Progress Toward Measles Elimination — African Region, 2013–2016

Masresha, Balcha; Dixon, Meredith; Kriss, Jennifer L.; Katsande, Reggis; Shibeshi, Messeret Eshetu; Luce, Richard; Fall, Amadou; Dosseh, Annick; Byabamazima, Charles; Dabbagh, Alya; Goodson, James L.; Mihigo, Richard

doi:10.15585/mmwr.mm6617a2

Cited by 43 publications

(71 citation statements)

References 2 publications

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“…Our findings resemble those of a recent report of vaccine uptake among a general paediatric sample in a Kampala-based or rural general paediatric sample without known chronic illness, 12,20 a 2015 WHO-based assessment of paediatric measles vaccination in Uganda, 21 and also a 31-country assessment performed in 31 other countries in the region. 22 Similar to our study, the latter report also relied on immunisation card inspection to confirm vaccine receipt and timing and uncovered a high prevalence of late vaccine administration.…”

Section: Discussionsupporting

confidence: 87%

Paediatric immunisation and chemoprophylaxis in a Ugandan sickle cell disease clinic

Chen

Bakeera-Kitaka

Mupere

et al. 2018

J Paediatrics Child Health

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Aim We aimed to assess the receipt of recommended care for young children with sickle cell disease (SCD) in a central SCD clinic in Kampala Uganda, focusing on standard vaccination and antibacterial and antimalarial prophylaxis. Methods A cross‐sectional assessment of immunisation status and timeliness and prescribed antibacterial and antimalarial prophylaxis was performed in a sample with SCD aged ≤71 months in Mulago Hospital SCD Clinic. Government‐issued immunisation cards and clinic‐issued visit records for prescribed prophylaxis were reviewed. Results Vaccinations were documented by immunisation cards in 104 patients, mean age 31.7 months (range 3–70 months). Only 48 (46.2%) received all doses of each of the four recommended vaccine types, including pneumococcal 10‐valent conjugate vaccine (pneumococcal conjugate vaccine (PCV)‐10), which became available in 2014. Vaccination completion was associated with younger age and, for polio, maternal employment. PCV‐10 series was completed in 54.8% of the sample and in 18.2% of those aged 48–71 months. Of children completing all vaccination types, an average 68.8% were immunised on time, defined as <60 days beyond the recommended age. Only 17 (13.5%) children were both fully and timely vaccinated. In an overlapping sample of 147 children, with a mean age of 38.4 months (4–70 months), 81.6% had ≥1 documented prescription for penicillin and/or antimalarial prophylaxis. Conclusions Standardised vaccination and antibacterial and antimalarial protective measures for young children at this central SCD clinic were incomplete, especially PCV‐10 for age ≥24 months, and often late. Child age, but not general maternal demographics, were associated with vaccination and chemoprophylaxis. Clinic‐based oversight may improve timely uptake of these preventative measures.

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Section: Discussionsupporting

confidence: 87%

Paediatric immunisation and chemoprophylaxis in a Ugandan sickle cell disease clinic

Chen

Bakeera-Kitaka

Mupere

et al. 2018

J Paediatrics Child Health

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“…In 2011, the 46 countries of the WHO African Region (AFR) set a goal for regional measles elimination by 2020. (2) Attainment of this goal will require significant efforts as AFR had the highest measles incidence among the WHO regions in 2012 at 125/1,000,000. (1) High coverage with two doses of measles-containing vaccine (MCV) is the cornerstone of measles elimination strategies.…”

Section: Introductionmentioning

confidence: 99%

“…Although coverage with the first dose of MCV (MCV1) in AFR increased from 53% to 72% during 2000-2012, (1) only 13 (28%) countries had estimated MCV1 coverage ࣙ90% in 2012. (2) Periodic supplemental immunization activities (SIAs) are conducted in AFR countries to provide a second opportunity for MCV. As of 2012, 12 (26%) AFR countries had introduced a routine second dose of MCV (MCV2).…”

Section: Introductionmentioning

confidence: 99%

Application of the World Health Organization Programmatic Assessment Tool for Risk of Measles Virus Transmission—Lessons Learned from a Measles Outbreak in Senegal

Harris

Badiane²,

Lam

et al. 2015

Risk Analysis

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The World Health Organization (WHO) African Region set a goal for regional measles elimination by 2020; however, regional measles incidence was 125/1,000,000 in 2012. To support elimination efforts, the WHO and U.S. Centers for Disease Control and Prevention developed a tool to assess performance of measles control activities and identify high-risk areas at the subnational level. The tool uses routinely collected data to generate district-level risk scores across four categories: population immunity, surveillance quality, program performance, and threat assessment. To pilot test this tool, we used retrospective data from 2006 to 2008 to identify high-risk districts in Senegal; results were compared with measles case-based surveillance data from 2009 when Senegal experienced a large measles outbreak. Seventeen (25%) of 69 districts in Senegal were classified as high or very high risk. The tool highlighted how each of the four categories contributed to the total risk scores for high or very high risk districts. Measles case-based surveillance reported 986 cases during 2009, including 368 laboratory-confirmed, 540 epidemiologically linked, and 78 clinically compatible cases. The seven districts with the highest numbers of laboratory-confirmed or epidemiologically linked cases were within the capital region of Dakar. All except one of these seven districts were estimated to be high or very high risk, suggesting that districts identified as high risk by the tool have the potential for measles outbreaks. Prospective use of this tool is recommended to help immunization and surveillance program managers identify high-risk areas in which to strengthen specific programmatic weaknesses and mitigate risk for potential measles outbreaks.

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“… 1 Eight participants who have measles serostatus data at 24 months are not included in this figure due to missing data from 1 month. These participants missed the month 1 visit but returned at the 24 month visit.…”

Section: Figurementioning

confidence: 99%

“…Despite advances in reducing overall measles incidence in Africa 1 , several large and deadly measles outbreaks have occurred in countries with high adult and child HIV prevalence 2 . HIV infection reduces both initial and sustained immune responses to measles vaccination.…”

Section: Introductionmentioning

confidence: 99%

Sustained Responses to Measles Revaccination at 24 Months in HIV-infected Children on Antiretroviral Therapy in Kenya

Newman

Njoroge

Magaret³

et al. 2017

Pediatric Infectious Disease Journal

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Background There are limited data on whether HIV-infected children in resource-limited countries who are receiving antiretroviral therapy (ART) are able to produce sustained, protective levels of measles antibody after multiple measles vaccinations. Methods We administered an additional measles vaccine to HIV-infected children 15 months to 12 years of age receiving ART in Nairobi, Kenya. Measles antibody concentrations were determined by enzyme-linked immunosorbent assay (ELISA) at enrollment, one month, 12 months, and 24 months post revaccination. Results At enrollment, 125 (54%) of 232 study participants had protective concentrations of measles antibody. Measles seropositivity increased to 98% of all children at one month post revaccination, but decreased to 71% at 12 months, and 60% at 24 months post revaccination. Measles seroconversion and sustained measles seropositivity among those who were measles seronegative at enrollment was 25% at 24 months post revaccination. In this group, 39% of children with <50 copies/mL plasma HIV RNA measles seroconverted compared with 4% of children with plasma HIV RNA ≥1,000 copies/mL (p=0.018). Conclusions Measles revaccination can result in a sustained antibody response in a subset of HIV-infected children receiving ART, especially among those with HIV suppression.

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Progress Toward Measles Elimination — African Region, 2013–2016

Cited by 43 publications

References 2 publications

Paediatric immunisation and chemoprophylaxis in a Ugandan sickle cell disease clinic

Paediatric immunisation and chemoprophylaxis in a Ugandan sickle cell disease clinic

Application of the World Health Organization Programmatic Assessment Tool for Risk of Measles Virus Transmission—Lessons Learned from a Measles Outbreak in Senegal

Sustained Responses to Measles Revaccination at 24 Months in HIV-infected Children on Antiretroviral Therapy in Kenya

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