Description of a large measles epidemic in Democratic Republic of Congo, 2010–2013

Abstract

BackgroundAlthough measles mortality has declined dramatically in Sub-Saharan Africa, measles remains a major public health problem in countries like the Democratic Republic of Congo (DRC). Here, we describe the large measles epidemic that occurred in the Democratic Republic of Congo between 2010 and 2013 using data from the national surveillance system as well as vaccine coverage surveys to provide a snapshot of the epidemiology of measles in DRC.MethodsStandardized national surveillance data were used to describe measles cases from 2010 to 2013. Attack rates and case fatality ratios were calculated and the temporal and spatial evolution of the epidemic described. Data on laboratory confirmation and vaccination coverage surveys as a part of routine program monitoring are also presented.FindingsBetween week 1 of 2010 and week 45 of 2013, a total of 294,455 cases and 5,045 deaths were reported. The cumulative attack rate (AR) was 0.4%. The Case Fatality Ratio (CFR) was 1.7% among cases reported in health structures through national surveillance. A total of 186,178 cases (63%) were under 5 years old, representing an estimated AR of 1.4% in this age group. Following the first mass vaccination campaigns, weekly reported cases decreased by 21.5%. Results of post-vaccination campaign coverage surveys indicated sub-optimal (under 95%) vaccination coverage among children surveyed.ConclusionsThe data reported here highlight the need to seek additional means to reinforce routine immunization as well as ensure the timely implementation of Supplementary Immunization Activities to prevent large and repeated measles epidemics in DRC. Although reactive campaigns were conducted in response to the epidemic, strategies to ensure that children are vaccinated in the routine system remains the foundation of measles control.

Does Measles Vaccination Reduce the Risk of Acute Respiratory Infection (ARI) and Diarrhea in Children: A Multi-Country Study?

“…Second, we could not attribute the ARI and diarrhea cases to measles in children because DHS does not collect any information on the prevalence of measles. However, large measles epidemics occurred in the Democratic Republic of Congo, Ethiopia, Nigeria and Pakistan in 2010–13 [25,56–58]. In India, measles is endemic in nature, and 6 outbreaks were serologically confirmed by Field Epidemiology Training Program (FETP) in 2004–06 [59].…”

Reduced vaccination and the risk of measles and other childhood infections post-Ebola

“…Pinatubo in 1991 (9)), and political crises (e.g., Haiti in the early 1990s (10)). The effects are most acute when measles epidemics are associated with famine or long term national instability: a survey of 595 households displaced due to the Ethiopian famine in 2000 found measles to be a contributing cause in 35 of 159 deaths (11), and after years of instability in the Demographic Republic of Congo the country experienced a measles outbreak of 294,455 cases and 5,045 deaths between 2010 and 2013 (12). …”

Seroepidemiology: an underused tool for designing and monitoring vaccination programmes in low‐ and middle‐income countries

“…In the Democratic Republic of Congo, the prevalence of both measles and tetanus antibodies measured on DBS samples during the 2013–2014 Demographic and Health Survey was also far below that expected (http://dhsprogram.com/pubs/pdf/FR300/FR300.vpd.pdf, 21 February 2016). National measles seroprevalence in children aged 6–59 months was 64.4%, and although seroprevalence did rise with age as expected in this country with ongoing large measles outbreaks , the finding of only 50% seropositivity in some of the provinces worst affected by the outbreak raises questions about assay sensitivity. Similarly, the prevalence of tetanus antibodies was very low and did not increase according to numbers of doses of vaccine received, even among children whose vaccination card was seen.…”