Accelerated measles control in sub-Saharan Africa

Abstract

M Otten and colleagues (Sept 3, p 832)1Otten M Kezaala R Fall A et al.Public-health impact of accelerated measles control in the WHO African Region 2000–03.Lancet. 2005; 366: 832-839Summary Full Text Full Text PDF PubMed Scopus (80) Google Scholar report a striking reduction in measles burden in 19 sub-Saharan African countries after wide-age-range mass measles campaigns. For nine countries (including Cameroon), Otten and colleagues report surveillance data for only 1 year after the mass campaigns. Cameroon has sustained the low measles transmission status for 3–4 years since the mass campaigns. The mean annual number of measles cases has dropped from 13 260 in 1996–20011Otten M Kezaala R Fall A et al.Public-health impact of accelerated measles control in the WHO African Region 2000–03.Lancet. 2005; 366: 832-839Summary Full Text Full Text PDF PubMed Scopus (80) Google Scholar to 340 (34% of 989 measles-like illnesses) in 2003–05. Before the mass measles campaigns, people in many areas of Cameroon knew (as the saying goes) that “one should never count his or her children until measles has come and gone”. In the past 3–4 years, some of these areas have not seen a single case of measles. Although debate on the possible negative effect of mass vaccination campaigns on routine health services has gone on for decades,2Mills A Mass campaigns versus general health services: what have we learnt in 40 years about vertical versus horizontal approaches?.Bull World Health Organ. 2005; 83: 315-316PubMed Google Scholar our experience points to an overall positive effect. High-quality mass campaigns usually achieve high vaccination coverage because of high-level political commitment and adequate planning and monitoring of vaccination activities. Cameroon's Ministry of Public Health has incorporated mass-campaign-style district planning and monitoring of vaccination services and community mobilisation into routine vaccination services. Districts now routinely produce and cost microplans before the start of each year, and permanent community dialogue structures have been established in all districts, resulting in regular contacts with the community and increased demand for vaccination services. Emphasis is put on intense supportive supervision, regular meetings to discuss data, use of data for programmatic action, and regular feedback. The result of these actions has been an increase in routine vaccination coverage from 47% in 2001 to 73% in 2004. Cameroon was thus able to complete high-quality mass vaccination campaigns and increase routine vaccination coverage. The delivery and monitoring of other child survival interventions (eg, vitamin A supplementation, malaria control, and integrated management of childhood diseases) are now being included in childhood immunisation programmes, which are often viewed as surrogate measures of the overall strength of the health-care delivery system. Therefore, mass vaccination campaigns can be used to improve routine primary health-care services in general. Another pertinent issue raised by Otten and colleagues is the effect of migration on measles transmission in sub-Saharan Africa. Epidemiological investigations linked measles outbreaks in Burkina Faso and Cameroon to movement of unvaccinated children from neighbouring countries that had not conducted mass measles vaccination campaigns.1Otten M Kezaala R Fall A et al.Public-health impact of accelerated measles control in the WHO African Region 2000–03.Lancet. 2005; 366: 832-839Summary Full Text Full Text PDF PubMed Scopus (80) Google Scholar This finding is an indication that the substantial progress made towards measles elimination in sub-Saharan Africa will only be sustained if mass measles vaccination campaigns are synchronised over large geographical areas covering several contiguous countries. A possible scenario would be for the Measles Initiative3Measles Initiativehttp://www.measlesinitiative.orgGoogle Scholar and national governments to synchronise catch-up mass measles campaigns in the remaining countries with the follow-up campaigns in countries that have already conducted catch-up campaigns. We declare that we have no conflict of interest.