Abstract
BackgroundOutbreaks of measles re-emerged in Guangxi province during 2013–2014, where measles again became a major public health concern. A better understanding of the patterns of measles cases would help in identifying high-risk areas and periods for optimizing preventive strategies, yet these patterns remain largely unknown. Thus, this study aimed to determine the patterns of measles clusters in space, time and space-time at the county level over the period 2004–2014 in Guangxi.MethodsAnnual data on measles cases and population sizes for each county were obtained from Guangxi CDC and Guangxi Bureau of Statistics, respectively. Epidemic curves and Kulldorff’s temporal scan statistics were used to identify seasonal peaks and high-risk periods. Tango’s flexible scan statistics were implemented to determine irregular spatial clusters. Spatio-temporal clusters in elliptical cylinder shapes were detected by Kulldorff’s scan statistics. Population attributable risk percent (PAR%) of children aged ≤24 months was used to identify regions with a heavy burden of measles.ResultsSeasonal peaks occurred between April and June, and a temporal measles cluster was detected in 2014. Spatial clusters were identified in West, Southwest and North Central Guangxi. Three phases of spatio-temporal clusters with high relative risk were detected: Central Guangxi during 2004–2005, Midwest Guangxi in 2007, and West and Southwest Guangxi during 2013–2014. Regions with high PAR% were mainly clustered in West, Southwest, North and Central Guangxi.ConclusionsA temporal uptrend of measles incidence existed in Guangxi between 2010 and 2014, while downtrend during 2004–2009. The hotspots shifted from Central to West and Southwest Guangxi, regions overburdened with measles. Thus, intensifying surveillance of timeliness and completeness of routine vaccination and implementing supplementary immunization activities for measles should prioritized in these regions.
Highlights
Outbreaks of measles re-emerged in Guangxi province during 2013–2014, where measles again became a major public health concern
Children should be vaccinated with MCV1 at the age of 8 months, and MCV2 should be given to children between the ages of 18 and 24 months
Despite the routine two-dose measles vaccination coverage across most regions of China being over 90%, large-scale outbreaks of measles still occurred in Guangxi, Beijing, Zhejiang and Shangdong provinces [4,5,6,7]
Summary
Outbreaks of measles re-emerged in Guangxi province during 2013–2014, where measles again became a major public health concern. More than 95% of measles deaths have been reported in low-middle income countries and regions with resource-poor health facilities [2]. A middle-income country, is one of the member nations in the WHO Western Pacific Region, accounting for approximately 70% of the reported measles cases in this region since 2003 [3]. According to the schedule of expanded program on immunization (EPI) in China, routine measles vaccination covers two doses of measles-containing vaccine (i.e. MCV1, MCV2). Despite the routine two-dose measles vaccination coverage across most regions of China being over 90%, large-scale outbreaks of measles still occurred in Guangxi, Beijing, Zhejiang and Shangdong provinces [4,5,6,7]
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