical Research Circle (MedReC), PO Box 73, Goma, Democratic Republic of the Congo
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Sodjinou VD, Douba A, Nimpa MM, Masembe YV, Randria M, Ndiaye CF. Madagascar 2018-2019 measles outbreak response: main strategic areas. Pan Afr Med J 2020; 37:20. [PMID: 33062122 PMCID: PMC7532848 DOI: 10.11604/pamj.2020.37.20.24530] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 08/15/2020] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION on October 4th, 2018, a measles outbreak was declared in Madagascar. This study describes the outbreak response in terms of coordination, case management, vaccination response and epidemiological surveillance. METHODS data were collected using a line list and vaccination tally sheet. Serum samples were collected within 30 days of rash onset for laboratory testing; confirmation was made by detection of measles immunoglobulin M antibody. RESULTS from September 2018 to May 2019, a total of 146,277 measles cases were reported which included 1394 (1%) laboratory-confirmed cases and 144,883 (99%) epidemiological link-confirmed cases. The outbreak affected equally males (72,917 cases; 49.85%) and females (73,233 cases; 50.06%). The sex was not specified for 127 (0.09%) cases. Case fatality rate and attack rate were high among children less than 5 years. Responses interventions include effective coordination, free of charge case management, reactive vaccination, strengthened real-time surveillance, communication and community engagement and the revitalization of the routine immunization. Reactive vaccination was implemented in different phases. A total of 7,265,990 children aged from 6 months to 9 years were vaccinated. Post campaign survey coverage was 95%, 96% and 97% for phase 1, 2, 3 respectively. CONCLUSION elimination of measles will be challenging in Madagascar because of low routine immunization coverage and the absence of a second dose of measles vaccine in the routine immunization schedule.
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Affiliation(s)
| | - Alfred Douba
- World Health Organization Country Office, Madagascar
- Felix Houphouet Boigny University, Abidjan, Côte d´Ivoire
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Chitanvis M, Daughton AR, Altherr F, Parikh N, Fairchild G, Rosenberger W, Velappan N, Hollander A, Alipio-Lyon E, Vuyisich G, Aberle D, Deshpande A. Development of a Supervised Learning Algorithm for Detection of Potential Disease Reemergence: A Proof of Concept. Health Secur 2020; 17:255-267. [PMID: 31433278 DOI: 10.1089/hs.2019.0020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Infectious disease reemergence is an important yet ambiguous concept that lacks a quantitative definition. Currently, reemergence is identified without specific criteria describing what constitutes a reemergent event. This practice affects reproducible assessments of high-consequence public health events and disease response prioritization. This in turn can lead to misallocation of resources. More important, early recognition of reemergence facilitates effective mitigation. We used a supervised machine learning approach to detect potential disease reemergence. We demonstrate the feasibility of applying a machine learning classifier to identify reemergence events in a systematic way for 4 different infectious diseases. The algorithm is applicable to temporal trends of disease incidence and includes disease-specific features to identify potential reemergence. Through this study, we offer a structured means of identifying potential reemergence using a data-driven approach.
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Affiliation(s)
- Maneesha Chitanvis
- Maneesha Chitanvis, MPH, and Forest Altherr, MPH, are Graduate Research Assistants; Nileena Velappan, MS, Attelia Hollander, Emily Alipio-Lyon, and Grace Vuyisich are Research Technologists; and Alina Deshpande, PhD, is Group Leader; all in Biosecurity and Public Health, Bioscience Division, Los Alamos National Laboratory, Los Alamos, NM
| | - Ashlynn R Daughton
- Ashlynn R. Daughton, MPH, Nidhi Parikh, PhD, Geoffrey Fairchild, PhD, and William Rosenberger are Scientists, Analytics, Intelligence, and Technology Division, Los Alamos National Laboratory, Los Alamos, NM
| | - Forest Altherr
- Maneesha Chitanvis, MPH, and Forest Altherr, MPH, are Graduate Research Assistants; Nileena Velappan, MS, Attelia Hollander, Emily Alipio-Lyon, and Grace Vuyisich are Research Technologists; and Alina Deshpande, PhD, is Group Leader; all in Biosecurity and Public Health, Bioscience Division, Los Alamos National Laboratory, Los Alamos, NM
| | - Nidhi Parikh
- Ashlynn R. Daughton, MPH, Nidhi Parikh, PhD, Geoffrey Fairchild, PhD, and William Rosenberger are Scientists, Analytics, Intelligence, and Technology Division, Los Alamos National Laboratory, Los Alamos, NM
| | - Geoffrey Fairchild
- Ashlynn R. Daughton, MPH, Nidhi Parikh, PhD, Geoffrey Fairchild, PhD, and William Rosenberger are Scientists, Analytics, Intelligence, and Technology Division, Los Alamos National Laboratory, Los Alamos, NM
| | - William Rosenberger
- Ashlynn R. Daughton, MPH, Nidhi Parikh, PhD, Geoffrey Fairchild, PhD, and William Rosenberger are Scientists, Analytics, Intelligence, and Technology Division, Los Alamos National Laboratory, Los Alamos, NM
| | - Nileena Velappan
- Maneesha Chitanvis, MPH, and Forest Altherr, MPH, are Graduate Research Assistants; Nileena Velappan, MS, Attelia Hollander, Emily Alipio-Lyon, and Grace Vuyisich are Research Technologists; and Alina Deshpande, PhD, is Group Leader; all in Biosecurity and Public Health, Bioscience Division, Los Alamos National Laboratory, Los Alamos, NM
| | - Attelia Hollander
- Maneesha Chitanvis, MPH, and Forest Altherr, MPH, are Graduate Research Assistants; Nileena Velappan, MS, Attelia Hollander, Emily Alipio-Lyon, and Grace Vuyisich are Research Technologists; and Alina Deshpande, PhD, is Group Leader; all in Biosecurity and Public Health, Bioscience Division, Los Alamos National Laboratory, Los Alamos, NM
| | - Emily Alipio-Lyon
- Maneesha Chitanvis, MPH, and Forest Altherr, MPH, are Graduate Research Assistants; Nileena Velappan, MS, Attelia Hollander, Emily Alipio-Lyon, and Grace Vuyisich are Research Technologists; and Alina Deshpande, PhD, is Group Leader; all in Biosecurity and Public Health, Bioscience Division, Los Alamos National Laboratory, Los Alamos, NM
| | - Grace Vuyisich
- Maneesha Chitanvis, MPH, and Forest Altherr, MPH, are Graduate Research Assistants; Nileena Velappan, MS, Attelia Hollander, Emily Alipio-Lyon, and Grace Vuyisich are Research Technologists; and Alina Deshpande, PhD, is Group Leader; all in Biosecurity and Public Health, Bioscience Division, Los Alamos National Laboratory, Los Alamos, NM
| | - Derek Aberle
- Derek Aberle is a Software Developer, Applied Modern Physics, Physics Division, Los Alamos National Laboratory, Los Alamos, NM
| | - Alina Deshpande
- Maneesha Chitanvis, MPH, and Forest Altherr, MPH, are Graduate Research Assistants; Nileena Velappan, MS, Attelia Hollander, Emily Alipio-Lyon, and Grace Vuyisich are Research Technologists; and Alina Deshpande, PhD, is Group Leader; all in Biosecurity and Public Health, Bioscience Division, Los Alamos National Laboratory, Los Alamos, NM
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Coulborn RM, Nackers F, Bachy C, Porten K, Vochten H, Ndele E, Van Herp M, Bibala-Faray E, Cohuet S, Panunzi I. Field challenges to measles elimination in the Democratic Republic of the Congo. Vaccine 2020; 38:2800-2807. [PMID: 32111528 DOI: 10.1016/j.vaccine.2020.02.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 02/06/2020] [Accepted: 02/07/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND During a measles epidemic, the Ministry of Public Health (MOH) of the Democratic Republic of the Congo conducted supplementary immunization activities (2016-SIA) from August 28-September 3, 2016 throughout Maniema Province. From October 29-November 4, 2016, Médecins Sans Frontières and the MOH conducted a reactive measles vaccination campaign (2016-RVC) targeting children six months to 14 years old in seven health areas with heavy ongoing transmission despite inclusion in the 2016-SIA, and a post-vaccination survey. We report the measles vaccine coverage (VC) and effectiveness (VE) of the 2016-SIA and VC of the 2016-RVC. METHODS A cross-sectional VC cluster survey stratified by semi-urban/rural health area and age was conducted. A retrospective cohort analysis of measles reported by the parent/guardian allowed calculation of the cumulative measles incidence according to vaccination status after the 2016-SIA for an estimation of crude and adjusted VE. RESULTS In November 2016, 1145 children (6-59 months old) in the semi-urban and 1158 in the rural areas were surveyed. Post-2016-SIA VC (documentation/declaration) was 81.6% (95%CI: 76.5-85.7) in the semi-urban and 91.0% (95%CI: 84.9-94.7) in the rural areas. The reported measles incidence in October among children less than 5 years old was 5.0% for 2016-SIA-vaccinated and 11.2% for 2016-SIA-non-vaccinated in the semi-urban area, and 0.7% for 2016-SIA-vaccinated and 4.0% for 2016-SIA-non-vaccinated in the rural area. Post-2016-SIA VE (adjusted for age, sex) was 53.9% (95%CI: 2.9-78.8) in the semi-urban and 78.7% (95%CI: 0-97.1) in the rural areas. Post 2016-RVC VC (documentation/declaration) was 99.1% (95%CI: 98.2-99.6) in the semi-urban and 98.8% (95%CI: 96.5-99.6) in the rural areas. CONCLUSIONS Although our VE estimates could be underestimated due to misclassification of measles status, the VC and VE point estimates of the 2016-SIA in the semi-urban area appear suboptimal, and in combination, could not limit the epidemic. Further research is needed on vaccination strategies adapted to urban contexts.
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Affiliation(s)
| | | | - C Bachy
- Médecins Sans Frontières, Brussels, Belgium
| | | | - H Vochten
- Médecins Sans Frontières, Kinshasa, Democratic Republic of the Congo
| | - E Ndele
- Médecins Sans Frontières, Kinshasa, Democratic Republic of the Congo
| | - M Van Herp
- Médecins Sans Frontières, Brussels, Belgium
| | - E Bibala-Faray
- Ministry of Public Health, Maniema, Democratic Republic of the Congo
| | | | - I Panunzi
- Médecins Sans Frontières, Brussels, Belgium
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Measles outbreak in an office building in the crowded Metropolis of Beijing, China. BMC Infect Dis 2019; 19:771. [PMID: 31481053 PMCID: PMC6724294 DOI: 10.1186/s12879-019-4404-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 08/25/2019] [Indexed: 12/11/2022] Open
Abstract
Background Although worldwide measles elimination achieved great progress for decades, outbreaks were still reported in certain countries. This study describes the epidemiologic features of a substantial measles outbreak in an office building in Beijing and explores control strategies in a crowded city. Methods We performed descriptive analyses of data on demographic characteristic, laboratory testing and epidemiological information. Results From February 25 to March 28, 2016, 43 outbreak-related measles cases occurred in an office building in Beijing. The total crude attack rate was 1.20% in the building. The age range of patients was 23 to 45 years old, of whom 30 (69.8%) were migrants and 5 (11.6%) were vaccinated but without documentation. The attack rate of the department and the company of the source case was 22.73 and 11.86%, respectively. The attack rate in the building was 1.78%, except for the commercial center on the lower floors, which was 0.34%. Of the 43 measles cases, only 19 cases (53.5%) were reported by hospitals through the National Notifiable Disease Reporting System (NNDRS), and the rest were found through active surveillance. Outbreak response immunization was conducted for 6216 persons. Conclusions Office buildings in crowded metropolis are prone to large-scale measles outbreaks, and require a rapid outbreak response. Early Outbreak response immunization and active surveillance are important strategies to control outbreaks such as the one reported herein.
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Sir-Ondo-Enguier PN, Ngoungou EB, Nghomo YN, Boundenga L, Moupiga-Ndong P, Ibinga E, Deparis X, Lékana-Douki JB. Syndromic surveillance of potentially epidemic infectious diseases: Detection of a measles epidemic in two health centers in Gabon, Central Africa. Infect Dis Rep 2019; 11:7701. [PMID: 31205640 PMCID: PMC6547028 DOI: 10.4081/idr.2019.7701] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 04/10/2019] [Indexed: 12/11/2022] Open
Abstract
Measles is a respiratory disease caused by the measles virus (MV) belonging to the Paramyxovirus family and the Morbillivirus genus. Due to a failure in maintaining immunization coverage in some countries, measles is a re-emerging disease in the human population, especially in Africa. The aim of this study was to describe a measles epidemic in Gabon. At first, a syndromic surveillance was set up. Blood samples from febrile patients with maculopapular rash were taken and sent to the measles reference center in Cameroon for laboratory confirmation. Between March and May 2016, 79 clinically suspected cases were reported including 82.3% (n=65) and 17.7% (n=14) in Oyem and Libreville, respectively. In total, 39.2% (n=31) of children were 11 months-old, 34.2% (n=27) were children aged 1 to 4 years, 11.4% (n=9) were older children from 5 to 9 years, 6.3% (n=5) of children were aged 10 to 15 years and 8.9% (n=7) were 15 years and older. 53.3% (16/30) were laboratory confirmed. This measles outbreak reiterates the importance of maintaining a high level of vaccine coverage in Gabon for vaccine-preventable diseases, as well as the usefulness of a near-real-time surveillance system for the detection of infectious diseases.
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Affiliation(s)
- Pater Noster Sir-Ondo-Enguier
- UMR 912 Sciences Economiques et Sociales de la Santé et Traitement de I'Information Médicale, Université d'Aix-Marseille, Marseille, France.,Unité, Evolution, Épidémiologie et Résistances Parasitaires, Centre International de Recherches Médicales de Franceville - CIRMF, Franceville, Gabon
| | - Edgard Brice Ngoungou
- Département d'Epidémiologie Biostatistiques et Informatique Médicale (DEBIM), Faculté de Médecine, Université des Sciences de la Santé, Libreville, Gabon
| | | | - Larson Boundenga
- Unité, Evolution, Épidémiologie et Résistances Parasitaires, Centre International de Recherches Médicales de Franceville - CIRMF, Franceville, Gabon
| | | | - Euloge Ibinga
- Département d'Epidémiologie Biostatistiques et Informatique Médicale (DEBIM), Faculté de Médecine, Université des Sciences de la Santé, Libreville, Gabon
| | - Xavier Deparis
- UMR 912 Sciences Economiques et Sociales de la Santé et Traitement de I'Information Médicale, Université d'Aix-Marseille, Marseille, France
| | - Jean-Bernard Lékana-Douki
- Unité, Evolution, Épidémiologie et Résistances Parasitaires, Centre International de Recherches Médicales de Franceville - CIRMF, Franceville, Gabon.,Département de Parasitologie-Mycologie et de Médecine Tropicale, Faculté de Médecine, Université des Sciences de la Santé, Libreville, Gabon
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Kundrick A, Huang Z, Carran S, Kagoli M, Grais RF, Hurtado N, Ferrari M. Sub-national variation in measles vaccine coverage and outbreak risk: a case study from a 2010 outbreak in Malawi. BMC Public Health 2018; 18:741. [PMID: 29902976 PMCID: PMC6003196 DOI: 10.1186/s12889-018-5628-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 05/29/2018] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Despite progress towards increasing global vaccination coverage, measles continues to be one of the leading, preventable causes of death among children worldwide. Whether and how to target sub-national areas for vaccination campaigns continues to remain a question. We analyzed three metrics for prioritizing target areas: vaccination coverage, susceptible birth cohort, and the effective reproductive ratio (RE) in the context of the 2010 measles epidemic in Malawi. METHODS Using case-based surveillance data from the 2010 measles outbreak in Malawi, we estimated vaccination coverage from the proportion of cases reporting with a history of prior vaccination at the district and health facility catchment scale. Health facility catchments were defined as the set of locations closer to a given health facility than to any other. We combined these estimates with regional birth rates to estimate the size of the annual susceptible birth cohort. We also estimated the effective reproductive ratio, RE, at the health facility polygon scale based on the observed rate of exponential increase of the epidemic. We combined these estimates to identify spatial regions that would be of high priority for supplemental vaccination activities. RESULTS The estimated vaccination coverage across all districts was 84%, but ranged from 61 to 99%. We found that 8 districts and 354 health facility catchments had estimated vaccination coverage below 80%. Areas that had highest birth cohort size were frequently large urban centers that had high vaccination coverage. The estimated RE ranged between 1 and 2.56. The ranking of districts and health facility catchments as priority areas varied depending on the measure used. CONCLUSIONS Each metric for prioritization may result in discrete target areas for vaccination campaigns; thus, there are tradeoffs to choosing one metric over another. However, in some cases, certain areas may be prioritized by all three metrics. These areas should be treated with particular concern. Furthermore, the spatial scale at which each metric is calculated impacts the resulting prioritization and should also be considered when prioritizing areas for vaccination campaigns. These methods may be used to allocate effort for prophylactic campaigns or to prioritize response for outbreak response vaccination.
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Affiliation(s)
- Avery Kundrick
- Hershey Medical School, The Pennsylvania State University, Hershey, PA, USA
| | - Zhuojie Huang
- Department of Biology, The Pennsylvania State University, University Park, PA, USA
| | - Spencer Carran
- Department of Biology, The Pennsylvania State University, University Park, PA, USA
| | | | | | | | - Matthew Ferrari
- Department of Biology, The Pennsylvania State University, University Park, PA, USA.
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Gignoux E, Polonsky J, Ciglenecki I, Bichet M, Coldiron M, Thuambe Lwiyo E, Akonda I, Serafini M, Porten K. Risk factors for measles mortality and the importance of decentralized case management during an unusually large measles epidemic in eastern Democratic Republic of Congo in 2013. PLoS One 2018. [PMID: 29538437 PMCID: PMC5851624 DOI: 10.1371/journal.pone.0194276] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
In 2013, a large measles epidemic occurred in the Aketi Health Zone of the Democratic Republic of Congo. We conducted a two-stage, retrospective cluster survey to estimate the attack rate, the case fatality rate, and the measles-specific mortality rate during the epidemic. 1424 households containing 7880 individuals were included. The estimated attack rate was 14.0%, (35.0% among children aged <5 years). The estimated case fatality rate was 4.2% (6.1% among children aged <5 years). Spatial analysis and linear regression showed that younger children, those who did not receive care, and those living farther away from Aketi Hospital early in the epidemic had a higher risk of measles related death. Vaccination coverage prior to the outbreak was low (76%), and a delayed reactive vaccination campaign contributed to the high attack rate. We provide evidences suggesting that a comprehensive case management approach reduced measles fatality during this epidemic in rural, inaccessible resource-poor setting.
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Affiliation(s)
| | | | | | - Mathieu Bichet
- Médecins Sans Frontières, Geneva, Switzerland
- Médecins Sans Frontières, Paris, France
| | | | | | - Innocent Akonda
- Ministère de la Santé Publique, Kinshassa, République Démocratique du Congo
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Hoff NA, Doshi RH, Colwell B, Kebela-Illunga B, Mukadi P, Mossoko M, Spencer D, Muyembe-Tamfum JJ, Okitolonda-Wemakoy E, Lloyd-Smith J, Rimoin AW. Evolution of a Disease Surveillance System: An Increase in Reporting of Human Monkeypox Disease in the Democratic Republic of the Congo, 2001-2013. ACTA ACUST UNITED AC 2017; 25. [PMID: 30123790 PMCID: PMC6095679 DOI: 10.9734/ijtdh/2017/35885] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Objective Evaluating the effectiveness of a surveillance system, and how it improves over time has significant implications for disease control and prevention. In the Democratic Republic of Congo (DRC), the Integrated Disease Surveillance and Response (IDSR) was implemented to estimate the burden of disease, monitor changes in disease occurrence, and inform resource allocation. For this effort we utilized national passive surveillance data from DRC's IDSR to explore reporting trends of human monkeypox (MPX) from 2001 to 2013. Methods We obtained surveillance data on MPX cases occurring between January 2001 and December 2013 from the DRC Ministry of Health (MoH). Phases of the surveillance system, yearly trends in reporting and estimated incidence for MPX were analyzed using SAS v9.2 and Health Mapper. Results Between 2001 and 2013, three discrete surveillance phases were identified that described the evolution of the surveillance system. Overall, an increase in suspected MPX cases was reported, beyond what would be expected from simply an improved reporting system. When restricting the analysis to the "stable phase," national estimated incidence increased from 2.13 per 100,000 in 2008 to 2.84 per 100,000 in 2013. Conclusions The reported increase in MPX, based on an evolving surveillance system, is likely to be a true increase in disease occurrence rather than simply improvements to the surveillance system. Further analyses should provide critical information for improved prevention and control strategies and highlight areas of improvement for future data collection efforts.
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Affiliation(s)
- Nicole A Hoff
- Fielding School of Public Health, University of California, Los Angeles, CA, USA
| | - Reena H Doshi
- Fielding School of Public Health, University of California, Los Angeles, CA, USA
| | - Brian Colwell
- Health Promotion and Community Health Sciences, Texas A&M School of Public Health, College Station, TX, USA
| | - Benoit Kebela-Illunga
- Ministry of Public Health, Direction for Disease Control, Democratic Republic of the Congo
| | - Patrick Mukadi
- National Institute for Biomedical Research, Democratic Republic of the Congo
| | - Mathias Mossoko
- Ministry of Public Health, Direction for Disease Control, Democratic Republic of the Congo
| | - D'Andre Spencer
- Fielding School of Public Health, University of California, Los Angeles, CA, USA
| | | | | | | | - Anne W Rimoin
- Fielding School of Public Health, University of California, Los Angeles, CA, USA
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11
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Corey KC, Noymer A. A 'post-honeymoon' measles epidemic in Burundi: mathematical model-based analysis and implications for vaccination timing. PeerJ 2016; 4:e2476. [PMID: 27672515 PMCID: PMC5028774 DOI: 10.7717/peerj.2476] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 08/23/2016] [Indexed: 12/27/2022] Open
Abstract
Using a mathematical model with realistic demography, we analyze a large outbreak of measles in Muyinga sector in rural Burundi in 1988–1989. We generate simulated epidemic curves and age × time epidemic surfaces, which we qualitatively and quantitatively compare with the data. Our findings suggest that supplementary immunization activities (SIAs) should be used in places where routine vaccination cannot keep up with the increasing numbers of susceptible individuals resulting from population growth or from logistical problems such as cold chain maintenance. We use the model to characterize the relationship between SIA frequency and SIA age range necessary to suppress measles outbreaks. If SIAs are less frequent, they must expand their target age range.
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Affiliation(s)
- Katelyn C Corey
- Fielding School of Public Health, University of California , Los Angeles , CA , United States
| | - Andrew Noymer
- Department of Population Health and Disease Prevention, University of California , Irvine , CA , United States
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12
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Thompson KM, Odahowski CL, Goodson JL, Reef SE, Perry RT. Synthesis of Evidence to Characterize National Measles and Rubella Exposure and Immunization Histories. RISK ANALYSIS : AN OFFICIAL PUBLICATION OF THE SOCIETY FOR RISK ANALYSIS 2016; 36:1427-1458. [PMID: 26249328 DOI: 10.1111/risa.12454] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 05/26/2015] [Accepted: 05/26/2015] [Indexed: 06/04/2023]
Abstract
Population immunity depends on the dynamic levels of immunization coverage that countries achieve over time and any transmission of viruses that occur within the population that induce immunity. In the context of developing a dynamic transmission model for measles and rubella to support analyses of future immunization policy options, we assessed the model inputs required to reproduce past behavior and to provide some confidence about model performance at the national level. We reviewed the data available from the World Health Organization (WHO) and existing measles and rubella literature for evidence of historical reported routine and supplemental immunization activities and reported cases and outbreaks. We constructed model input profiles for 180 WHO member states and three other areas to support disease transmission model development and calibration. The profiles demonstrate the significant variability in immunization strategies used historically by regions and member states and the epidemiological implications of these historical choices. The profiles provide a historical perspective on measles and rubella immunization globally at the national level, and they may help immunization program managers identify existing immunity and/or knowledge gaps.
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Affiliation(s)
- Kimberly M Thompson
- Kid Risk, Inc, Orlando, FL, USA
- University of Central Florida, College of Medicine, Orlando, FL, USA
| | | | - James L Goodson
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Susan E Reef
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
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13
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The effect of immunization on measles incidence in the Democratic Republic of Congo: Results from a model of surveillance data. Vaccine 2015; 33:6786-92. [PMID: 26476363 DOI: 10.1016/j.vaccine.2015.10.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 10/01/2015] [Accepted: 10/06/2015] [Indexed: 11/22/2022]
Abstract
BACKGROUND Measles continues to be a leading cause of vaccine-preventable disease mortality among children under five despite a safe and efficacious vaccine being readily available. While global vaccination coverage has improved tremendously, measles outbreaks persist throughout sub-Saharan Africa. Since 2010, the Democratic Republic of Congo (DRC) has seen a resurgence of measles outbreaks affecting all 11 provinces. These outbreaks are mainly attributed to gaps in routine immunization (RI) coverage compounded with missed supplementary immunization activities (SIAs). We utilized national passive surveillance data from DRC's Integrated Disease Surveillance and Response (IDSR) system to estimate the effect of immunization on measles incidence in DRC. METHODS We investigated the decline in measles incidence post-immunization with one dose of measles containing vaccine (MCV1) with and without the addition of supplementary immunization activities (SIAs) and outbreak response immunization (ORI) campaigns. Measles case counts by health zone were obtained from the IDSR system between January 1, 2010 and December 31, 2013. The impact of measles immunization was modeled using a random effects multi-level model for count data with RI coverage levels and mass campaign activities from one year prior. RESULTS The presence of an SIA (aIRR [95% CI] 0.86 [0.60-1.25]) and ORI (0.28 [0.20-0.39]) in the year prior were both associated with a decrease in measles incidence. When interaction terms were included, our results suggested that the high levels of MCV1 reported in the year prior and the presence of either mass campaign was associated with a decrease in measles incidence. CONCLUSIONS Our results highlight the importance of a two-dose measles vaccine schedule and the need for a strong routine immunization program coupled with frequent SIAs. Repeated occurrences of large-scale outbreaks in DRC suggest that vaccination coverage rates are grossly overestimated and signify the importance of the evaluation and modification of measles prevention and control strategies.
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Gerard SP, Kyrousis E, Zachariah R. Measles in the Democratic Republic of Congo: an urgent wake-up call to adapt vaccination implementation strategies. Public Health Action 2015; 4:6-8. [PMID: 26423753 DOI: 10.5588/pha.13.0099] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Accepted: 01/08/2014] [Indexed: 11/10/2022] Open
Abstract
All countries in Africa have made a commitment to eliminate measles by 2020. This is laudable, as measles elimination will have a crucial impact on reducing childhood mortality. An important operational challenge is the resurgence of measles outbreaks in a number of countries; one of the main reasons for this is that many children are being missed by vaccination programmes. In the Democratic Republic of Congo (DRC), outbreaks continue unabated despite repeated vaccination campaigns and high reported coverage by the Ministry of Health. This paper brings into question the effectiveness of the current approach and the need for better reflection on bottlenecks and strategies that can address this issue. If we are to eliminate measles by 2020, there will be a need for impetus, a need for decisive action to reach that goal and prevent unnecessary childhood deaths in countries such as the DRC.
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Affiliation(s)
- S P Gerard
- Analysis and Advocacy Unit, Brussels Operational Centre, Médecins Sans Frontières (MSF), Brussels, Belgium
| | - E Kyrousis
- MSF, Kinshasa, Democratic Republic of Congo
| | - R Zachariah
- Operational Research Unit, Brussels Operational Centre, MSF, Luxembourg
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15
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Scobie HM, Ilunga BK, Mulumba A, Shidi C, Coulibaly T, Obama R, Tamfum JJM, Simbu EP, Smit SB, Masresha B, Perry RT, Alleman MM, Kretsinger K, Goodson J. Antecedent causes of a measles resurgence in the Democratic Republic of the Congo. Pan Afr Med J 2015; 21:30. [PMID: 26401224 PMCID: PMC4561157 DOI: 10.11604/pamj.2015.21.30.6335] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 04/20/2015] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Despite accelerated measles control efforts, a massive measles resurgence occurred in the Democratic Republic of the Congo (DRC) starting in mid-2010, prompting an investigation into likely causes. METHODS We conducted a descriptive epidemiological analysis using measles immunization and surveillance data to understand the causes of the measles resurgence and to develop recommendations for elimination efforts in DRC. RESULTS During 2004-2012, performance indicator targets for case-based surveillance and routine measles vaccination were not met. Estimated coverage with the routine first dose of measles-containing vaccine (MCV1) increased from 57% to 73%. Phased supplementary immunization activities (SIAs) were conducted starting in 2002, in some cases with sub-optimal coverage (≤95%). In 2010, SIAs in five of 11 provinces were not implemented as planned, resulting in a prolonged interval between SIAs, and a missed birth cohort in one province. During July 1, 2010-December 30, 2012, high measles attack rates (>100 cases per 100,000 population) occurred in provinces that had estimated MCV1 coverage lower than the national estimate and did not implement planned 2010 SIAs. The majority of confirmed case-patients were aged <10 years (87%) and unvaccinated or with unknown vaccination status (75%). Surveillance detected two genotype B3 and one genotype B2 measles virus strains that were previously identified in the region. CONCLUSION The resurgence was likely caused by an accumulation of unvaccinated, measles-susceptible children due to low MCV1 coverage and suboptimal SIA implementation. To achieve the regional goal of measles elimination by 2020, efforts are needed in DRC to improve case-based surveillance and increase two-dose measles vaccination coverage through routine services and SIAs.
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Affiliation(s)
- Heather Melissa Scobie
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA ; Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta
| | | | - Audry Mulumba
- Ministry of Public Health, Kinshasa, Democratic Republic of the Congo
| | - Calixte Shidi
- Ministry of Public Health, Kinshasa, Democratic Republic of the Congo
| | | | | | | | | | | | - Balcha Masresha
- World Health Organization African Regional Office, Brazzaville, Republic of the Congo
| | | | | | | | - James Goodson
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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16
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Doshi RH, Mukadi P, Shidi C, Mulumba A, Hoff NA, Gerber S, Okitolonda-Wemakoy E, Ilunga BK, Muyembe JJ, Rimoin AW. Field evaluation of measles vaccine effectiveness among children in the Democratic Republic of Congo. Vaccine 2015; 33:3407-14. [PMID: 25937449 DOI: 10.1016/j.vaccine.2015.04.067] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Revised: 04/10/2015] [Accepted: 04/17/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND Large-scale measles outbreaks in areas with high administrative vaccine coverage rates suggest the need to re-evaluate measles prevention and control in the Democratic Republic of Congo (DRC). Monitoring of measles Vaccine Effectiveness (VE) is a useful measure of quality control in immunization programs. We estimated measles VE among children aged 12-59 months in the Democratic Republic of Congo (DRC) using laboratory surveillance data from 2010-2012. METHODS We used the case-based surveillance system with laboratory confirmation to conduct a case-control study using the test negative design. Cases and controls were selected based on presence (n=1044) or absence (n=1335) of measles specific antibody IgM or epidemiologic linkage. Risk factors for measles were assessed using unconditional logistic regression, stratified by age. RESULTS Among children 12-59 months, measles vaccination was protective against measles [aOR (95%C)], 0.20 (0.15-0.26) and estimated VE was 80% (95% CI 74-85%). Year of diagnosis, 2011: 6.02 (4.16-8.72) and 2012; 8.31 (5.57-12.40) was a risk factor for measles when compared to 2010. Compared to Kinshasa, children in Bas-Congo, Kasai-Oriental, Maniema and South Kivu provinces all had higher odds of developing measles. Measles VE was similar for children 12-23 months and 24-59 months (80% and 81% respectively). CONCLUSIONS Repeated occurrences of measles outbreaks and lower than expected VE estimates suggest the need to further evaluate measles vaccine efficacy and improve vaccine delivery strategies in DRC.
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Affiliation(s)
- Reena H Doshi
- Department of Epidemiology, UCLA Fielding School of Public Health, 650 S Charles E Young Drive, Los Angeles, CA 90095, USA.
| | - Patrick Mukadi
- Department of Microbiology, Kinshasa School of Medicine, B.P. 127 Kinshasa, Lemba, Kinshasa, Democratic Republic of the Congo.
| | - Calixte Shidi
- Expanded Programme on Immunization, Ave de la Justice, Kinshasa, Democratic Republic of the Congo.
| | - Audry Mulumba
- Expanded Programme on Immunization, Ave de la Justice, Kinshasa, Democratic Republic of the Congo.
| | - Nicole A Hoff
- Department of Epidemiology, UCLA Fielding School of Public Health, 650 S Charles E Young Drive, Los Angeles, CA 90095, USA.
| | - Sue Gerber
- Polio Program, Bill and Melinda Gates Foundation, 500 Fifth Avenue North, Seattle, WA 98109, USA.
| | - Emile Okitolonda-Wemakoy
- Kinshasa School of Public Health, B.P. 127 Kinshasa, Lemba, Kinshasa, Democratic Republic of the Congo.
| | - Benoit Kebela Ilunga
- Division of Disease Control, Ministry of Public Health, Ave de la Justice, Kinshasa, Democratic Republic of the Congo.
| | - Jean-Jacques Muyembe
- National Institute for Biomedical Research, Minister of Public Health, Avenue de la Democratie, Kinshasa, Democratic Republic of the Congo.
| | - Anne W Rimoin
- Department of Epidemiology, UCLA Fielding School of Public Health, 650 S Charles E Young Drive, Los Angeles, CA 90095, USA.
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Gil Cuesta J, Mukembe N, Valentiner-Branth P, Stefanoff P, Lenglet A. Measles vaccination coverage survey in moba, katanga, democratic republic of congo, 2013: need to adapt routine and mass vaccination campaigns to reach the unreached. PLOS CURRENTS 2015; 7:ecurrents.outbreaks.8a1b00760dfd81481eb42234bd18ced3. [PMID: 25713744 PMCID: PMC4336195 DOI: 10.1371/currents.outbreaks.8a1b00760dfd81481eb42234bd18ced3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The Democratic Republic of Congo (DRC) has committed to eliminate measles by 2020. In 2013, in response to a large outbreak, Médecins Sans Frontières conducted a mass vaccination campaign (MVC) in Moba, Katanga, DRC. We estimated the measles vaccination coverage for the MVC, the Expanded Programme on Immunization routine measles vaccination (EPI) and assessed reasons for non-vaccination. We conducted a household-based survey among caretakers of children aged 6 months-15 years in Moba from November to December 2013. We used a two-stage-cluster-sampling, where clusters were allocated proportionally to village size and households were randomly selected from each cluster. The questionnaire included demographic variables, vaccination status (card or oral history) during MVC and EPI and reasons for non-vaccination. We estimated the coverage by gender, age and the reasons for non-vaccination and calculated 95% confidence intervals (95% CI). We recruited 4,768 children living in 1,684 households. The MVC coverage by vaccination card and oral history was 87% (95% CI 84-90) and 66% (95% CI 61-70) if documented by card. The EPI coverage was 76% (95% CI 72-81) and 3% (95% CI 1-4) respectively. The MVC coverage was significantly higher among children previously vaccinated during EPI 91% (95% CI 88-93), compared to 74% (95% CI 66-80) among those not previously vaccinated. Six percent (n=317) of children were never vaccinated. The main reason for non-vaccination was family absence 68% (95% CI 58-78). The MVC and EPI measles coverage was insufficient to prevent the recurrence of outbreaks in Moba. Lack of EPI vaccination and lack of accessibility by road were associated with lower MVC coverage. We recommend intensified social mobilization and extended EPI and MVCs to increase the coverage of absent residents and unreached children. Routine and MVCs need to be adapted accordingly to improve coverage in hard-to-reach populations in DRC.
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Affiliation(s)
- Julita Gil Cuesta
- Infectious Disease Epidemiology, Statens Serum Institute, European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Copenhager, Denmark
| | - Narcisse Mukembe
- Médecins Sans Frontières, Operational Center Amsterdam, Lubumbashi, Democratic Republic of Congo
| | | | - Pawel Stefanoff
- Department of Infectious Disease Epidemiology, Norwegian Institute of Public Health, Oslo, Norway
| | - Annick Lenglet
- Public Health Department, Médecins Sans Frontières, Operational Center Amsterdam, Amsterdam, The Netherlands
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18
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Mancini S, Coldiron ME, Ronsse A, Ilunga BK, Porten K, Grais RF. Description of a large measles epidemic in Democratic Republic of Congo, 2010-2013. Confl Health 2014; 8:9. [PMID: 25053974 PMCID: PMC4105555 DOI: 10.1186/1752-1505-8-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Accepted: 06/24/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although measles mortality has declined dramatically in Sub-Saharan Africa, measles remains a major public health problem in countries like the Democratic Republic of Congo (DRC). Here, we describe the large measles epidemic that occurred in the Democratic Republic of Congo between 2010 and 2013 using data from the national surveillance system as well as vaccine coverage surveys to provide a snapshot of the epidemiology of measles in DRC. METHODS Standardized national surveillance data were used to describe measles cases from 2010 to 2013. Attack rates and case fatality ratios were calculated and the temporal and spatial evolution of the epidemic described. Data on laboratory confirmation and vaccination coverage surveys as a part of routine program monitoring are also presented. FINDINGS Between week 1 of 2010 and week 45 of 2013, a total of 294,455 cases and 5,045 deaths were reported. The cumulative attack rate (AR) was 0.4%. The Case Fatality Ratio (CFR) was 1.7% among cases reported in health structures through national surveillance. A total of 186,178 cases (63%) were under 5 years old, representing an estimated AR of 1.4% in this age group. Following the first mass vaccination campaigns, weekly reported cases decreased by 21.5%. Results of post-vaccination campaign coverage surveys indicated sub-optimal (under 95%) vaccination coverage among children surveyed. CONCLUSIONS The data reported here highlight the need to seek additional means to reinforce routine immunization as well as ensure the timely implementation of Supplementary Immunization Activities to prevent large and repeated measles epidemics in DRC. Although reactive campaigns were conducted in response to the epidemic, strategies to ensure that children are vaccinated in the routine system remains the foundation of measles control.
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Affiliation(s)
- Silvia Mancini
- Epicentre, 8 Rue Saint Sabin, Paris 75011, France
- Médecins Sans Frontières, Via Magenta 5, Rome, Italy
| | | | | | - Benoît Kebela Ilunga
- Ministry of Health, Av. De la Justice 39, Gombe I, Kinshasa, Democratic Republic of Congo
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Lejon V, Mumba Ngoyi D, Kestens L, Boel L, Barbé B, Kande Betu V, van Griensven J, Bottieau E, Muyembe Tamfum JJ, Jacobs J, Büscher P. Gambiense human african trypanosomiasis and immunological memory: effect on phenotypic lymphocyte profiles and humoral immunity. PLoS Pathog 2014; 10:e1003947. [PMID: 24603894 PMCID: PMC3946376 DOI: 10.1371/journal.ppat.1003947] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Accepted: 01/09/2014] [Indexed: 12/25/2022] Open
Abstract
In mice, experimental infection with Trypanosoma brucei causes decreased bone marrow B-cell development, abolished splenic B-cell maturation and loss of antibody mediated protection including vaccine induced memory responses. Nothing is known about this phenomenon in human African trypanosomiasis (HAT), but if occurring, it would imply the need of revaccination of HAT patients after therapy and abolish hope for a HAT vaccine. The effect of gambiense HAT on peripheral blood memory T- and B-cells and on innate and vaccine induced antibody levels was examined. The percentage of memory B- and T-cells was quantified in peripheral blood, prospectively collected in DR Congo from 117 Trypanosoma brucei gambiense infected HAT patients before and six months after treatment and 117 controls at the same time points. Antibodies against carbohydrate antigens on red blood cells and against measles were quantified. Before treatment, significantly higher percentages of memory B-cells, mainly T-independent memory B-cells, were observed in HAT patients compared to controls (CD20+CD27+IgM+, 13.0% versus 2.0%, p<0.001). The percentage of memory T-cells, mainly early effector/memory T-cells, was higher in HAT (CD3+CD45RO+CD27+, 19.4% versus 16.7%, p = 0.003). After treatment, the percentage of memory T-cells normalized, the percentage of memory B-cells did not. The median anti-red blood cell carbohydrate IgM level was one titer lower in HAT patients than in controls (p<0.004), and partially normalized after treatment. Anti-measles antibody concentrations were lower in HAT patients than in controls (medians of 1500 versus 2250 mIU/ml, p = 0.02), and remained so after treatment, but were above the cut-off level assumed to provide protection in 94.8% of HAT patients, before and after treatment (versus 98.3% of controls, p = 0.3). Although functionality of the B-cells was not verified, the results suggest that immunity was conserved in T.b. gambiense infected HAT patients and that B-cell dysfunction might not be that severe as in mouse models.
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Affiliation(s)
- Veerle Lejon
- Institute of Tropical Medicine, Antwerp, Belgium
- Institut de Recherche pour le Développement, UMR 177 IRD-CIRAD INTERTRYP, Montpellier, France
| | - Dieudonné Mumba Ngoyi
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
| | - Luc Kestens
- Institute of Tropical Medicine, Antwerp, Belgium
| | - Luc Boel
- Institute of Tropical Medicine, Antwerp, Belgium
| | | | - Victor Kande Betu
- Programme Nationale de Lutte contre la Trypanosomiase Humaine Africaine, Kinshasa, Democratic Republic of the Congo
| | | | | | | | - Jan Jacobs
- Institute of Tropical Medicine, Antwerp, Belgium
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Grout L, Conan N, Juan Giner A, Hurtado N, Fermon F, N'Goran A, Grellety E, Minetti A, Porten K, Grais RF. Local discrepancies in measles vaccination opportunities: results of population-based surveys in Sub-Saharan Africa. BMC Public Health 2014; 14:193. [PMID: 24559281 PMCID: PMC3938072 DOI: 10.1186/1471-2458-14-193] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Accepted: 01/31/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The World Health Organization recommends African children receive two doses of measles containing vaccine (MCV) through routine programs or supplemental immunization activities (SIA). Moreover, children have an additional opportunity to receive MCV through outbreak response immunization (ORI) mass campaigns in certain contexts. Here, we present the results of MCV coverage by dose estimated through surveys conducted after outbreak response in diverse settings in Sub-Saharan Africa. METHODS We included 24 household-based surveys conducted in six countries after a non-selective mass vaccination campaign. In the majority (22/24), the survey sample was selected using probability proportional to size cluster-based sampling. Others used Lot Quality Assurance Sampling. RESULTS In total, data were collected on 60,895 children from 2005 to 2011. Routine coverage varied between countries (>95% in Malawi and Kirundo province (Burundi) while <35% in N'Djamena (Chad) in 2005), within a country and over time. SIA coverage was <75% in most settings. ORI coverage ranged from >95% in Malawi to 71.4% [95% CI: 68.9-73.8] in N'Djamena (Chad) in 2005.In five sites, >5% of children remained unvaccinated after several opportunities. Conversely, in Malawi and DRC, over half of the children eligible for the last SIA received a third dose of MCV. CONCLUSIONS Control pre-elimination targets were still not reached, contributing to the occurrence of repeated measles outbreak in the Sub-Saharan African countries reported here. Although children receiving a dose of MCV through outbreak response benefit from the intervention, ensuring that programs effectively target hard to reach children remains the cornerstone of measles control.
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Affiliation(s)
- Lise Grout
- Epicentre, 8, rue St Sabin, 75011 Paris, France.
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21
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Minetti A, Bopp C, Fermon F, François G, Grais RF, Grout L, Hurtado N, Luquero FJ, Porten K, Sury L, Terzian M. Measles outbreak response immunization is context-specific: insight from the recent experience of Médecins Sans Frontières. PLoS Med 2013; 10:e1001544. [PMID: 24223523 PMCID: PMC3818158 DOI: 10.1371/journal.pmed.1001544] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Andrea Minetti and colleagues compare measles outbreak responses from the Democratic Republic of the Congo and Malawi and argue that outbreak response strategies should be tailored to local measles epidemiology. Please see later in the article for the Editors' Summary.
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22
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Abstract
BACKGROUND Measles is the leading killer among vaccine-preventable diseases; it is responsible for an estimated 44% of the 1.7 million vaccine-preventable deaths among children annually. OBJECTIVES To assess the effects of antibiotics given to children with measles to prevent complications and reduce pneumonia, other morbidities and mortality. SEARCH METHODS We searched CENTRAL 2013, Issue 4, MEDLINE (1966 to May week 4, 2013) and EMBASE (1980 to May 2013). SELECTION CRITERIA Randomised controlled trials (RCTs) and quasi-RCTs comparing antibiotics with placebo or no treatment, to prevent complications in children with measles. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed trial quality. MAIN RESULTS Seven trials with 1263 children were included. The methodological quality of most studies was poor. Only two studies were randomized, double-blind trials. There was variation in antibiotics used, their doses, schedule and evaluation of outcome. Pooled study data showed that the incidence of pneumonia was lower in the treatment group compared to the control group. However, the difference was not statistically significant. Of the 654 children who received antibiotics, 27 (4.1%) developed pneumonia; while out of 609 children in the control group, 59 (9.6%) developed pneumonia (odds ratio (OR) 0.35; 95% confidence interval (0.12 to 1.01). The one trial that showed an increase in the rate of pneumonia with antibiotics was conducted in 1942 and compared oral sulfathiazole with symptomatic treatment. If the results of this trial are removed from the meta-analysis, there is a statistically significant reduction in the incidence of pneumonia in children receiving antibiotics (OR 0.26; 95% CI 0.12 to 0.60). The incidence of other complications was significantly lower in children receiving antibiotics: purulent otitis media (OR 0.34; 95% CI 0.16 to 0.73) and tonsillitis (OR 0.08; 95% CI 0.01 to 0.72). There was no difference in the incidence of conjunctivitis (OR 0.39; 95% CI 0.15 to 1.0), diarrhea (OR 0.53; 95% CI 0.23 to 1.22) or croup (OR 0.16; 95% CI 0.01 to 4.06). No major adverse effects attributable to antibiotics were reported. AUTHORS' CONCLUSIONS The studies reviewed were of poor quality and used older antibiotics. This review suggests a beneficial effect of antibiotics in preventing complications such as pneumonia, purulent otitis media and tonsillitis in children with measles. On the basis of this review, it is not possible to recommend definitive guidelines on the type of antibiotic, duration or the day of initiation. There is a need for more evidence from high-quality RCTs to answer these questions.
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Affiliation(s)
- Sushil K Kabra
- All India Institute of Medical SciencesPediatric Pulmonology Division, Department of PediatricsAnsari NagarNew DelhiIndia110029
| | - Rakesh Lodha
- All India Institute of Medical SciencesDepartment of PediatricsAnsari NagarNew DelhiIndia110029
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