Abstract
BackgroundThere is a global resurgence of measles, consequent upon worldwide stagnating measles vaccination coverage. The study aim was to document trends and characteristics of reported cases of measles, measles-related deaths, and measles vaccination coverage (MCV1—first dose of measles-containing vaccine and MCV2—second dose of measles-containing vaccine) at national and sub-national level in Myanmar over a five year period between 2014 and 2018.MethodsThis was a descriptive study using routine data collected and submitted to the Expanded Programme on Immunization.ResultsBetween 2014 and 2018, there were 2673 measles cases of which 2272 (85%) occurred in 2017 and 2018. Five adjacent regions in lower Myanmar were the most affected: in 2017 and 2018, these regions reported 1647 (73%) of the 2272 measles cases in the country. Overall, 73% of measles cases were laboratory confirmed, 21% were epidemiologically linked, and 6% were clinically compatible (clinical diagnosis only), with more laboratory confirmed cases in recent years. Annual measles-related deaths were either zero or one except in 2016 when there were 21 deaths, all occurring in one remote village. In the recent years, the most commonly affected age groups were 0–8 months, 9 months to 4 years, and ≥ 15 years. Among 1907 measles cases with known vaccination status, only 22% had been vaccinated and 70% of those had only received one dose of vaccine. Annual MCV1 coverage nationally varied from 83 to 93% while annual MCV2 coverage nationally varied from 78 to 87%, with no clear trends over the years. Between 2014 and 2018, a high proportion of the 330 townships had MCV coverage < 95%. Over 80% of measles cases were reported from townships that had MCV coverage < 95%.ConclusionThere have been a large number of measles cases in recent years associated with sub-optimal measles vaccine coverage. Myanmar has already conducted supplemental immunization activities in October and November, 2019. Myanmar also needs to improve routine immunization services and targeted responses to measles outbreaks.
Highlights
Measles is a highly infectious disease that results from infection with the measles virus
Measles was one of the top causes of childhood morbidity and mortality and responsible for over 2 million childhood deaths each year before the introduction of measles vaccines and the increase in global measles vaccine coverage resulting from the Expanded Programme on Immunization that started in the 1980s [1]
Over the whole 5-year period, 80% of measles cases occurred in townships with Measles-containing vaccine (MCV1) coverage < 95% and 88% of measles cases occurred in townships with Measles-containing vaccine (MCV2) coverage < 95%. These proportions varied each year with no clear trends shown. This is the first national study to report on measles cases and deaths in Myanmar over a 5-year period (2014–2018), the epidemiological profile of the disease, and measles vaccination coverage
Summary
Measles is a highly infectious disease that results from infection with the measles virus. Measles was one of the top causes of childhood morbidity and mortality and responsible for over 2 million childhood deaths each year before the introduction of measles vaccines and the increase in global measles vaccine coverage resulting from the Expanded Programme on Immunization that started in the 1980s [1]. Measles incidence and mortality have declined substantially in the last 20 years due to the improvement in socioeconomic status, better nutrition, and the increasing use of live attenuated measles vaccines administered through routine childhood immunization programmes and mass vaccination campaigns. High levels of population immunity necessary to interrupt measles transmission, cannot be achieved with a single dose schedule, and a second dose (MCV2) is usually given at 15–18 months of age with a minimum of 4 weeks between the two doses [2]. The study aim was to document trends and characteristics of reported cases of measles, measles-related deaths, and measles vaccination coverage (MCV1—first dose of measles-containing vaccine and MCV2—second dose of measles-containing vaccine) at national and sub-national level in Myanmar over a five year period between 2014 and 2018
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