Antecedent causes of a measles resurgence in the Democratic Republic of Congo

Abstract

IntroductionDespite accelerated measles control efforts, a massive measles resurgence occurred in the Democratic Republic of the Congo (DRC) starting in mid-2010, prompting an investigation into likely causes.MethodsWe conducted a descriptive epidemiological analysis using measles immunization and surveillance data to understand the causes of the measles resurgence and to develop recommendations for elimination efforts in DRC.ResultsDuring 2004-2012, performance indicator targets for case-based surveillance and routine measles vaccination were not met. Estimated coverage with the routine first dose of measles-containing vaccine (MCV1) increased from 57% to 73%. Phased supplementary immunization activities (SIAs) were conducted starting in 2002, in some cases with sub-optimal coverage (≤95%). In 2010, SIAs in five of 11 provinces were not implemented as planned, resulting in a prolonged interval between SIAs, and a missed birth cohort in one province. During July 1, 2010-December 30, 2012, high measles attack rates (>100 cases per 100,000 population) occurred in provinces that had estimated MCV1 coverage lower than the national estimate and did not implement planned 2010 SIAs. The majority of confirmed case-patients were aged <10 years (87%) and unvaccinated or with unknown vaccination status (75%). Surveillance detected two genotype B3 and one genotype B2 measles virus strains that were previously identified in the region.ConclusionThe resurgence was likely caused by an accumulation of unvaccinated, measles-susceptible children due to low MCV1 coverage and suboptimal SIA implementation. To achieve the regional goal of measles elimination by 2020, efforts are needed in DRC to improve case-based surveillance and increase two-dose measles vaccination coverage through routine services and SIAs.

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

“…Similar trends have been observed in many difficult settings in Africa and South America were follow-up campaigns and intervals of resurgence of multiple outbreaks occurred in less than 2 years. 10,11 Implementation of high quality follow-up campaigns in low resourced settings therefore remains a challenge.…”

“…In recent times, similar factors have accounted for the occurrence of outbreaks in both developing and underdeveloped countries. 10,11,[16][17][18][19] Comparing the risk of measles among vaccinated population over time was limited by possible recall bias since vaccination status of cases was not evidenced by card and detailed history of vaccine handling. Therefore, the extent of variation of trends that could be attributed to vaccine failure may be deficient but possibly cannot be discounted considering the weak health system.…”

A ‘post-honeymoon’ measles epidemic in Burundi: mathematical model-based analysis and implications for vaccination timing

“…Measles continues to be a challenge in sub-Saharan Africa; although the data we analyze come from an epidemic in Burundi from 25 years ago, the lessons from the present analysis are still applicable today. For instance, measles outbreaks are a current public health problem in the Democratic Republic of Congo, a border nation of Burundi ( Grout et al, 2013 ; Maurice, 2015 ; Scobie et al, 2015 ; Restrepo-Méndez et al, 2016 ), as well as elsewhere in sub-Saharan Africa ( Luquero et al, 2011 ; Minetti et al, 2013 ). The use of SIAs to achieve measles control is not a novel idea; existing policy recognizes their importance (e.g., Measles & Rubella Initiative, 2016 ).…”

Use of FTA Cards To Transport Throat Swabs and Oral Fluid Samples for Molecular Detection and Genotyping of Measles and Rubella Viruses

“…Measles and rubella remain endemic in the Democratic Republic of the Congo, with periodic large measles outbreaks causing substantial childhood morbidity and mortality (26)(27)(28)(29). In 2012, the estimated coverage with one dose of measles vaccine was 73% (30), while rubella vaccination has not yet been included in routine vaccinations or vaccination campaigns.…”