Impact of alternative approaches to accelerated measles control: experience in the African region, 1996-2002.
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From 1996 to 2000, several African countries accelerated measles control by providing a second opportunity for measles vaccine through supplemental campaigns. Fifteen countries completed campaigns in children aged 9 months to 14 years. Seven countries completed campaigns in children aged 9-59 months. In almost all countries that conducted campaigns in children aged 9 months to 14 years, measles deaths were reduced to near zero. In six countries, near-zero measles mortality has been maintained for 4-6 years. Supplemental immunization in children <5 years old was only partially effective (range, 0-67%) in reducing mortality. Measles cases decreased by 50% when routine vaccination coverage increased from 50% to 80%. Initial measles campaigns in children aged 9 months to 14 years, follow-up campaigns in those aged 9-59 months every 3-5 years, and increased routine coverage to 80% will be needed to reduce and maintain measles deaths in African countries at near zero. (+info)
Determining measles-containing vaccine demand and supply: an imperative to support measles mortality reduction efforts.
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Measles remains a major cause of mortality with an estimated 745,000 deaths in 2001. The timely, sustained, and uninterrupted supply of affordable vaccines is critical for global efforts to reduce measles mortality. The measles vaccine supply needs to be considered in the context of vaccine security. In 2000, the World Health Organization (WHO) and United Nations Children's Fund (UNICEF) issued a number of new recommendations for measles control that resulted in a two-fold increase in the number of measles-containing vaccine (MCV) doses administered between 2000 and 2002. Any additional increments in mass campaigns must be duly planned and have time lines so that vaccine production capacities are increased to optimal levels. The cornerstone of vaccine security efforts remains at the country level. WHO and UNICEF, with major partners, will review progress on measles mortality reduction and assess the feasibility of global measles eradication. Strong collaboration by all key stakeholders will be invaluable. (+info)
Future savings from measles eradication in industrialized countries.
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Estimates are made of monetary savings associated with measles eradication in seven industrialized countries. Three scenarios were studied: First, changing from the present two-dose measles-mumps-rubella (MMR) immunization schedule to one-dose of MMR; second, the use of an MMR and mumps-rubella schedule; or third, continuing the present schedule. Results show that the largest savings (US $623 million) would be achieved by changing to a one-dose MMR schedule with an assumption of a 3% discount rate and measles eradication in 2010. The smallest overall savings would result from option 3, by use of a 5% discount rate and the assumption that measles eradication occurs in 2020 ($10 million). These savings are less than previously estimated for the United States, partly because of the assumption that measles vaccines will continue to be delivered in response to possible bioterrorism threats. (+info)
Progress in the control of measles in Ghana, 1980-2000.
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By review of available literature, routine surveillance data, coverage surveys, and hospital records, measles control in Ghana was assessed since vaccinations began in 1978. Nationally, measles vaccination coverage increased from 24% in 1980 to 84% in 2000. This achievement is attributed to health sector reforms that included a higher district share of the total recurrent health budget from 20% in 1996 to 42% in 1999. The budget reallocation resulted in improved access to immunization services, supply procurement, transport management, staff motivation, and information flow. On the client side, the age of the child, socioeconomic status of parents, and type of prenatal care were associated with vaccination coverage. Routine vaccination coverage of >80% has resulted in lower measles incidence, a longer interepidemic interval, and a shift in cases to older children. Ghana recently developed a strategic plan to reduce measles deaths to near zero. (+info)
Failure of targeted urban supplemental measles vaccination campaigns (1997-1999) to prevent measles epidemics in Mozambique (1998-2001).
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This study assessed the effect of urban supplemental measles vaccination campaigns (1997-1999) in Mozambique that targeted children aged 9-59 months. Reported measles cases were analyzed to the end of 2001 to determine campaign impact. Hospital inpatient data were collected in the national capital and in three provincial capitals where epidemics occurred the year after the campaigns. Measles epidemics followed campaigns in the capital city, in 4 of 9 provincial capitals, and in 39 of 126 districts. Reasons for limited campaign impact included a low proportion of urban dwellers, the geographic location of some provincial capitals, the limited target age group, and low routine and campaign coverage. Routine immunization and disease surveillance should be strengthened and campaigns must achieve >90% coverage and target wider age groups and geographic areas in order to reach a high proportion of persons susceptible to measles. (+info)
Impact of mass measles campaigns among children less than 5 years old in Uganda.
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In 1999-2001, a national measles control strategy was implemented in Uganda, including routine immunization and mass vaccination campaigns for children aged 6 months to 5 years. This study assesses the impact of the campaigns on measles morbidity and mortality. Measles cases reported from 1992 through 2001 were obtained from the Health Management Information System, and measles admissions and deaths were assessed in six sentinel hospitals. Measles incidence declined by 39%, measles admissions by 60%, and measles deaths by 63% in the year following the campaigns, with impact lasting 15 to 22 months. Overall, 64% of measles cases were among children <5 years of age, and 93% were among children +info)
Evaluation of urban measles mass campaigns for children aged 9-59 months in Mali.
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There are an estimated 234,000 cases of measles and 13,851 measles-related deaths per year in Mali. In 1998 and 1999, 548,309 children aged 9-59 months were vaccinated against measles during mass campaigns in urban centers across Mali. After the first campaign, measles incidence decreased by 95% in districts encompassing vaccinated urban centers and by 41% in nonvaccinated districts. There was no shift in the proportion of cases by age group in vaccinated centers. Measles in vaccinated districts after the campaign was likely related to persistent transmission in age groups not targeted for vaccination and among children living in nonvaccinated districts. The second campaign (1999) did not change the incidence of measles in vaccinated compared with nonvaccinated centers. Urban mass measles vaccination probably did not affect overall measles transmission in Mali. Mass vaccination of all children in Mali, targeting a larger age group, will be necessary to reach measles control objectives. (+info)
Measles vaccination coverage during poliomyelitis national immunization days in Burkina Faso, 1999.
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In 1999, Burkina Faso added measles vaccine during the second round of its poliomyelitis national immunization days (NIDs). A cluster survey was conducted in each of the country's 53 health districts to assess vaccination coverage achieved by the campaign. Forty-four percent of children aged 9-59 months had a documented prior measles vaccination, and 88% were vaccinated during NIDs. Eighty-five percent of children not previously vaccinated received measles vaccine during the campaign. Although routine vaccination coverage varied substantially among children from various socioeconomic groups, the campaign appeared to almost equally reach all groups of children surveyed. Poliovirus vaccine coverage was 90% when measles vaccine was added to the campaign, compared with 88% during the first round. In Burkina Faso, the addition of measles vaccine to poliomyelitis NIDs achieved greater equity in measles vaccination coverage according to a number of socioeconomic factors without compromising the coverage of poliovirus vaccination. (+info)