Routine Measles Vaccination Research Articles

Measles Vaccination Coverage and Anti-Measles Herd Immunity Levels in the World and WHO Regions Worsened from 2019 to 2023

Objectives: The objectives of this study were as follows: to determine mean percentages of measles vaccination coverage with zero, one and two doses of vaccine and anti-measles herd immunity levels in World Health Organization (WHO) regions in 2023; to assess variations in measles vaccination coverage and anti-measles herd immunity-related indicators from 2019 to 2023; and to assess whether zero-dose measles vaccination coverage indicators were on track to achieve the Immunization Agenda 2030 objective. Methods: Mean percentages of vaccination coverage with two, one and zero doses of measles vaccine in WHO regions in 2023 were calculated using data from the WHO/UNICEF global and regional immunization information system. Results: In 2023, the global mean two-dose measles vaccination coverage was 65.3%, and mean two-dose vaccination coverage was lower than 95% in all WHO regions; the mean prevalence of measles-protected individuals in the target vaccination population was 87.6%, and anti-measles herd immunity levels in the target vaccination population were sufficient to block the transmission of measles viruses with greater transmissibility (Ro ≥ 15) only in the Western Pacific and European WHO regions. The global mean two-dose measles vaccination coverage decreased by 3.7% from 2019 to 2023. In 2023, the mean zero-dose measles coverage and number of zero-dose measles children were, respectively, 36.7% and 40.6% greater than the values required to be on track to achieve the 2030 objective. Conclusion: This study found that all measles-vaccination-coverage-related indicators worsened from 2019 to 2023, and the zero-dose measles vaccination coverage and number of zero-dose measles children in 2023 were not on track to achieve the AI2030 objective. Interventions to increase routine two-dose measles vaccination coverage should be developed in all WHO regions.

Measles: What Goes Around, Comes Around.

Measles cases are increasing globally and in the United States because of low routine measles vaccine coverage and disruptions to immunization services during the coronavirus disease 2019 (COVID-19) pandemic. To achieve and sustain measles elimination requires maintaining high coverage with 2 doses of measles vaccine, addressing vaccine hesitancy and misinformation, strong political commitment, and the necessary financial resources.

Case Ascertainment of Measles during a Large Outbreak-Laboratory Compared to Epidemiological Confirmation.

Measles is a highly contagious viral disease, and hence, sufficient herd immunity is obligatory to prevent infection transmission. Measles is still a cause of considerable disease burden globally, mainly in children. During a national measles outbreak in Israel in 2018-2019, the peak incidence rates occurred in the Jerusalem district. Most measles cases in the Jerusalem district (75.5%, 1702) were observed in children younger than 15 years of age, 49.2% (1109) were in children under 5 years of age, and 18.9% (425) were in infants under 1 year of age. The routine measles vaccination schedule includes two doses at 1 and 6 years of age. Most cases (1828, 81.1%) were unvaccinated (zero measles vaccine doses). These cases comprised the 425 affected infants under 1 year of age, who were ineligible for vaccination, along with the 1403 children over 1 year of age, who were otherwise unvaccinated. This study aimed to describe the epidemiologic and laboratory features of this measles outbreak, and to investigate case ascertainment (laboratory confirmed compared to epidemiologically confirmed cases). The study population included 2254 measles cases notified during the period spanning June 2018 to May 2019 in the Jerusalem district (incidence rate 176 per 10,000 population). Of the 2254 cases, 716 (31.8%) were laboratory confirmed, and 1538 (68.2%) were confirmed as epidemiologically linked. Most laboratory confirmed cases (420, 58.7%) underwent real-time PCR tests. Serological tests (measles IgM and IgG) were used in 189 (26.4%) cases, and a combination of RT-PCR and serology was used in 107 (14.9%) cases. In a multivariate model analysis, the variables significantly associated (after adjustment) with higher odds for laboratory confirmation included month of disease onset (late), additional measles cases in the household (single case), place of medical treatment (hospital; either emergency department, or hospitalization) and vaccination status (at least one prior vaccine dose). The measles outbreak described demonstrates the urgency of addressing vaccination gaps with appropriate outbreak prevention programs. The road to measles elimination needs to be paved with robust public health infrastructure, excellent field epidemiology for outbreak surveillance, investigation, and control, and laboratory proficiency.

Effect of postpartum family planning intervention and associated factors during child immunization in Addis Ababa, Ethiopia.

World Health Organization (WHO) recommends postpartum family planning (PPFP) as a critical component of health care that has the potential to save millions of maternal and infant lives in low- and middle-income countries. participants in our randomized, controlled trial were mothers coming for vaccination of their child in three selected health centers in Addis Ababa during the first 10 weeks postpartum. Eligible mothers were randomly assigned to intervention (pamphlet-supported counseling about the benefits of family planning) and non-intervention (routine care) arms. Data were collected when mothers came with their infants for a routine measles vaccination at nine months of life. Family planning (FP) use was compared between the groups using logistic regression, and bivariate and multivariate analyses. The study also used Kaplan Meier and Cox regressions to compare the median time of PPFP use and its correlation using SPSS version 26. The research was undertaken from December 2019 to June 2021. a total of 347 women (177 control, 170 intervention) enrolled in the study. Fifty-eight percent were 24-30 years old. Young age, knowledge about FP, previous use of an FP method, and being married were found to be independent predictors for PPFP use. When comparing intervention and non-intervention groups, there was no significant effect on contraceptive use (adjusted OR 0.633 [95% CI 0.385-1.040]). pamphlet-supported counseling of mothers in the first 10 weeks postpartum did not increase PPFP at nine months postpartum. Successful interventions will likely require holistic strategies, especially in resource-limited settings. The trial had been registered with clinicaltrials.gov (NCT04521517) on September 24, 2019.

Health system barriers to timely routine measles vaccinations in rural southwest China: a qualitative study on the perspectives of township vaccination professionals and village doctors

ObjectivesA well-functioning health system ensures timely routine measles vaccinations for age-appropriate children, minimising measles risk. However, there is limited knowledge about the impact of the performance of immunisation programmes in...

The effect of COVID-19 pandemic on routine immunization: A case study of measles outbreak in Kambia District, Sierra Leone, October 2021

Measles is one of the leading causes of death among children under five in Africa. Studies showed that COVID19 has affected routine health services, including immunization services. We investigated to confirm the diagnosis, identify the source, mode of transmission, instituted control and prevention measures. We interviewed caregivers and community people to find the source of infection. We used case investigation form to collect demographic, clinical, travel, and contact data. We conducted active case search in communities and health facilities. We collected blood samples to test for measles antibodies and isolated case patients to prevent transmission. A total of 60 measles cases were reported, five were laboratory confirmed and 55 by epidemiological link. The median age was 4 years (range: 4 months – 23 years). Females accounted for 67% of the cases. No travel history was reported. Bamoi Luma's Measles-Rubella vaccination coverage was 28%. Only 20 patients (12%) received measles vaccination and vitamin A supplementation. Measles outbreak was confirmed with more cases in the community. Factors contributed to this outbreak included low vaccination coverage, impact of COVID-19 pandemic on routine health services, and contact with measles cases. We recommend routine measles vaccination and community sensitization on measles prevention.

Subacute sclerosing panencephalitis: current threat

The relevance of this problem is associated with a predicted increased incidence of subacute sclerosing panencephalitis, a steadily progressive and difficult to diagnose fatal brain disease. Subacute sclerosing panencephalitis develops after measles and it does not correlate with clinical type of an acute measles infection: it affects both persons with manifest measles and ones who have had an asymptomatic or abortive disease. WHO estimates the incidence of subacute sclerosing panencephalitis as 4–11 per 100,000 measles cases. The latency period from measles to the onset of subacute sclerosing panencephalitis is between 2.5 and 34 years. As a result of measles outbreaks in 2011–2014 and 2017–2019 an increase in the number of subacute sclerosing panencephalitis cases in Russia is expected soon. Diagnostic difficulties are caused by multiplicity of subacute sclerosing panencephalitis clinical manifestation and the absence of MRI changes in early stages. Thereby, it is important to exclude SSPE in patients with neurological symptoms. Screening tests for subacute sclerosing panencephalitis should be conducted in children with acute cognitive impairment, myoclonus, or a new onset of epileptic syndrome. The specific cure for subacute sclerosing panencephalitis has not been developed yet. Most treatments aim at reducing symptoms. Up to date, the only way to conquer this disease is routine measles vaccination.

Health effects of routine measles vaccination and supplementary immunisation activities in 14 high-burden countries: a Dynamic Measles Immunization Calculation Engine (DynaMICE) modelling study

WHO recommends at least 95% population coverage with two doses of measles-containing vaccine (MCV). Most countries worldwide use routine services to offer a first dose of measles-containing vaccine (MCV1) and later, a second dose of measles-containing vaccine (MCV2). Many countries worldwide conduct supplementary immunisation activities (SIAs), offering vaccination to all people in a specific age range irrespective of previous vaccination history. We aimed to estimate the relative effects of each dose and delivery route in 14 countries with high measles burden. We used an age-structured compartmental dynamic model, the Dynamic Measles Immunization Calculation Engine (DynaMICE), to assess the effects of different vaccination strategies on measles susceptibility and burden during 2000-20 in 14 countries with high measles incidence (containing 53% of the global birth cohort and 78% of the global measles burden). Country-specific routine MCV1 and MCV2 coverage data during 1980-2020 were obtained from the WHO and UNICEF Estimates of National Immunization Coverage database for all modelled countries and SIA data were obtained from the WHO summary of measles and rubella SIAs. We estimated the incremental health effects of different vaccination strategies using prevented cases of measles and deaths from measles and their efficiency using the incremental number needed to vaccinate (NNV) to prevent an additional measles case. Compared with no vaccination, MCV1 implementation was estimated to have prevented 824 million cases of measles and 9·6 million deaths from measles, with a median NNV of 1·41 (IQR 1·35-1·44). Adding routine MCV2 to MCV1 was estimated to have prevented 108 million cases and 404 270 deaths, whereas adding SIAs to MCV1 was estimated to have prevented 256 million cases and 4·4 million deaths. Despite larger incremental effects, adding SIAs to MCV1 (median incremental NNV 6·02, 5·30-7·68) showed reduced efficiency compared with adding routine MCV2 (5·41, 4·76-6·11). Vaccination strategies, including non-selective SIAs, reach a greater proportion of children who are unvaccinated and reduce measles burden more than MCV2 alone, but efficiency is lower because of the wide age range targeted by SIAs. This analysis provides information to help improve the health effects and efficiency of measles vaccination strategies. The interplay between MCV1, MCV2, and SIAs should be considered when planning future measles vaccination strategies. Gavi, the Vaccine Alliance and the Bill & Melinda Gates Foundation.

Public Health Actions to Control Measles Among Afghan Evacuees During Operation Allies Welcome - United States, September-November 2021.

On August 29, 2021, the United States government oversaw the emergent establishment of Operation Allies Welcome (OAW), led by the U.S. Department of Homeland Security (DHS) and implemented by the U.S. Department of Defense (DoD) and U.S. Department of State (DoS), to safely resettle U.S. citizens and Afghan nationals from Afghanistan to the United States. Evacuees were temporarily housed at several overseas locations in Europe and Asia* before being transported via military and charter flights through two U.S. international airports, and onward to eight U.S. military bases,† with hotel A used for isolation and quarantine of persons with or exposed to certain infectious diseases.§ On August 30, CDC issued an Epi-X notice encouraging public health officials to maintain vigilance for measles among Afghan evacuees because of an ongoing measles outbreak in Afghanistan (25,988 clinical cases reported nationwide during January-November 2021) (1) and low routine measles vaccination coverage (66% and 43% for the first and second doses, respectively, in 2020) (2).

Health Impact of Routine Measles Vaccination and Supplementary Immunisation Activities in 14 High Burden Countries: A DynaMICE Modelling Study

Health Impact of Routine Measles Vaccination and Supplementary Immunisation Activities in 14 High Burden Countries: A DynaMICE Modelling Study

Effectiveness of structured teaching programme on knowledge regarding rubella vaccine among parents of children, 1-12 year

Background: Rubella also known as German measles is a mild viral disease characterized by mild fever and maculopapular rash. During 2000-2018, measles vaccination prevented an estimated 23.2 million deaths. Routine measles vaccination for children combined with mass immunization campaigns in countries with high case and death rates, are key public health strategies to reduce global measles deaths. The aim of the study is to assess the effectiveness of structured teaching programme on knowledge regarding rubella vaccine among parents of children (1-12 year).Methods: Pre experimental one group pre-test post-test design. Total 60 parents were taken who have children (1-12 years); purposive sampling technique was used to select the parents. A structured knowledge questionnaire was prepared by the investigator. Informed consent was taken from each participant prior to data collection and Descriptive and inferential statistics i.e., frequency, percentage, paired’ test, chi-square test was used for analysis.Results: Pre-test knowledge score of parents regarding rubella vaccine revealed that 53.33% parents had inadequate knowledge, and 46.66% parents had moderately knowledge. After structured teaching programme, the posttest knowledge scores of parents shows that 13.33% parents had adequate knowledge, 83.33% parents had moderately adequate knowledge and 3.33% have inadequate knowledge.Conclusions: The structured teaching programme (STP) through flash cards, charts and roller board etc. found to be very effective in improving the knowledge among parents who have children (1-12 year) on rubella vaccine.

Mapping routine measles vaccination in low- and middle-income countries

The safe, highly effective measles vaccine has been recommended globally since 1974, yet in 2017 there were more than 17 million cases of measles and 83,400 deaths in children under 5 years old, and more than 99% of both occurred in low- and middle-income countries (LMICs)1–4. Globally comparable, annual, local estimates of routine first-dose measles-containing vaccine (MCV1) coverage are critical for understanding geographically precise immunity patterns, progress towards the targets of the Global Vaccine Action Plan (GVAP), and high-risk areas amid disruptions to vaccination programmes caused by coronavirus disease 2019 (COVID-19)5–8. Here we generated annual estimates of routine childhood MCV1 coverage at 5 × 5-km2 pixel and second administrative levels from 2000 to 2019 in 101 LMICs, quantified geographical inequality and assessed vaccination status by geographical remoteness. After widespread MCV1 gains from 2000 to 2010, coverage regressed in more than half of the districts between 2010 and 2019, leaving many LMICs far from the GVAP goal of 80% coverage in all districts by 2019. MCV1 coverage was lower in rural than in urban locations, although a larger proportion of unvaccinated children overall lived in urban locations; strategies to provide essential vaccination services should address both geographical contexts. These results provide a tool for decision-makers to strengthen routine MCV1 immunization programmes and provide equitable disease protection for all children.

Seroprevalence of Measles in Healthcare Workers in South Korea

Background: Measles is a highly contagious disease that is transmissible by airborne particles but is preventable by vaccination. South Korea has maintained a highly immunized adult population; however, small local outbreaks of measles continued to occur, and there have been some reports of pockets of underimmunity among the young adult population. It is important to know the seroepidemiology of healthcare workers (HCWs) for policy-making process, but data on the seroprevalence of measles in HCWs in South Korea are limited. Methods: We investigated the seroprevalence of HCWs at Asan Medical Center, a 2,705-bed tertiary-care hospital in Seoul, South Korea, with 8,329 HCWs. In 2014, after an outbreak of measles occurred in a university in Seoul, Asan Medical Center required measles IgG tests for all HCWs born in and after 1967 for point-prevalence surveillance. In addition, we have routinely performed measles antibody test for new HCWs since 2014. In 2018, antibody tests were administered to HCWs who were born before 1967 or who had taken a leave of absence in 2014. We provided MMR vaccination to all HCWs whose antibody tests yielded negative results. Results: In total, 7,411 HCWs (89%) underwent measles antibody tests from 2014 to 2018. The overall seropositivity was 73% (95% CI, 72%–74%); seroprevalence was 73% in HCWs born in of after 1967, whereas the seroprevalence in HCWs born before 1967 was 98%. The seroprevalence sharply decreased from 85% in the 1986 birth cohort to 42% in the 1995 birth cohort. Conclusions: In conclusion, the proportion of measles-susceptible individuals was substantially high in HCWs, especially in young adults. Because the impact of measles outbreak in healthcare facilities would be critical, a policy regarding routine serologic screening followed by measles vaccination or routine measles vaccination in healthcare facilities should be considered, especially for young Korean HCWs.Funding: NoneDisclosures: None

Reduction in Short-term Outpatient Consultations After a Campaign With Measles Vaccine in Children Aged 9-59 Months: Substudy Within a Cluster-Randomized Trial.

We assessed a measles vaccination campaign's potential short-term adverse events. In a cluster-randomized trial assessing a measles vaccination campaign's effect on all-cause mortality and hospital admission among children aged 9-59 months in Guinea-Bissau, children received a measles vaccination (intervention) or a health check-up (control). One month to 2 months later, we visited a subgroup of children to ask mothers/guardians about outpatient consultations since enrollment. In log-binomial models, we estimated the relative risk (RR) of nonaccidental outpatient consultations. Among 8319 children (4437 intervention/3882 control), 652 nonaccidental outpatient consultations occurred (322 intervention/330 control). The measles vaccination campaign tended to reduce nonaccidental outpatient consultations by 16% (RR, 0.84 [95% confidence interval {CI}, .65-1.11]), especially if caused by respiratory symptoms (RR, 0.68 [95% CI, .42-1.11]). The reduction tended to be larger in children who prior to trial enrollment had a pentavalent vaccination (diphtheria, tetanus, pertussis, hepatitis B, and Haemophilus influenzae type b) as the most recent vaccination (RR, 0.61 [95% CI, .42-.89]) than in children who prior to trial enrollment had a routine measles vaccination as the most recent vaccination (RR, 0.93 [95% CI, .68-1.26]) (P = .04 for interaction). In the short term, a measles vaccination campaign seems not to increase nonaccidental outpatient consultations but may reduce them. NCT03460002.

Comparative Distributional Impact of Routine Immunization and Supplementary Immunization Activities in Delivery of Measles Vaccine in Low- and Middle-Income Countries.

Objectives:In many countries, measles disproportionately affects poorer households. To achieve equitable delivery, national immunization programs can use 2 main delivery platforms: routine immunization and supplementary immunization activities (SIAs). The objective of this article is to use data concerning measles vaccination coverage delivered via routine and SIA strategies to make inferences about the associated equity impact.Methods:We relied on Demographic and Health Survey and Multiple Indicator Cluster Surveys multi-country survey data to conduct a comparative analysis of routine and SIA measles vaccination status of children by wealth quintile. We estimated the value of the angle, θ, for the ratio of the difference between coverage levels of adjacent wealth quintiles by using the arc-tangent formula. For each country/year observation, we averaged the θ estimates into one summary measurement, defined as the “equity impact number.”Results:Across 20 countries, the equity impact number summarized across wealth quintiles was greater (and hence less equitable) for routine delivery than for SIAs in the survey rounds (years) during, before, and after an SIA about 65% of the time. The equity impact numbers for routine measles vaccination averaged across wealth quintiles were usually greater than for SIA measles vaccination across country-year observations.Conclusions:This analysis examined how different measles vaccine delivery platforms can affect equity. It can serve to elucidate the impact of immunization and public health programs in terms of comparing horizontal to vertical delivery efforts and in reducing health inequalities in global and country-level decision-making.

Are the Objectives Proposed by the WHO for Routine Measles Vaccination Coverage and Population Measles Immunity Sufficient to Achieve Measles Elimination from Europe?

Background: The World Health Organization (WHO) proposed two-dose measles vaccination coverage of at least 95% of the population and percentages of measles immunity in the population of 85%−95% in order to achieve measles elimination in Europe. The objectives of this study were: (1) to determine the measles vaccination coverage required to establish herd immunity against measles viruses with basic reproduction numbers (Ro) ranging from 6 to 60, and (2) to assess whether the objectives proposed by the WHO are sufficient to establish herd immunity against measles viruses. Methods: The herd immunity effects of the recommended objectives were assessed by considering the prevalence of protected individuals required to establish herd immunity against measles viruses with Ro values ranging from 6 to 60. Results: The study found that percentages of two-dose measles vaccination coverage from 88% to 100% could establish herd immunity against measles viruses with Ro from 6 to 19, assuming 95% measles vaccination effectiveness. The study found that the objective of 95% for two-dose measles vaccination coverage proposed by the WHO would not be sufficient to establish herd immunity against measles viruses with Ro ≥ 10, assuming 95% measles vaccination effectiveness. By contrast, a 97% measles vaccination coverage objective was sufficient to establish herd immunity against measles viruses, with Ro values from 6 to 13. Measles immunity levels recommended in individuals aged 1−4 years (≥85%) and 5−9 years (≥90%) might not be sufficient to establish herd immunity against most measles viruses, while those recommended in individuals aged 10 or more years (≥95%) could be sufficient to establish herd immunity against measles viruses with Ro values from 6 to 20. Conclusion: To meet the goal of measles elimination in Europe, it is necessary to achieve percentages of two-dose measles vaccination coverage of at least 97%, and measles immunity levels in children aged 1−9 years of at least 95%.

Detection of measles cases in the Republic of Guinea in 2017–2018

In 2017, WHO reported 596 confirmed measles cases in Guinea Republic connected to the 2016–2017 epidemic outbreak that was stopped after additional immunization (SIA) against measles in two provinces of the country. Improving the effectiveness of SIA is associated with the identification of epidemiologically significant groups of the population. The aim of the study was to analyze 2017–2018 measles cases and assess population immunity to measles virus in the Republic of Guinea. Materials and methods. A total of 810 blood serum samples collected from patients with maculo-papular rash and clinical diagnosis “measles?” were tested for measles virus-specific IgM-and IgG antibody level. 445 sera of conditionally healthy individuals aged 7 months to 67 years were examined for anti-measles virus IgG antibody level. Immunoglobulins of classes M and G were detected by ELISA with test systems «Anti-Measles Virus ELISA (IgM)» (Euro immun, Germany) and «Anti-Measles Virus ELISA (IgG)» (Euroimmun, Germany). Results and discussion.In 2017–2018, the epidemic process of the measles in the Republic of Guinea proceeded very intensively, being markedly prevalent in children among age groups. In 2018, more than half of the cases (61.6%) were identified in children aged 1 to 5 years old; the second most abundant age group was children under one year (18.6%), probably due to violated measles vaccination, which in GR are subject to children of nine months of age. It was found that 16.4% of patients (60 out of 366) had documented data on measles vaccination. Potentially, high proportion of measles cases among pre-vaccinated subjects was due to insufficient immune response to a single immunization in children of 9 months of age. Moreover, lowered vaccine-related properties might also be violated “cold chain” during vaccine transportation occurring in tropical climate. Analyzing 445 subjects revealed that total number of measles virus seronegative subjects was 8.3%. However, the vast majority of them were children and young adults aged 7 months to 22 years, where 52.4% of seronegative subjects were identified. Thus, the data obtained indicate that intensive measles virus circulation in human population was continued that necessitate interventions for improving epidemiological surveillance, extend routine measles vaccination coverage and conduct SIAs against measles in GR.

Investigation and control of measles outbreak in Puli-Khumri and Baghlan-Markazi Districts, Baghlan province, Afghanistan: a teaching case-study

Measles is a highly contagious viral disease that remains a significant cause of death among young children globally despite the availability of a safe and effective vaccine. Measles is transmitted via droplets from the nose, mouth, or throat of infected persons, and initial symptoms include a high fever, runny nose, bloodshot eyes, and tiny white spots on the inside of the mouth. Several days later, a rash develops, starting on the face and upper neck and gradually spreading downwards. Routine measles vaccination for children, combined with mass immunization campaigns in countries with low routine coverage, are key public health strategies to reduce global measles deaths. In Afghanistan, 25,000 cases were reported in 2017 of which 85% were among children under the age of 10. These cases span over 20 of the 34 provinces across Afghanistan, with the worst affected provinces being Kabul, Paktika, Kunar, Badghis and Ghor. The majority of outbreaks are reported, investigated, and responded to throughout recent years in the country. This current outbreak of measles with an almost two-year duration is investigated and reported from Baghlan province. The goal of this case study is to develop competencies and consolidate understanding of participants to investigate and control outbreaks. This case study stimulates the students to investigate and control a measles outbreak and critically appraise an epidemic report. The case study is designed for training novice field epidemiology trainees. The case study can be administered in 3-4 hours. Used as adjunct training material, the case study provides the trainees with competencies in investigating outbreaks and identifying factors affecting outbreaks.

Implementation of the program of measles elimination in the WHO African region

The review is devoted to the analysis of the available literature on the elimination of measles. The review focuses on the current measles epidemic situation in the African Region (AFR) and the implementation of the WHO strategic plan for the elimination of measles in AFR by 2020. Measles in the AFR is characterized by a severe course with a high risk of death due to malnutrition, vitamin A deficiency, concomitant bacterial and viral infections, and malaria. In 2015, 105,256 cases of measles were reported in the WHO African Region, most of them among children under 5 years old, 79% of whom were not vaccinated or had unknown vaccine status. Initially, the strategy for implementing the measles elimination program in AFRs was based on a combination of immunization campaigns for children under 14 years of age (coverage of more than 90%) and routine vaccination of at least 90% of children aged 9–15 months. It was recommended to repeat the campaign of mass immunization of children aged 9 months up to 4 years every 3–5 years. The use of this strategy has reduced the number of measles cases by 83–97% during the first year of additional immunization programs. The recommended age of routine measles vaccination in AFRs is 9 months — a strategy to reduce infant mortality, including that due to complications of measles. In 2016, measles vaccination was introduced into the national immunization schedule in all AFR countries, and 24 countries introduced revaccination. Currently, the measles elimination program in a number of AFR countries is based on two-dose immunization (MCV1 and MCV2). The measles prevention program in a number of AFR countries was disrupted due to the Ebola epidemic. There are some common problems in the realization of the program in AFR countries. All AFR countries are committed to the measles elimination program. The review provides information on strategies and successes in overcoming challenges to achieve the goals set for the WHO African Region in the implementation of the programme of measles elimination.

Assessment of Routine Measles Vaccine Effectiveness Among Children Referring to Tertiary Fever Hospital in Egypt

Background: Measles is one of the leading causes of childhood morbidity and mortality in the world despite the availability of a relatively inexpensive, safe, and effective vaccine. Objectives: The study aimed to evaluate measles vaccine effectiveness as one of the fundamental actions to eliminate measles infection. The specific objectives were to estimate the measles vaccine effectiveness at the level of under 12-year-old children population using the Egyptian surveillance data for cases seeking medical care at Embaba Fever Hospital between March 2017 and February 2018 and to determine the trend of measles virus infection during the same period. Methods: This hospital-based cross-sectional analytical study was conducted at Embaba Fever Hospital in Giza Governorate for the evaluation of measles vaccine effectiveness. In total, 466 patients were enrolled in the study and investigated clinically and laboratory to confirm the diagnosis of measles. Results: Of the 466 children, 69 (14.8%) tested positive for measles IgM antibodies. Children in the 1 - 4 year age group had the highest positivity rate to measles antibodies (43.5%), followed by the age group of ≥ 5 years (29%) and the age group of < 1 year (27.5%). The overall estimated vaccine effectiveness was 80.7% (95% CI: 63.7 - 90.8%) for the one-dose measles-mumps-rubella (MMR) and 91.8% (95% CI: 88.0 - 94.5%) for the two-dose vaccine. Conclusions: Measles infection is still high among vaccinated and unvaccinated children in Egypt. Therefore, it is suggested that a sustainable plan be developed for achieving high vaccination coverage among children younger than five years of age.