Singapore's efforts to achieve measles elimination in 2018.

Wanhan See,Lin Cui,Yuske Kita,Stenven Peng-Lim Ooi,Yi Kai Ng ,Vernon Lee ,Derrick Heng ,Raymond Tzer Pin Lin

doi:10.5365/wpsar.2019.10.4.002

Abstract

The World Health Organization verified that Singapore had eliminated endemic transmission of measles in October 2018. This report summarizes the evidence presented to the Regional Verification Commission for Measles and Rubella Elimination, comprising information about immunization schedules; laboratory testing protocols and the surveillance system; and data on immunization coverage and the epidemiology of cases. Between 2015 and 2017, a total of 246 laboratory confirmed cases of measles were reported. The source or country of infection was unknown for most cases (195; 79.3%). There were 22 clusters, ranging from two to five cases. The most common genotypes detected were D8 and D9. Transmission of B3 was interrupted in 2017, and H1 cases were sporadic and imported. Phylogenetic analyses of the D8 isolates showed the existence of 13 lineages or clusters. Although a few lineages were circulating concurrently, no lineage propagated continuously for a prolonged period, and transmission of each lineage eventually stopped. Although cases and clusters were reported yearly, molecular data showed that none of the lineages resulted in prolonged transmission. There were fewer measles cases in 2017 compared with 2016. The higher number of clusters was likely due to the overall increase in cases because cluster sizes remained small. The occurrence of small clusters is not unexpected since measles is highly infectious. The majority of imported cases did not result in secondary transmission. With the global increase in the number of measles cases, Singapore needs to stay vigilant and continue to promptly test suspected cases; vaccination is the key to preventing infection.

Highlights

Introduction of second dose ofMMR vaccine to children in primary school at age 11 to 12 yearsThe age for the second dose of MMR vaccine is lowered to 6 to 7 yearsThe age for vaccination is lowered to 12 months for first dose and 15 to 18 months for second doseMMR: measles, mumps and rubellaNo ethics approval was required
Our analysis provides the evidence for Singapore to be verified as having measles elimination status – there is a well-performing surveillance system for measles and an absence of endemic transmission for more than 12 months
A variety of genotypes were detected in Singapore, similar to other countries in the Western Pacific Region.[12,19]

Summary

Introduction

Introduction of second dose ofMMR vaccine to children in primary school at age 11 to 12 yearsThe age for the second dose of MMR vaccine is lowered to 6 to 7 yearsThe age for vaccination is lowered to 12 months for first dose and 15 to 18 months for second doseMMR: measles, mumps and rubellaNo ethics approval was required. MMR vaccine to children in primary school at age 11 to 12 years. The age for the second dose of MMR vaccine is lowered to 6 to 7 years. The age for vaccination is lowered to 12 months for first dose and 15 to 18 months for second dose. Data were collected under the Infectious Diseases Act of Singapore (1976), and only unidentifiable data were used for analysis

Methods

Results

Conclusion