Measles epidemic in Brazil in the post-elimination period: Coordinated response and containment strategies

Abstract

Purpose: The measles virus circulation was halted in Brazil in 2001 and the country has a routine vaccination coverage against measles, mumps and rubella higher than 95%. In Ceará, the last confirmed case was in 1999. This abstract describes the strategies adopted and the effectiveness of the surveillance and control measures implemented during the epidemic in an attempt to understand the challenges posed by the regional context of post-measles elimination and explain the actions taken to prevent the re-establishment of endemic transmission when the virus is imported. Methods & Materials: A descriptive study was conducted to examine immunization strategies, epidemiological and laboratory surveillance, and communication to contain and halt the chains of measles transmission during an epidemic between December 2013 and October 2015. Results: The epidemic started in December 2013 and lasted 20 months, reaching 38 cities and 1,052 confirmed cases. The D8 genotype was identified. More than 50,000 samples were tested for measles and 86.4% of the confirmed cases had a laboratory diagnosis. The beginning of an campaign vaccination was delayed in part by the availability of vaccine of vaccine. The classic control measures were not enough to control the epidemic. The creation of a committee of experts, the agreement signed between managers of the three spheres of government, the conducting of an institutional active search of suspected cases, vaccination door to door at alternative times, the use of micro planning, a broad advertising campaign at local media and technical operative support contributed to containing the epidemic. Conclusion: It is important to recognize the possibility of epidemics at this stage of post-elimination and prepare a sensitive surveillance system for timely response. The point in the epidemic when the number of cases began to decrease clearly coincided with the point at which the activities of epidemiological surveillance, the immunization sector, coordinated communication actions, laboratory surveillance and primary care were integrated. This coordinated response reduces the chances of spreading the virus and thus the harm and the impact of a measles epidemic