>
>"ToolPackinMama" <[email protected]> wrote in message
>news:[email protected]...
>> Never mind that measles, mumps, and chicken pox used to be harmless
>> childhood diseases that never killed anybody.
>>
>
>Actually, even today measles kills more in Africa than AIDS. Ask Patricia
>Neal if she would have rather had her daughter get the vaccine or the
>disease (her husband was Roald Dahl... his autobiography _Boy_ is a good
>read )
>http://www.measlesinitiative.org/index3.asp
Measles in Africa, particularly about how children adopted from underdeveloped
nations have brought measles outbreaks with them.
http://www.cdc.gov/nip/diseases/measles/news-archive.htm
And, from the CDC:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5302a2.htm
The World Health Organization (WHO) estimates that, during 2000, measles
accounted for approximately 777,000 deaths worldwide, of which 452,000 (58%)
occurred in Africa (1). In response, in 2000, WHO's African Regional Office
(AFRO) adopted a plan to reduce measles mortality >50% by 2005 (2). The plan
recommended 1) increasing measles vaccination by strengthening routine health
services; 2) providing a second opportunity for measles vaccination for all
children, primarily through wide--age-range supplemental immunization
activities (SIAs); 3) enhancing measles surveillance; and 4) improving
management of measles cases. The initial wide--age-range SIA targets all
children aged 9 months--14 years, regardless of history of measles disease or
vaccination. Follow-up SIAs are needed 3--5 years after the initial SIA to
provide a second opportunity for vaccination to children born since the
previous SIA (i.e., those aged 9 months--4 years). During the 1990s, the
countries of the Americas and seven countries in southern Africa used this
strategy to reduce the number of measles deaths to near zero (3--5). This
report describes the recent implementation of this strategy in three West
African countries, where reported measles cases declined 83%--97% during the
first year after SIAs. Successful implementation of this strategy by other
African countries should result in achieving the goal of >50% reduction in
measles mortality by 2005.
Routine and Supplemental Immunizations
In 2001, before use of wide--age-range SIAs, routine measles vaccination
coverage was estimated to be 69% by the administrative method* in Burkina Faso,
37% by survey†in Mali, and 33% by survey in Togo (WHO/United Nations
Children's Fund [UNICEF], unpublished data, 2002). During December
2001--January 2002, nationwide SIAs among children aged 9 months--14 years were
conducted to give a second opportunity for measles vaccination in these three
countries.
Impact
A total of 12.7 million children were targeted in the three countries. National
SIA coverage was estimated to be 95%--99% by survey method and 99%--104% by
administrative method (Table 1). The number of reported measles cases and
deaths has decreased 91% and 84%, respectively, compared with the annual
averages for 1996--2001 (Table 1). The number of deaths averted was estimated
by applying the observed percentage reduction in reported measles deaths in
2002, compared with the average annual number of deaths reported during
1996--2001, to the estimated number of measles deaths in 1998 (6) (Tables 1 and
2). WHO estimated the number of measles deaths in 1998 (before SIAs) by using
the size of the surviving birth cohort, the reported vaccine coverage, vaccine
efficacy, and a measles case-fatality ratio (CFR) of 6.0 (6).§ The estimated
number of deaths averted in the three countries during 2002 was 26,365 (Table
2).
Surveillance
In 2002, surveillance for measles was enhanced by starting measles case-based
surveillance with laboratory confirmation and intensifying supervision of all
districts by provincial surveillance supervisors. According to regional
guidelines, any clinician diagnosis of measles or illnesses consistent with the
case definition of rash, fever, and cough, coryza, or conjunctivitis should be
reported as suspected measles. In addition, all patients in whom measles is
suspected should have blood collected for serologic confirmation.
In 2002, in Burkina Faso, blood specimens were taken for 1,060 (62%) of the
1,712 suspected cases. Of the 1,029 cases with laboratory results, 709 (69%)
were measles-IgM positive. Of these, 255 (36%) cases were in persons aged >15
years. A total of 319 (45%) laboratory-confirmed cases occurred in the target
age group for the SIAs (i.e., ages 9 months--14 years). In Mali, specimens were
collected for 63 (12%) of 533 suspected measles cases; 22 (35%) tested
measles-IgM positive. Laboratory-confirmed measles outbreaks were detected in
one northern district among a nomadic population (n = 39) and in one district
along the Guinea border (n = 36). During January 2001--December 2002, in Togo,
specimens were collected from 250 (75%) of 333 suspected measles cases; 23 (9%)
tested measles-IgM positive. Of these, 14 (61%) were in the northeastern
province of Savane, and 11 (78%) were in the Tone district bordering Burkina
Faso.
Reported by: Ministries of Health, Burkina Faso, Mali, and Togo; Country
Offices for Burkina Faso, Mali, and Togo, World Health Organization. Measles
Programme, Regional Office for Africa, World Health Organization, Harare,
Zimbabwe. Global Immunization Div, National Immunization Program, CDC.
Editorial Note:
The measles mortality reduction strategies implemented in Burkina Faso, Mali,
and Togo reduced the annual numbers of measles cases and deaths by 91% and 84%,
respectively, during the first year after implementation of SIAs, compared with
6 years preceding SIAs. In 2002, an estimated 26,365 measles deaths were
prevented. The Ministries of Health in Burkina Faso, Mali, and Togo were
responsible for planning and conducting SIAs. Financial and technical support
for implementing this strategy is being provided by a coalition of partners
(The Measles Initiative) led by the American Red Cross; other partners include
the United Nations Foundation, UNICEF, WHO, and CDC.
Although the reductions in cases and deaths in Burkina Faso were substantial
compared with levels during 1996--2001, widespread measles transmission
continued after the campaign. Widespread transmission after successful
wide--age-range SIAs has not been reported in 13 other African countries (5;
WHO, unpublished data, 2003). An outbreak investigation is under way to
determine why the decline in cases in Burkina Faso was not as marked as in the
other countries.
Remaining subjects of concern for the measles mortality reduction program
include 1) the duration of effect of the wide--age-range SIAs, 2) the
appropriate interval between the initial wide--age-range and subsequent SIAs,
and 3) the best methods for increasing routine vaccination. On the basis of
experience in the Americas and southern Africa, a 4-year interval between SIAs
will maintain measles mortality at near zero if the routine measles coverage
remains at >80% and the SIAs achieve coverage of >90% (3--6). However,
attaining routine coverage of >80% will be challenging for these countries.
From 1998--2000 to 2002, the reported routine coverage with the third dose of
combined diphtheria-pertussis-tetanus vaccine (DPT3) increased in Mali, from
32%--53% to 74%; in Burkina Faso, from 34%--57% to 75%; and in Togo, from
36%--50% to 59% (WHO, unpublished data, 2003). The low routine measles
vaccination coverage in these countries will result in accumulation of
susceptible children born since the 2001 SIAs. This might result in small- to
moderate-sized measles outbreaks before the scheduled follow-up SIAs planned
for the fall of 2004.
The findings in this report are subject to at least two limitations. First, the
decline in reported measles cases and deaths might be underestimated; <50% of
serologic specimens, compared with >70% in countries with widespread measles
transmission, drawn from patients with measles-compatible illnesses after SIAs
in Mali and Togo were confirmed as measles on the basis of positive-IgM
results. These findings are consistent with those observed in southern Africa
after nationwide wide--age-range SIAs (5). Second, the estimated number of
measles deaths before implementation of SIAs assumed no herd immunity and
relied on available CFRs for measles (6). In the absence of recent
population-based studies, these CFR estimates might have changed as a result of
improvements in case management and a shift in the age distribution of
patients. During 1989--1991, a population-based study in rural Ghana found a
measles CFR of 15%, even in an area with vitamin A supplementation (7); this
figure is substantially higher than the 6% CFR used to estimate the number of
measles deaths averted.
During the next few years, improved surveillance for measles will be important
to determine the effectiveness of the measles mortality reduction strategy. An
increase in population immunity to measles decreases the positive predictive
value of the clinical case definition (3,5), thereby necessitating laboratory
confirmation of suspected cases. The implementation of case-based surveillance
with serologic confirmation of suspected cases will require capacity for
specimen collection, transportation, testing, and reporting of results.
Previous experience with case-based surveillance, specimen collection, and
testing for acute flaccid paralysis cases will guide this process.
References
Stein C, Birmingham M, Kurian M, Duclos P, Strebel P. The global burden of
measles in the year 2000---a model using country-specific indicators. J Infect
Dis 2000;187(suppl 1):S8--S14.
African Regional Office of the World Health Organization. Plan of Action for
Measles Mortality Reduction in the African Region, 2001--2005. Harare,
Zimbabwe: African Regional Office of the World Health Organization, 2000.
de Quadros CA, Olive J-M, Hersh BS, et al. Measles elimination in the
Americas---evolving strategies. JAMA 1996;275:224--9.
Hersh BS, Tambini G, Nogueira AC, Carrasco P, de Quadros C. Review of regional
measles surveillance data in the Americas, 1996--99. Lancet 2000;355:1943--8.
Biellik R, Madema S, Taole A, et al. First five years of measles elimination in
Southern Africa: 1996--2000. Lancet 2002;359:1564--8.
Otten M, Okwo-Bele JM, Kezaala R, Biellik R, Eggers R, Nshimirimana D. Impact
of alternative approaches to accelerated measles control: report on the
experience in the African Region, 1996--2002. J Infect Dis 2003;187(suppl
1):S36--S43.
Dollimore N, Cutts F, Binka FN, Ross DA, Morris SS, Smith PG. Measles
incidence, case fatality, and delayed mortality in children with or without
vitamin A supplementation in rural Ghana. Am J Epidemiol 1997;146:646--54.
* Calculated by dividing the number of doses of vaccine administered through
routine health services by the birth cohort of the previous year.
†Using either the Expanded Programme on Immunization method with 30 clusters
of seven children per cluster or population-based probability surveys conducted
by international organizations (e.g., MACRO International, Inc. and UNICEF).
§ Measles cases (i.e., number of susceptible children) = (1 -- [coverage X
vaccine efficacy]) X number of surviving infants.
