Measles Case-based Surveillance Research Articles

Performance of National Measles Case-Based Surveillance Systems in The WHO African Region. 2012 - 2016

Case based surveillance for measles is implemented in the African Region integrated with Acute Flaccid Paralysis (AFP) surveillance. In 2011, the Region adopted a measles elimination goal to be achieved by 2020, which included coverage, incidence and surveillance performance targets. We reviewed measles case-based surveillance data and surveillance performance from countries in the African Region for the years 2012 - 2016. During this period, a total of 359,019 cases of suspected measles were reported from the 44 of 47 (94%) countries using the case based surveillance system. Of these, 202,126 (56%) had specimens collected for laboratory testing. A total of 39,806 measles cases and 25,679 rubella cases were confirmed by IgM serology. Twelve countries met the two principal surveillance performance indicators for each year during the period and four countries met neither indicator over the period. At the Regional level, both surveillance targets were met in 3 of the 5 years in the period of study; however performance varies widely by country. Surveillance performance did not improve across the Region during the 5 years period. High quality surveillance performance is critical to support the achievement of the regional measles elimination goal. Better integrating implementation with AFP surveillance, securing predictable long-term funding sources, and conducting detailed evaluations at country level to identify and address the root cause of performance gaps is recommended.

Progress Towards Measles Elimination in Nigeria: 2012 - 2016

Nigeria has adopted the African Regional measles elimination targets and is implementing the recommended strategies. Nigeria provides routine measles vaccination for children aged 9 months. In addition, since 2006, Nigeria has been conducting nationwide measles supplemental Immunisation activities (SIAs) or mass vaccination campaigns every 2 years, and has established measles case-based surveillance. We reviewed routine and supplemental measles immunization coverage data, as well as measles case-based surveillance data from Nigeria for the years 2012 - 2016, in an attempt to determine the country's progress towards these elimination targets. The first dose measles vaccination coverage in Nigeria ranged from 42% and 54% between 2012 and 2015, according to the WHO UNICEF national coverage estimates. Nigeria achieved 84.5% coverage by survey following the 2015 nationwide measles supplemental immunisation activities (SIAs). During this period, the incidence of confirmed measles ranged from 25 - 300 confirmed cases per million population per year, with the Northern States having significantly higher incidence as compared to the Southern States. At the same time, the pattern of confirmed cases indicated a consistent shift in epidemiological susceptibility including older age children. In order to accelerate its progress towards the measles elimination targets, Nigeria should build population immunity on a sustainable basis by addressing systemic issues in order to scale up routine immunisation coverage, especially in the Northern half of the country; tailoring the target age for measles SIAs so as to sharply reduce measles incidence in age groups heavily affected by the disease; effectively mobilising resources and improving the quality of planning and coverage outcome of SIAs.

Progress Toward Rubella and Congenital Rubella Syndrome Control - South-East Asia Region, 2000-2016.

In 2013, the 66th session of the Regional Committee of the World Health Organization (WHO) South-East Asia Region (SEAR)* adopted the goal of elimination of measles and control† of rubella and congenital rubella syndrome (CRS) by 2020 (1). Rubella is the leading vaccine-preventable cause of birth defects. Although rubella typically causes a mild fever and rash in children and adults, rubella virus infection during pregnancy, especially during the first trimester, can result in miscarriage, fetal death, or a constellation of congenital malformations known as CRS, commonly including visual, auditory, and/or cardiac defects, and developmental delay (2). Rubella and CRS control capitalizes on the momentum created by pursuing measles elimination because the efforts are programmatically linked. Rubella-containing vaccine (RCV) is administered as a combined measles and rubella vaccine, and rubella cases are detected through case-based surveillance for measles or fever and rash illness (3). This report summarizes progress toward rubella and CRS control in SEAR during 2000-2016. Estimated coverage with a first RCV dose (RCV1) increased from 3% of the birth cohort in 2000 to 15% in 2016 because of RCV introduction in six countries. RCV1 coverage is expected to increase rapidly with the phased introduction of RCV in India and Indonesia beginning in 2017; these countries are home to 83% of the SEAR birth cohort. During 2000-2016, approximately 83 million persons were vaccinated through 13 supplemental immunization activities (SIAs) conducted in eight countries. During 2010-2016, reported rubella incidence decreased by 37%, from 8.6 to 5.4 cases per 1 million population, and four countries (Bangladesh, Maldives, Sri Lanka, and Thailand) reported a decrease in incidence of ≥95% since 2010. To achieve rubella and CRS control in SEAR, sustained investment to increase routine RCV coverage, periodic high-quality SIAs to close immunity gaps, and strengthened rubella and CRS surveillance are needed.

Progress Toward Measles Elimination - Western Pacific Region, 2013-2017.

In 2005, the Regional Committee for the World Health Organization (WHO) Western Pacific Region (WPR)* established a goal for measles elimination† by 2012 (1). To achieve this goal, the 37 WPR countries and areas implemented the recommended strategies in the WPR Plan of Action for Measles Elimination (2) and the Field Guidelines for Measles Elimination (3). The strategies include 1) achieving and maintaining ≥95% coverage with 2 doses of measles-containing vaccine (MCV) through routine immunization services and supplementary immunization activities (SIAs), when required; 2) conducting high-quality case-based measles surveillance, including timely and accurate testing of specimens to confirm or discard suspected cases and detect measles virus for genotyping and molecular analysis; and 3) establishing and maintaining measles outbreak preparedness to ensure rapid response and appropriate case management. This report updates the previous report (4) and describes progress toward measles elimination in WPR during 2013-2017. During 2013-2016, estimated regional coverage with the first MCV dose (MCV1) decreased from 97% to 96%, and coverage with the routine second MCV dose (MCV2) increased from 91% to 93%. Eighteen (50%) countries achieved ≥95% MCV1 coverage in 2016. Seven (39%) of 18 nationwide SIAs during 2013-2017 reported achieving ≥95% administrative coverage. After a record low of 5.9 cases per million population in 2012, measles incidence increased during 2013-2016 to a high of 68.9 in 2014, because of outbreaks in the Philippines and Vietnam, as well as increased incidence in China, and then declined to 5.2 in 2017. To achieve measles elimination in WPR, additional measures are needed to strengthen immunization programs to achieve high population immunity, maintain high-quality surveillance for rapid case detection and confirmation, and ensure outbreak preparedness and prompt response to contain outbreaks.

Sensitivity and positive predictive value of the measles surveillance system in Uganda, 2012-2015

Introduction : disease surveillance is a critical component in the control and elimination of vaccine preventable diseases. The Uganda National Expanded Program on Immunization strives to have a sensitive surveillance system within the Integrated Disease Surveillance and Response (IDSR) framework. We analyzed measles surveillance data to determine the effectiveness of the measles case-based surveillance system and estimate its positive predictive value in order to inform policy and practice. Methods : an IDSR alert was defined as 1 suspected measles case reported by a district in a week, through the electronic Health Management Information System. We defined an alert in the measles case-based surveillance system (CBS) as 1 suspected measles case with a blood sample collected for confirmation during the corresponding week in a particular district. Effectiveness of CBS was defined as having 80% of IDSR alerts with a blood sample collected for laboratory confirmation. Positive predictive value was defined as the proportion of measles case-patients who also had a positive measles serological result (IgM +). We reviewed case-based surveillance data with laboratory confirmation and measles surveillance data from the electronic Health Management Information System from 2012-2015. Results : a total of 6,974 suspected measles case-persons were investigated by the measles case-based surveillance between 2012 and 2015. Of these, 943 (14%) were measles specific IgM positive. The median age of measles case-persons between 2013 and 2015 was 4.0 years. Between 2013 and 2015, 72% of the IDSR alerts reported in the electronic Health Management Information System, had blood samples collected for laboratory confirmation. This was however less than the WHO recommended standard of 80%. The PPV of CBS between 2013 and 2015 was 8.6%. Conclusion : effectiveness of measles case-based surveillance was sub-optimal, while the PPV showed that true measles cases have significantly reduced in Uganda. We recommended strengthening of case-based surveillance to ensure that all suspected measles cases have blood samples collected for laboratory confirmation to improve detection and ensure elimination by 2020.

Evaluation of measles surveillance system in Enugu State, South - East Nigeria, 2010 - 2015

Introduction: measles remains one of the leading causes of death among young children globally, despite the availability of a safe and effective vaccine. The disease is endemic in Nigeria. In 2005, measles case-based surveillance was introduced in Nigeria. Hence, between January and March 2017, we evaluated Enugu State Measles Surveillance System in order to describe the various attributes of the system, determine whether the system is meeting its set public health objectives, identify gaps in the surveillance system and recommend appropriate measures for improvement.

Evaluation of measles case-based surveillance system in Edo State, Nigeria, 2016

Introduction : measles is one of the leading causes of death in children despite availability of effective and accessible measles vaccine. In 2015, over 134,200 deaths were recorded globally. Measles infection is endemic in Nigeria with outbreaks recorded all year round. In Nigeria, measles surveillance is active and it involves case reporting and feedback. The objectives of measles surveillance include predicting outbreaks by identifying geographic locations and age groups at risk and evaluating vaccination strategies. We described the surveillance system, assessed the system attributes and performance indicators.

Evaluation of measles case-based surveillance system in Edo State, Nigeria, January to December, 2016

Introduction: measles is one of the leading causes of death in children despite availability of effective and accessible measles vaccine. In 2015, over 134,200 deaths were recorded globally. Measles infection is endemic in Nigeria with outbreaks recorded all year round. In Nigeria, measles surveillance is active and it involves case reporting and feedback. The objectives of measles surveillance include predicting outbreaks by identifying geographic locations and age groups at risk and evaluating vaccination strategies. We described the surveillance system, assessed the system attributes and performance indicators.

Progress towards elimination of measles in Kenya, 2003-2016.

IntroductionMeasles is targeted for elimination in the World Health Organization African Region by the year 2020. In 2011, Kenya was off track in attaining the 2012 pre-elimination goal. We describe the epidemiology of measles in Kenya and assess progress made towards elimination.MethodsWe reviewed national case-based measles surveillance and immunization data from January 2003 to December 2016. A case was confirmed if serum was positive for anti-measles IgM antibody, was epidemiologically linked to a laboratory-confirmed case or clinically compatible. Data on case-patient demographics, vaccination status, and clinical outcome and measles containing vaccine (MCV) coverage were analyzed. We calculated measles surveillance indicators and incidence, using population estimates for the respective years.ResultsThe coverage of first dose MCV (MCV1) increased from 65% to 86% from 2003-2012, then declined to 75% in 2016. Coverage of second dose MCV (MCV2) remained < 50% since introduction in 2013. During 2003-2016, there were 26,188 suspected measles cases were reported, with 9043(35%) confirmed cases, and 165 deaths (case fatality rate, 1.8%). The non-measles febrile rash illness rate was consistently > 2/100,000 population, and “80% of the sub-national level investigated a case in 11 of the 14 years. National incidence ranged from 4 to 62/million in 2003-2006 and decreased to 3/million in 2016. The age specific incidence ranged from 1 to 364/million population and was highest among children aged < 1 year.ConclusionKenya has made progress towards measles elimination. However, this progress remains at risk and the recent declines in MCV1 coverage and the low uptake in MCV2 could reverse these gains.

Positive predictive value and effectiveness of measles case-based surveillance in Uganda, 2012-2015.

IntroductionDisease surveillance is a critical component in the control and elimination of vaccine preventable diseases. The Uganda National Expanded Program on Immunization strives to have a sensitive surveillance system within the Integrated Disease Surveillance and Response (IDSR) framework. We analyzed measles surveillance data to determine the effectiveness of the measles case-based surveillance system and estimate its positive predictive value in order to inform policy and practice.MethodsAn IDSR alert was defined as ≥1 suspected measles case reported by a district in a week, through the electronic Health Management Information System. We defined an alert in the measles case-based surveillance system (CBS) as ≥1 suspected measles case with a blood sample collected for confirmation during the corresponding week in a particular district. Effectiveness of CBS was defined as having ≥80% of IDSR alerts with a blood sample collected for laboratory confirmation. Positive predictive value was defined as the proportion of measles case-patients who also had a positive measles serological result (IgM +). We reviewed case-based surveillance data with laboratory confirmation and measles surveillance data from the electronic Health Management Information System from 2012–2015.ResultsA total of 6,974 suspected measles case-persons were investigated by the measles case-based surveillance between 2012 and 2015. Of these, 943 (14%) were measles specific IgM positive. The median age of measles case-persons between 2013 and 2015 was 4.0 years. Between 2013 and 2015, 72% of the IDSR alerts reported in the electronic Health Management Information System, had blood samples collected for laboratory confirmation. This was however less than the WHO recommended standard of ≥80%. The PPV of CBS between 2013 and 2015 was 8.6%.ConclusionIn conclusion, the effectiveness of measles case-based surveillance was sub-optimal, while the PPV showed that true measles cases have significantly reduced in Uganda. We recommended strengthening of case-based surveillance to ensure that all suspected measles cases have blood samples collected for laboratory confirmation to improve detection and ensure elimination by 2020.

Progress Toward Measles Elimination - Bangladesh, 2000-2016.

In 2013, at the 66th session of the Regional Committee of the World Health Organization (WHO) South-East Asia Region (SEAR), a regional goal was established to eliminate measles and control rubella and congenital rubella syndrome* by 2020 (1). WHO-recommended measles elimination strategies in SEAR countries include 1) achieving and maintaining ≥95% coverage with 2 doses of measles-containing vaccine (MCV) in every district, delivered through the routine immunization program or through supplementary immunization activities (SIAs)†; 2) developing and sustaining a sensitive and timely measles case-based surveillance system that meets targets for recommended performance indicators; and 3) developing and maintaining an accredited measles laboratory network (2). In 2014, Bangladesh, one of 11 countries in SEAR, adopted a national goal for measles elimination by 2018 (2,3). This report describes progress and challenges toward measles elimination in Bangladesh during 2000-2016. Estimated coverage with the first MCV dose (MCV1) increased from 74% in 2000 to 94% in 2016. The second MCV dose (MCV2) was introduced in 2012, and MCV2 coverage increased from 35% in 2013 to 93% in 2016. During 2000-2016, approximately 108.9 million children received MCV during three nationwide SIAs conducted in phases. During 2000-2016, reported confirmed measles incidence decreased 82%, from 34.2 to 6.1 per million population. However, in 2016, 56% of districts did not meet the surveillance performance target of ≥2 discarded nonmeasles, nonrubella cases§ per 100,000 population. Additional measures that include increasing MCV1 and MCV2 coverage to ≥95% in all districts with additional strategies for hard-to-reach populations, increasing sensitivity of measles case-based surveillance, and ensuring timely transport of specimens to the national laboratory will help achieve measles elimination.

Epidemiology of rubella infection in Cameroon: a 7-year experience of measles and rubella case-based surveillance, 2008–2014

ObjectiveThe aim of this study was to estimate the proportion of rubella disease in a measles case-based surveillance in Cameroon prior to rubella vaccine introduction into the national immunisation programme.DesignThis...

Epidemiology of laboratory confirmed measles virus cases in the southern nations of Ethiopia, 2007\u20132014

BackgroundIn Ethiopia, measles case-based surveillance was introduced in 2004 as one strategy for measles control by laboratory confirmation of suspected cases. In this article, epidemiological distribution of laboratory-confirmed measles cases were reported from the Southern Nation Nationalities and Peoples Region (SNNPR) of Ethiopia between 2007 and 2014, as the region is one of the highly measles affected areas in Ethiopia.MethodA serum sample was collected from all measles suspected cases, and patient information was captured by case reporting format (CRF). Samples were transported to the National Measles Laboratory for Measles IgM testing by ELISA technique. Data entry and analysis were done using Epi-Info 3.5.4 software.ResultA total of 4810 samples were tested for measles IgM using ELISA technique and 1507 (31.3%) were found positive during 2007–2014 in SNNPR of Ethiopia. Patients with age 1–4 years were the most affected regardless of sex. The incidence of measles confirmed cases increased from 15 in 2007 to 180 in 2013 per million population. The highest percentage of laboratory-confirmed cases were found in 2014. Measles was found distributed throughout the regional state.ConclusionMeasles was found a public health important disease in SNNPR of Ethiopia, mostly affecting children 1–4 years. The incidence of measles cases is increasing from time to time. Additional research to determine the genotype of circulating measles virus, knowledge, attitude and practice of professionals and the population for measles vaccination and infection in the region is important. A wide age group measles vaccination campaign is highly recommended.

Measles burden in urban settings: characteristics of measles cases in Addis Ababa city administration, Ethiopia, 2004-2014.

IntroductionIn developing countries, measles was a major cause of morbidity and mortality before the wide spread use of measles vaccine. The purpose of this study was to describe measles burden in an urban setting, Addis Ababa- since the implementation of measles case-based surveillance in Ethiopia. We analyzed measles surveillance data for 2004 -2014.MethodsIncidence of measles was described by sub city, by year and by age groups. Age specific incidence rate were calculated. Logistic regression was used to identify the predictors of confirmed measles cases.ResultsOf 4220 suspected measles cases 39% were confirmed cases. Males and females were equally affected. The mean affected age was 7.59 years. Measles cases peaked in 2010 and 2013-2014. Incidence of measles is higher among children less than five years old. Outer sub cities were more affected by measles in all years.ConclusionSub cities bordering with Oromia Regional State were more affected by measles. Older age groups were more affected than younger age groups (age ≤ five years old). Efforts to close immunity gaps against measles and further strengthen surveillance in urban settings, particularly among children below five years old, should be prioritized.

Evaluation of the Measles Surveillance System in Kaduna State, Nigeria (2010-2012).

ObjectiveTo evaluate the case-based measles surveillance system in Kaduna State of Nigeria and identify gaps in its operation.IntroductionIn Africa, approximately 13 million cases, 650,000 deaths due to measles occur annually, with sub-Saharan Africa having the highest morbidity and mortality. Measles infection is endemic in Nigeria and has been documented to occur all year round, despite high measles routine and supplemental immunization coverage. The frequent outbreaks of measles in Kaduna State prompted the need for the evaluation of the measles case-based surveillance system.MethodsWe interviewed stakeholders and conducted a retrospective record review of the measles case-based surveillance data from 2010 – 2012 and adapted the 2001 CDC guidelines on surveillance evaluation and the Framework for Evaluating Public Health Surveillance Systems for Early Detection of Outbreaks, to assess the systems usefulness, representativeness, timeliness, stability, acceptability and data quality. We calculated the annualized detection rate of measles and non-measles febrile rash, proportion of available results, proportion of LGAs (Districts) that investigated at least one case with blood, proportion of cases that were IgM positive and the incidence of measles. We compared the results with WHO(2004) recommended performance indicators to determine the quality and effectiveness of measles surveillance system.ResultsAccording to the Stakeholders, the case-based surveillance system was useful and acceptable. Median interval between specimen collection and release of result was 7days (1 – 25 days) in 2010, 38 days (Range: 16 – 109 days) in 2011 and 11 days (Range: 1 – 105 days) in 2012. The annualized detection rate of measles rash in 2010 was 2.1 (target: 32), 1.0 (target: 32) in 2011 and 1.4 (target: 32) in 2012. The annualized detection rate of non-measles febrile rash in 2010 was 2.1 (target: 32), 0.6 (target: 32) in 2011 and 0.8 (target: 32) in 2012. Case definitions are simple and understood by all the operators.ConclusionThis evaluation showed that the surveillance system was still useful. Also, the efficiency and effectiveness of the laboratory component as captured by the “median interval between specimen collection and the release of results improved in 2010 and 2012 compared to 2011. However, there was a progressive decline in the timeliness and completeness of weekly reports in the years under review.

Spatial analysis of Measles risk areas in Bantul District of Yogyakarta Province

Spatial analysis of measles risk areas in Bantul District of Yogyakarta Province in 2014 PurposeThe purpose of this study was to determine the area of measles risk.MethodsThis research used a cross-sectional design and was performed from June to August 2015. The data on measles patients were obtained from Case-Based Measles Surveillance (CBMS) activities in Health Office of Bantul District. The coordinate locations of patients’ homes were obtained by direct visits. Meanwhile, the information regarding village/ward areas was derived from all village/ ward offices and Public Health Centers in Bantul Districts. The data were analyzed by spatially weighted regression tests.ResultsThere were 185 measles cases and 6 outbreaks spread-out in 50 (67%) villages/wards. The entire villages/wards have achieved immunization coverage of &gt;90%, 66% with good nutritional status, 51% with high education status, 37% with high population density, and 24% with low economic status. The variable of population density was spatially associated with measles incidents while immunization coverage, nutritional status, education level, and economic status were not spatially associated with measles incidents. Measles case clustering was found in the areas of Banguntapan Sub-district.ConclusionThe immunization program in Bantul District should be evaluated in the light that the villages/wards have achieved immunization coverage of 90% but 185 measles cases and 6 outbreaks were still found in 2014. In addition, the improvement of the immunization recording system needs be conducted for CBMS activities.

Targeted Measles Outbreak Response Vaccination In The Context of Measles Control and Elimination: Experiences From South Sudan

Introduction: Measles elimination interventions in South Sudan have relied on mass campaigns due to reoccurring humanitarian crisis over decades. This paper examines the effects of targeted measles vaccinations on efforts at eliminating measles in the country. Methods: Time trend and an analytical cross-sectional design were applied on South Sudan Measles case-based surveillance dataset 2011-2015. Logistic regression of IgM positive cases against vaccination status and adjusted for age and unknown vaccination status were used to determine the likelihood of reduced risk of measles at 95% CI. Results: Routine immunization, follow-up and outbreak response coverage for measles vaccination over the period were sub-optimal. Even though the proportion of confirmed measles cases among vaccinated population was irregular ranging 14.2% to 61.9% within the period reviewed, measles vaccination generally reduced the risk of the disease in the population by 30% (odds 0.7, 95% CI 0.4, 1.0) from 2011-2015. A trend analysis showed that the likelihood of reduction of measles burden varied per year, but a higher reduction of risk was observed in 2015 (odds 0.05 (95% CI <0.01, 0.35) preceded by follow-up campaigns. Adjusting for age and unknown vaccination status, there were no statistically significant difference for the trends of odds, however the significant decrease in odds in 2015 (OR 0.01 (95% CI [0.01, 0.35]) R2 0.45) is due to a unit change in age. Conclusions: Targeted measles outbreak vaccinations generally reduce the burden of measles however the extent of reduction is more reflected in a year following a mass measles campaign as compared to outbreak response vaccination. Thus measles follow-up campaigns are necessary for sustained measles control and elimination.

Measles outbreak reveals measles susceptibility among adults in Namibia, 2009 - 2011.

The World Health Organization, African Region, set the goal of achieving measles elimination by 2020. Namibia was one ofseven African countries to implement an accelerated measles control strategy beginning in 1996. Following implementation of this strategy,measles incidence decreased; however, between 2009 and 2011 a major outbreak occurred in Namibia. Measles vaccination coverage data were analysed and a descriptive epidemiological analysis of the measles outbreak wasconducted using measles case-based surveillance and laboratory data. During 1989 - 2008, MCV1 (the first routine dose of measles vaccine) coverage increased from 56% to 73% and five supplementaryimmunisation activities were implemented. During the outbreak (August 2009 - February 2011), 4 605 suspected measles cases werereported; of these, 3 256 were confirmed by laboratory testing or epidemiological linkage. Opuwo, a largely rural district in north-westernNamibia with nomadic populations, had the highest confirmed measles incidence (16 427 cases per million). Infants aged ≤11 months hadthe highest cumulative age-specific incidence (9 252 cases per million) and comprised 22% of all confirmed cases; however, cases occurredacross a wide age range, including adults aged ≥30 years. Among confirmed cases, 85% were unvaccinated or had unknown vaccinationhistory. The predominantly detected measles virus genotype was B3, circulating in concurrent outbreaks in southern Africa, and B2,previously detected in Angola. A large-scale measles outbreak with sustained transmission over 18 months occurred in Namibia, probably caused by importation.The wide age distribution of cases indicated measles-susceptible individuals accumulated over several decades prior to the start of the outbreak.

Progress Toward Measles Elimination - Nepal, 2007-2014.

In 2013, the 66th session of the Regional Committee of the World Health Organization (WHO) South-East Asia Region (SEAR) established a goal to eliminate measles and to control rubella and congenital rubella syndrome (CRS) in SEAR by 2020. Current recommended measles elimination strategies in the region include 1) achieving and maintaining ≥95% coverage with 2 doses of measles-containing vaccine (MCV) in every district, delivered through the routine immunization program or through supplementary immunization activities (SIAs); 2) developing and sustaining a sensitive and timely measles case-based surveillance system that meets minimum recommended performance indicators; 3) developing and maintaining an accredited measles laboratory network; and 4) achieving timely identification, investigation, and response to measles outbreaks. In 2013, Nepal, one of the 11 SEAR member states, adopted a goal for national measles elimination by 2019. This report updates a previous report and summarizes progress toward measles elimination in Nepal during 2007-2014. During 2007-2014, estimated coverage with the first MCV dose (MCV1) increased from 81% to 88%. Approximately 3.9 and 9.7 million children were vaccinated in SIAs conducted in 2008 and 2014, respectively. Reported suspected measles incidence declined by 13% during 2007-2014, from 54 to 47 cases per 1 million population. However, in 2014, 81% of districts did not meet the measles case-based surveillance performance indicator target of ≥2 discarded non-measles cases per 100,000 population per year. To achieve and maintain measles elimination, additional measures are needed to strengthen routine immunization services to increase coverage with MCV1 and a recently introduced second dose of MCV (MCV2) to ≥95% in all districts, and to enhance sensitivity of measles case-based surveillance by adopting a more sensitive case definition, expanding case-based surveillance sites nationwide, and ensuring timely transport of specimens to the accredited national laboratory.

Trends of measles in Nigeria: A systematic review

Background: Measles, a highly infectious viral disease, is endemic in developing countries with a peak of transmission from October to March. The case fatality rate of measles in the developing countries stands at around 3-5%; this could be as high as 10% during epidemics. Although natural infection with the measles virus confers life-long immunity, those vaccinated with the vaccine could get up to 10 years of protection. In spite of the availability of measles vaccines, there have been sporadic measles outbreaks, especially in developing countries, hence the need to know the underlying cause. Study Design: Systematic review. Method: Relevant literature was reviewed on trend of measles. The literature accessed from the W.H.O and UNICEF sites, and also using Google search include case-series studies, community-based studies on age-specific measles case fatality ratios (CFRs), and cohort analysis of surveillance data. Results: The review shows that lowest measles CFR is seen among the vaccinated children and highest seen among the unvaccinated children. Additionally, the broad range of case and death definitions of measles as well as the study population and geography, clearly highlight the complexities in extrapolating results for global public health planning. Conclusion: The outcome of several studies has shown that measles outbreaks are associated with factors that include: weak measles case-based surveillance in some areas, lack of awareness about the disease among parents, vaccine stock-out, and lack of adequate cold chain equipment to preserve the vaccine in remote hard-to-reach areas.