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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Joseph JJ, Mkali HR, Reaves EJ, Mwaipape OS, Mohamed A, Lazaro SN, Aaron S, Chacky F, Mahendeka A, Rulagirwa HS, Mwenesi M, Mwakapeje E, Ally AY, Kitojo C, Serbantez N, Nyinondi S, Lalji SM, Wilillo R, Al-mafazy AW, Kabula BI, John C, Bisanzio D, Eckert E, Reithinger R, Ngondi JM. Improvements in malaria surveillance through the electronic Integrated Disease Surveillance and Response (eIDSR) system in mainland Tanzania, 2013-2021. Malar J 2022; 21:321. [PMID: 36348409 PMCID: PMC9641756 DOI: 10.1186/s12936-022-04353-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 10/27/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Tanzania has made remarkable progress in reducing malaria burden and aims to transition from malaria control to sub-national elimination. In 2013, electronic weekly and monthly reporting platforms using the District Health Information System 2 (DHIS2) were introduced. Weekly reporting was implemented through the mobile phone-based Integrated Disease Surveillance and Response (eIDSR) platform and progressively scaled-up from 67 to 7471 (100%) public and private health facilities between 2013 and 2020. This study describes the roll-out and large-scale implementation of eIDSR and compares the consistency between weekly eIDSR and monthly DHIS2 malaria indicator data reporting, including an assessment of its usefulness for malaria outbreak detection and case-based surveillance (CBS) in low transmission areas. METHODS The indicators included in the analysis were number of patients tested for malaria, number of confirmed malaria cases, and clinical cases (treated presumptively for malaria). The analysis described the time trends of reporting, testing, test positivity, and malaria cases between 2013 and 2021. For both weekly eIDSR and monthly DHIS2 data, comparisons of annual reporting completeness, malaria cases and annualized incidence were performed for 2020 and 2021; additionally, comparisons were stratified by malaria epidemiological strata (parasite prevalence: very low < 1%, low 1 ≤ 5%, moderate 5 ≤ 30%, and high > 30%). RESULTS Weekly eIDSR reporting completeness steadily improved over time, with completeness being 90.2% in 2020 and 93.9% in 2021; conversely, monthly DHIS2 reporting completeness was 98.9% and 98.7% in 2020 and 2021, respectively. Weekly eIDSR reporting completeness and timeliness were highest in the very low epidemiological stratum. Annualized malaria incidence as reported by weekly eIDSR was 17.5% and 12.4% lower than reported by monthly DHIS2 in 2020 and 2021; for both 2020 and 2021, annualized incidence was similar across weekly and monthly data in the very low stratum. CONCLUSION The concurrence of annualized weekly eIDSR and monthly DHIS2 reporting completeness, malaria cases and incidence in very low strata suggests that eIDSR could be useful tool for early outbreak detection, and the eIDSR platform could reliably be expanded by adding more indicators and modules for CBS in the very low epidemiological stratum.
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Affiliation(s)
| | | | - Erik J. Reaves
- U.S. President’s Malaria Initiative, U.S. Center for Disease Control and Prevention, Dar es Salaam, United Republic of Tanzania
| | | | - Ally Mohamed
- grid.415734.00000 0001 2185 2147Ministry of Health, Dodoma, United Republic of Tanzania ,grid.415734.00000 0001 2185 2147National Malaria Control Programme, Dodoma, United Republic of Tanzania
| | - Samwel N. Lazaro
- grid.415734.00000 0001 2185 2147Ministry of Health, Dodoma, United Republic of Tanzania ,grid.415734.00000 0001 2185 2147National Malaria Control Programme, Dodoma, United Republic of Tanzania
| | - Sijenunu Aaron
- grid.415734.00000 0001 2185 2147Ministry of Health, Dodoma, United Republic of Tanzania ,grid.415734.00000 0001 2185 2147National Malaria Control Programme, Dodoma, United Republic of Tanzania
| | - Frank Chacky
- grid.415734.00000 0001 2185 2147Ministry of Health, Dodoma, United Republic of Tanzania ,grid.415734.00000 0001 2185 2147National Malaria Control Programme, Dodoma, United Republic of Tanzania
| | - Anna Mahendeka
- grid.415734.00000 0001 2185 2147Ministry of Health, Dodoma, United Republic of Tanzania ,grid.415734.00000 0001 2185 2147National Malaria Control Programme, Dodoma, United Republic of Tanzania
| | - Hermes S. Rulagirwa
- grid.415734.00000 0001 2185 2147Ministry of Health, Dodoma, United Republic of Tanzania
| | - Mwendwa Mwenesi
- grid.415734.00000 0001 2185 2147Ministry of Health, Dodoma, United Republic of Tanzania
| | - Elibariki Mwakapeje
- grid.415734.00000 0001 2185 2147Ministry of Health, Dodoma, United Republic of Tanzania
| | - Ally Y. Ally
- grid.415734.00000 0001 2185 2147Ministry of Health, Dodoma, United Republic of Tanzania
| | - Chonge Kitojo
- U.S. President’s Malaria Initiative, U.S. Agency for International Development, Dar es Salaam, United Republic of Tanzania
| | - Naomi Serbantez
- U.S. President’s Malaria Initiative, U.S. Agency for International Development, Dar es Salaam, United Republic of Tanzania
| | - Ssanyu Nyinondi
- RTI International, Dar es Salaam, United Republic of Tanzania
| | | | | | | | | | - Claud John
- U.S. President’s Malaria Initiative, U.S. Center for Disease Control and Prevention, Dar es Salaam, United Republic of Tanzania
| | - Donal Bisanzio
- grid.62562.350000000100301493RTI International, Washington, DC USA
| | - Erin Eckert
- grid.62562.350000000100301493RTI International, Washington, DC USA
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