Abstract
IntroductionDespite 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.MethodsWe 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.ResultsDuring 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.ConclusionThe 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.
Highlights
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
In 2008, countries in the World Health Organization (WHO) African Region (AFR) adopted a measles pre-elimination goal to be achieved by the end of 2012 with the following targets: 1) >98% reduction in estimated regional measles mortality compared with 2000; 2) national measles incidence of 90% national coverage with the first dose of measles-containing vaccine (MCV1) and >80% MCV1 coverage in all districts; and 4) >95% coverage in all districts for MCV supplementary immunization activities (SIAs)
We reviewed WHO-United Nations Children's Fund (UNICEF) annual estimates of national MCV1 coverage among children aged
Summary
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. Estimated coverage with the routine first dose of measles-containing vaccine (MCV1) increased from 57% to 73%. 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. Measles is a highly-infectious and potentially fatal viral disease characterized by fever and rash. In 2008, countries in the WHO African Region (AFR) adopted a measles pre-elimination goal to be achieved by the end of 2012 with the following targets: 1) >98% reduction in estimated regional measles mortality compared with 2000; 2) national measles incidence of 90% national coverage with the first dose of measles-containing vaccine (MCV1) and >80% MCV1 coverage in all districts; and 4) >95% coverage in all districts for MCV supplementary immunization activities (SIAs). Included were surveillance performance targets of: 1) ≥2 cases of non-measles febrile rash illness per 100,000 population; 2) ≥1 suspected measles case investigated with blood specimens in ≥80% of districts [4]
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