Abstract
BackgroundSince 1995, measles vaccination at nine and 18 months has been routine in South Africa; however, coverage seldom reached >95%. We describe the epidemiology of laboratory-confirmed measles case-patients and assess the impact of the nationwide mass vaccination campaign during the 2009 to 2011 measles outbreak in South Africa.MethodsSerum specimens collected from patients with suspected-measles were tested for measles-specific IgM antibodies using an enzyme-linked immunosorbent assay and genotypes of a subset were determined. To estimate the impact of the nationwide mass vaccination campaign, we compared incidence in the seven months pre- (1 September 2009–11 April 2010) and seven months post-vaccination campaign (24 May 2010–31 December 2010) periods in seven provinces of South Africa.ResultsA total of 18,431 laboratory-confirmed measles case-patients were reported from all nine provinces of South Africa (cumulative incidence 37 per 100,000 population). The highest cumulative incidence per 100,000 population was in children aged <1 year (603), distributed as follows: <6 months (302/100,000), 6 to 8 months (1083/100,000) and 9 to 11 months (724/100,000). Forty eight percent of case-patients were ≥5 years (cumulative incidence 54/100,000). Cumulative incidence decreased with increasing age to 2/100,000 in persons ≥40 years. A single strain of measles virus (genotype B3) circulated throughout the outbreak. Prior to the vaccination campaign, cumulative incidence in the targeted vs. non-targeted age group was 5.9-fold higher, decreasing to 1.7 fold following the campaign (P<0.001) and an estimated 1,380 laboratory-confirmed measles case-patients were prevented.ConclusionWe observed a reduction in measles incidence following the nationwide mass vaccination campaign even though it was conducted approximately one year after the outbreak started. A booster dose at school entry may be of value given the high incidence in persons >5 years.
Highlights
Measles is a highly infectious disease and may cause extensive epidemics [1,2]
In the World Health Organisation (WHO) African region, routine measles vaccination is offered at nine months of age but about 15% of children vaccinated at this age will not develop protective immune response [6]
Data source Data presented here represent measles patients from whom laboratory results were received during the 2009–2011 measles outbreak by the National Institute for Communicable Diseases (NICD) of the National Health Laboratory Service (NHLS) from 16 March 2009 to 31 August 2011
Summary
Despite the availability of a safe and highly effective vaccine, measles still remains one of the leading causes of vaccine-preventable deaths in children ,5 years of age worldwide, especially in developing countries, with up to 20% of these deaths occurring in those ,1 year [2,3,4]. In the World Health Organisation (WHO) African region, routine measles vaccination is offered at nine months of age but about 15% of children vaccinated at this age will not develop protective immune response [6]. Since 1995, measles vaccination at nine and 18 months has been routine in South Africa; coverage seldom reached .95%. We describe the epidemiology of laboratory-confirmed measles case-patients and assess the impact of the nationwide mass vaccination campaign during the 2009 to 2011 measles outbreak in South Africa
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