RESUMEN
BACKGROUND: To develop a successful model for accelerating measles elimination in poor areas of China, we initiated a seven-year project in Guizhou, one of the poorest provinces, with reported highest measles incidence of 360 per million population in 2002. METHODS: Project strategies consisted of strengthening routine immunization services, enforcement of school entry immunization requirements at kindergarten and school, conducting supplemental measles immunization activities (SIAs), and enhancing measles surveillance. We measured coverage of measles containing vaccines (MCV) by administrative reporting and population-based sample surveys, systematic random sampling surveys, and convenience sampling surveys for routine immunization services, school entry immunization, and SIAs respectively. We measured impact using surveillance based measles incidence. RESULTS: Routine immunization coverage of the 1st dose of MCV (MCV1) increased from 82% to 93%, while 2nd dose of MCV (MCV2) coverage increased from 78% to 91%. Enforcement of school entry immunization requirements led to an increase in MCV2 coverage from 36% on primary school entry in 2004 to 93% in 2009. Province-wide SIAs achieved coverage greater than 90%. The reported annual incidence of measles dropped from 200 to 300 per million in 2003 to 6 per million in 2009, and sustained at 0.9-2.2 per million in 2010-2013. CONCLUSIONS: This project found that a package of strategies including periodic SIAs, strengthened routine immunization, and enforcing school entry immunization requirements, was an effective approach toward achieving and sustaining measles elimination in less-developed area of China.
Asunto(s)
Erradicación de la Enfermedad/métodos , Programas de Inmunización/estadística & datos numéricos , Programas de Inmunización/normas , Vacuna Antisarampión , Sarampión/prevención & control , Niño , Preescolar , China/epidemiología , Erradicación de la Enfermedad/normas , Femenino , Humanos , Incidencia , Masculino , Vacuna Antisarampión/administración & dosificación , Vigilancia de la Población , Población Rural , Encuestas y Cuestionarios , Factores de TiempoRESUMEN
In the spring of 1990, local community health workers reported a measles outbreak in several partially vaccinated villages in the Punial Valley in northern Pakistan. The authors conducted an investigation in one of these villages to assess vaccine coverage and vaccine efficacy and to describe the patterns of measles outbreaks that prevailed in this community. The results of a survey of the entire village revealed two major gaps in vaccine coverage: the small minority Sunni community and children over 3 years of age. Vaccine efficacy was estimated to range from 73 to 90% but was markedly reduced in children who were vaccinated under 12 months of age. The occurrence of an outbreak in a community in which a relatively new vaccination program is primarily directed at younger children has been predicted by theoretical models of measles dynamics and is consistent with the experience of other vaccination programs in the developing world. These observations suggest that, in some areas of the developing world, the age groups targeted to receive measles vaccinations may need to be broadened to ensure adequate coverage to prevent recurrent outbreaks.
PIP: This report documents an investigation of a measles outbreak in Punial Valley, northern Pakistani village in which a vaccination program was well established. These villages had been receiving routine immunizations from the Expanded Program on Immunization administered by the Aga Khan Health Service, Pakistan. The authors conducted an investigation in one of these villages to assess vaccine coverage and vaccine efficacy and to describe the patterns of measles outbreak that prevailed in this community. Two major gaps in vaccine coverage were revealed in the survey: the small minority Sunni community, and children over 3 years of age. Vaccine efficacy was estimated to range from 73% to 90% but was significantly reduced in children who were vaccinated under 12 months of age. Theoretical models of measles dynamics have predicted the occurrence of an outbreak in a community in which a relatively new vaccination program is primarily directed at younger children. Such is also consistent with the experience of other vaccination programs in the developing world. These observations suggest that in some areas of the developing world, the scope of age coverage for measles vaccinations may need to be broadened to prevent recurrent outbreaks.
Asunto(s)
Brotes de Enfermedades , Vacuna Antisarampión , Sarampión/epidemiología , Sarampión/prevención & control , Adolescente , Factores de Edad , Niño , Preescolar , Países en Desarrollo , Femenino , Encuestas Epidemiológicas , Humanos , Esquemas de Inmunización , Lactante , Recién Nacido , Masculino , Pakistán/epidemiologíaRESUMEN
A measles epidemic occurred in Romania with 32,915 cases and 21 deaths reported between November 1996 and June 1998, despite high vaccination coverage since the early 1980s. Most cases were unvaccinated children aged <2 years and vaccinated school-aged children. A case-control study among preschool children and a cohort study among primary-school children were conducted to estimate effectiveness of Romanian-produced measles vaccine, and to evaluate age at vaccination and waning immunity as risk factors for vaccine failure. Both studies indicated that measles vaccine was highly effective. One dose reduced the risk for measles by 89% (95% confidence interval (CI) 85, 91); two doses reduced the risk by 96% (95% CI 92, 98). Children vaccinated at <1 year of age were not at increased risk for measles compared with children vaccinated at > or =1 year. Waning immunity was not identified as a risk factor since vaccine effectiveness was similar for children vaccinated 6-8, 9-11, and 12-14 years in the past. Because specific groups were not at risk for vaccine failure, an immunization campaign that targets all school-aged children who lack two doses may be an effective strategy for preventing outbreaks. A mass campaign followed by increased first-dose coverage should provide the population immunity required to interrupt indigenous measles virus transmission in Romania.
PIP: Two studies examined the effectiveness of measles vaccines in Romania during the measles epidemic between 1996 and 1998. A case control study among preschool children and a cohort study among primary school children were conducted to estimate Romanian-produced vaccine effectiveness and to identify risk factors for measles among these age groups. Both studies found that measles vaccine was highly effective. Single-dose vaccine effectiveness was 89% and double-dose vaccine effectiveness was 96%. Univariate analysis of the case-control study indicated that being unvaccinated and being born of itinerant parents were significant risk factors for measles among preschool children. Children vaccinated at less than 1 year of age were not at increased risk for measles compared with children who receive the vaccine at 1 year or older. Because specific groups were not at risk for vaccine failure, an immunization campaign targeting all school-aged children who lacks two doses of measles vaccine may be an effective measure to prevent outbreaks in Romania.
Asunto(s)
Brotes de Enfermedades , Vacuna Antisarampión , Sarampión/epidemiología , Adolescente , Adulto , Factores de Edad , Estudios de Casos y Controles , Niño , Preescolar , Estudios de Cohortes , Humanos , Esquemas de Inmunización , Lactante , Recién Nacido , Sarampión/prevención & control , Sarampión/transmisión , Vacuna Antisarampión/inmunología , Vacuna Antisarampión/normas , Modelos Teóricos , Estudios Retrospectivos , Rumanía/epidemiología , VacunaciónRESUMEN
PIP: Despite the availability of safe and effective measles vaccines since 1963, measles still accounts for approximately 10% of global mortality from all causes among children aged less than 5 years, an estimated 36.5 million cases and 1 million deaths in 1996. Worldwide in 1996, routine coverage with 1 dose of measles vaccine was 81%, although the African Region of the World Health Organization reports the lowest coverage, at 56%, and the largest proportion of measles cases and deaths. There is an urgent need to strengthen measles control and explore the best ways to achieve that end, especially in areas such as West Africa. However, the data presented by Cisse et al. do not show that the 1995 outbreak of measles in Niakhar, Senegal, was due mainly to the waning of vaccine-induced immunity among school-aged children. Waning immunity therefore cannot be used to justify the introduction of a multidose vaccination schedule as a key strategy for improving measles control in developing countries. The authors explain the basis for their opinions. The immediate objective of any measles control program should be to provide a first dose of measles vaccine to unvaccinated children.^ieng
Asunto(s)
Países en Desarrollo , Brotes de Enfermedades/prevención & control , Vacuna Antisarampión/administración & dosificación , Sarampión/prevención & control , Población Rural , Adolescente , Niño , Preescolar , Femenino , Humanos , Esquemas de Inmunización , Lactante , Masculino , Sarampión/transmisión , Instituciones Académicas , Senegal , Insuficiencia del TratamientoRESUMEN
PIP: Strebel et al. misinterpreted the authors' paper on the role of schools in measles transmission. As Strebel et al. noted, the main reason for the outbreak was low vaccine coverage among children aged 5-14 years, together with a marked reduction in the incidence of measles over the past 10 years. Because of the high measles vaccine coverage in younger age groups, many children in Niakhar have gone through their first 5 years of life without being infected with the measles virus. The waning of vaccine-induced immunity has played a role. Strebel et al. believe that there is no indication of waning immunity in the authors' paper and that there is a downward bias in vaccine efficacy due to faulty methodology. Their argument, however, misses the point. The children's ages at vaccination with standard vaccine were completely different in those age groups, with the median age being 295 days for those under age 5 years and 1017 days for those aged 10-14 years. Whether waning immunity will translate into declining vaccine efficacy with age depends upon whether misclassification of vaccination status and measles history is the same in all age groups. Other observations support the existence of waning immunity. The phenomenon of waning vaccine-induced immunity needs to be examined for measles and other vaccine-preventable diseases.^ieng
Asunto(s)
Brotes de Enfermedades , Vacuna Antisarampión/inmunología , Sarampión/inmunología , Adolescente , Anticuerpos Antivirales/sangre , Niño , Preescolar , Brotes de Enfermedades/prevención & control , Femenino , Humanos , Esquemas de Inmunización , Lactante , Masculino , Sarampión/prevención & control , Sarampión/transmisión , Vacuna Antisarampión/administración & dosificación , Virus del Sarampión/inmunología , Instituciones Académicas , Senegal , Insuficiencia del TratamientoRESUMEN
PIP: The Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia, USA has joined the Pan American Health Organization (PAHO) in the effort to eradicate measles in the Western Hemisphere by the year 2000. This partnership will ensure the successful completion of the target of measles eradication and will play a critical role in complementing national efforts toward the prevention, control, and eradication of other vaccine-preventable diseases. The PAHO and CDC partnership will focus on strengthening measles surveillance in the Americas and on ensuring that countries implement in full the PAHO-recommended vaccination strategy to eradicate the disease. This partnership will also be critical in the advancement toward the adoption and implementation of a global measles eradication goal.^ieng
Asunto(s)
Centers for Disease Control and Prevention, U.S. , Niño , Sarampión , Organización Panamericana de la Salud , Desarrollo de Programa , Vacunación , Adolescente , Factores de Edad , Américas , Atención a la Salud , Demografía , Países Desarrollados , Enfermedad , Agencias Gubernamentales , Salud , Servicios de Salud , Inmunización , Agencias Internacionales , América del Norte , Organizaciones , Población , Características de la Población , Atención Primaria de Salud , Naciones Unidas , Estados Unidos , United States Public Health Service , Virosis , Organización Mundial de la SaludRESUMEN
PIP: Since May of 1998 Bolivia has been affected by a measles outbreak, which began in the municipality of Yacuiba, within the department of Tarija. Bolivia reported 1004 confirmed measles cases in 1998, and during the first 40 weeks of 1999 there have been 1218 confirmed cases. About 51% of the total measles cases for 1999 in the Region have been reported in Bolivia. In response to this situation, the Ministry of Health of Bolivia has prepared a special plan of action and issued a Ministerial Resolution on October 26, aimed at ending the outbreak and interrupting virus transmission. The objective is to vaccinate at least 95% of all children between the ages of 6 months and 4 years (1,071,723 children) in a National Measles Vaccination Campaign, to be held between 28 November and 17 December in each municipality. This decision of the Ministry of Health indicates the high-level commitment of national authorities to the health of the population, and it is an excellent example of Panamericanism in action. (full text).^ieng
Asunto(s)
Incidencia , Sarampión , Investigación , Vacunación , Américas , Bolivia , Atención a la Salud , Países en Desarrollo , Enfermedad , Salud , Servicios de Salud , Inmunización , América Latina , Organización y Administración , Atención Primaria de Salud , Proyectos de Investigación , América del Sur , VirosisRESUMEN
PIP: Through December 11, 1999, a total of 39,941 suspected measles cases were reported from the countries of the Americas. Bolivia is the country most affected by the disease, with 51% of all reported cases in the region (1420 confirmed cases). It has suffered large outbreaks in urban areas due to large pockets of underimmunized populations, despite intensified vaccination activities that began in November 1998 and continued through March 1999. To control this measles outbreak, the Bolivian government, together with the support of other organizations developed an Emergency Plan. In addition, the Ministry of Health issued a Ministerial Resolution supporting the implementation of a comprehensive national campaign during December of 1999. A dramatic drop in measles cases has been observed, in the areas undertaking intensive follow-up activities on measles vaccination. Similar situations to that of Bolivia have become apparent in the countries of Brazil, Argentina, Colombia, and the Dominican Republic.^ieng
Asunto(s)
Inmunización , Sarampión , Formulación de Políticas , Vacunación , Américas , Atención a la Salud , Países Desarrollados , Países en Desarrollo , Enfermedad , Salud , Planificación en Salud , Servicios de Salud , Organización y Administración , Atención Primaria de Salud , VirosisRESUMEN
PIP: During July-December 1997, Bahamas conducted its first mass measles, mumps, and rubella (MMR) campaign targeting people aged 4-40 years living on 19 islands. 68% of the Bahamas' population reside on New Providence and Grand Bahama. The campaign was implemented to keep the country free of measles, interrupt rubella virus transmission, and prevent further cases of congenital rubella syndrome (CRS), by eliminating susceptible populations for rubella and mumps infection. No cases of measles and rubella have been reported since the campaign, despite the fact that the island receives more than 1 million tourists annually. in July 1998, the Ministry of Health of the Bahamas asked PAHO/SVI to evaluate the MMR campaign. A summary is presented of the evaluation report, with regard to the measles and rubella situation, safe syringe practices, vaccination coverage, the surveillance of adverse reactions, and vaccination during pregnancies.^ieng
Asunto(s)
Sarampión , Embarazo , Investigación , Rubéola (Sarampión Alemán) , Seguridad , Jeringas , Vacunación , Américas , Bahamas , Región del Caribe , Atención a la Salud , Países en Desarrollo , Enfermedad , Equipos y Suministros , Salud , Servicios de Salud , Inmunización , América del Norte , Organización y Administración , Atención Primaria de Salud , Salud Pública , Reproducción , VirosisRESUMEN
PIP: For the first 6 weeks of 1999, 114 confirmed measles cases have been reported from Argentina, Bolivia, Chile, Colombia, Dominican Republic, Uruguay, and the US. Dominican Republic had reported 34% of all cases up to February 13. Although this outbreak was first detected in December 1998, the first cases seem to have occurred early in November 1998. The outbreak is currently being investigated to identify possible sources of infection. Preliminary findings are that most of the 39 confirmed cases occurred among nonvaccinated individuals eligible for vaccination. Measles vaccination efforts have been slow in Bolivia's Cochabamba department. All countries in the region need to monitor the build-up of susceptibles as a result of either low vaccination coverage in routine programs or an inadequate coverage in follow-up campaigns. A sensitive surveillance system must also be maintained and cases aggressively investigated. These measures should prevent the re-establishment of measles virus circulation in the region.^ieng
Asunto(s)
Brotes de Enfermedades , Necesidades y Demandas de Servicios de Salud , Inmunización , Sarampión , Prevalencia , Américas , Bolivia , Región del Caribe , Atención a la Salud , Países Desarrollados , Países en Desarrollo , Enfermedad , República Dominicana , Economía , Salud , Servicios de Salud , América Latina , América del Norte , Atención Primaria de Salud , Investigación , Proyectos de Investigación , América del Sur , VirosisRESUMEN
PIP: The Pan American Health Organization's recommended strategy for measles eradication is for countries to "catch-up" on mass vaccination, to "keep-up" by maintaining better than 95% coverage in every district, and to "follow-up" on with rapid investigation of suspected measles cases. This latter effort will allow health workers to determine if a case resulted from importation or indigenous transmission and to determine the chain of transmission if more than one case occurs. In turn, this determination will allow officials to make necessary changes to avoid future cases of program failure. Recent surveillance efforts in Uruguay enabled identification of 23 cases of measles in four chains of transmission, three of which involved a health worker as transmitter or receptor of the infection.^ieng
Asunto(s)
Sarampión , Vacunación , Américas , Atención a la Salud , Países en Desarrollo , Enfermedad , Salud , Servicios de Salud , Inmunización , América Latina , Atención Primaria de Salud , América del Sur , Uruguay , VirosisRESUMEN
In 1993 a large outbreak of paralytic poliomyelitis occurred in Sudan as a result of an accumulation of large numbers of susceptible children that was accelerated by faltering immunization services. The extent of the outbreak led to the rapid rehabilitation of Sudan's Expanded Programme on Immunization (EPI); the government began financing vaccine purchase, operational aspects of EPI were decentralized, vaccine delivery was changed from a mobile to a fixed-site strategy, a solar cold chain network was installed, inservice training was resuscitated, and social mobilization was enhanced. National immunization days (NIDs) for poliomyelitis eradication were conducted throughout the country, including the southern states during a cease fire in areas of conflict. Measles immunization coverage was increased by offering measles vaccine during the second round of NIDs and subsequently through routine immunization services. Supplemental tetanus toxoid immunization of women of child-bearing age began in three provinces at high risk for neonatal tetanus. From 1994 to 1996 reported immunization coverage increased and the incidence of all EPI target diseases fell. Trends in coverage, disease incidence, financing, and the implementation of WHO-recommended disease-control strategies suggest that more sustainable immunization services have been re-established in Sudan.
PIP: A large outbreak of paralytic poliomyelitis in 1993 in the Sudan prompted rapid rehabilitation of Sudan's Expanded Program on Immunization (EPI). A World Health Organization team visited Sudan in 1993, 1995, and 1996 to review such efforts and their impact. Measures taken to eradicate poliomyelitis, control measles, and eliminate neonatal tetanus included government financing of vaccine purchase, decentralization of EPI operations, a shift from a mobile to a less expensive fixed-site vaccine delivery strategy, installation of a solar cold chain network, resumption of managerial in-service training, and social mobilization. National immunization days were conducted in 1994, 1996, and 1997 throughout the country (during a cease fire in the southern areas). From 1993-96, reported infant immunization coverage increased for all antigens, with a concomitant decrease in the incidence of EPI target diseases. National coverage for the third dose of diphtheria-tetanus-pertussis increased from 51% in 1993 to 79% in 1996, while the proportion of immunizations delivered at fixed sites rose from 35% to 70%. By 1996, 19 of Sudan's 26 states were financing some of the operational costs for EPI.
Asunto(s)
Brotes de Enfermedades , Programas de Inmunización , Poliomielitis/epidemiología , Poliomielitis/prevención & control , Adulto , Niño , Preescolar , Femenino , Humanos , Incidencia , Lactante , Recién Nacido , Masculino , Sarampión/epidemiología , Sarampión/prevención & control , Vacuna Antisarampión/administración & dosificación , Sudán/epidemiología , Tétanos/epidemiología , Tétanos/prevención & control , Toxoide Tetánico/administración & dosificaciónRESUMEN
In a randomized controlled trial in a measles endemic area, standard-dose (4.0 log10pfu) AIK-C measles vaccine administered at 6 months of age was compared to standard-dose Schwarz vaccine (3.7log10pfu) given at 9 months. Seroconversion rates at 3 and 6 months after immunization in the two groups were comparable and similar. The geometric mean titres achieved were, however, significantly higher in the Schwarz group (P < 0.05). No immediate serious side-effects were observed with either vaccine. We conclude that standard-dose AIK-C measles vaccine can be recommended for measles immunization in children below 9 months of age, especially in highly endemic and high-risk areas in developing countries.
PIP: The seroresponse of standard-dose heat-stable AIK-C measles vaccine administered to infants at 6 months of age was compared to that of standard-dose Schwarz vaccine administered at 9 months of age in a measles-endemic area in West Africa. The study was conducted in Asamankese, the capital town of Ghana's East Akim District. Infants 24-27 weeks of age who had been attending the Asamankese maternal-child health clinic regularly and had received all the required immunizations were enrolled and randomly assigned to receive the AIK-C (n = 184) or the Schwarz (n = 193) vaccine. No severe adverse reactions were reported during the 10-day follow-up period in either vaccine group. In the AIK-C group, 96.9% of infants who were seronegative at preimmunization and 79.4% of those with preexisting antibodies had seroconverted by 3 months after immunization; at 6 months after immunization, these rates were 97.3% and 100%, respectively. In the Schwarz group, 98.2% of infants seronegative at immunization and 100% of those with preexisting antibodies seroconverted by 3 months after immunization; at 6 months, these rates were 99.1% and 80%, respectively. Although the geometric mean titres achieved were significantly higher in the Schwarz vaccine group, these titres were above the protective level of 200 mIU in the AIK-C group. Administration of measles vaccine at a younger age may be more easily incorporated into current Expanded Program on Immunization schedules.
Asunto(s)
Enfermedades Endémicas , Vacuna Antisarampión/administración & dosificación , Sarampión/epidemiología , Factores de Edad , Anticuerpos Antivirales/análisis , Interpretación Estadística de Datos , Estudios de Evaluación como Asunto , Femenino , Estudios de Seguimiento , Ghana , Humanos , Lactante , Masculino , Sarampión/inmunología , Sarampión/prevención & control , Vacuna Antisarampión/efectos adversos , Vacuna Antisarampión/inmunología , Virus del Sarampión/inmunología , Factores de TiempoRESUMEN
The control of diarrhoeal diseases, acute respiratory infections and other childhood killers--such as measles, malaria and malnutrition--is now combined in WHO's Division of Child Health and Development. The need for integrated management of childhood illness is shown in its historical context.
PIP: Until the late 1960s, health professionals most often recommended that people with diarrheal disease take antidiarrheal drugs and refrain from eating for at least 24 hours. At the same time, work was underway on the development of oral rehydration therapy (ORT), which was subsequently adopted in 1971 to complement the limited supply of intravenous treatment for thousands of patients in West Bengal. The success of ORT in treating diarrheal disease led to the establishment of the World Health Organization's (WHO) Program for the Control of Diarrheal Diseases in 1980, and the subsequent broader access to packets of oral rehydration salts in health facilities. WHO was also involved in efforts to control acute respiratory infections, establishing the Acute Respiratory Infections Program to validate the use of clinical signs for diagnosis and evaluate the impact of the approach. Since WHO's maintenance of these two parallel single-disease programs resulted in some duplication of effort, they were merged in 1990 to form the Division of Diarrheal and Acute Respiratory Disease Control. The division's mandate was later modified and expanded in 1996 in the creation of the Division of Child Health and Development responsible for the control of diarrheal diseases, acute respiratory infections, and other childhood killers like measles, malaria, and malnutrition.
Asunto(s)
Servicios de Salud del Niño/organización & administración , Prestación Integrada de Atención de Salud/organización & administración , Diarrea/prevención & control , Infecciones del Sistema Respiratorio/prevención & control , Organización Mundial de la Salud/organización & administración , Enfermedad Aguda , Niño , Preescolar , Países en Desarrollo , Diarrea/etiología , Humanos , LactanteRESUMEN
Systematic immunization on a worldwide scale was not officially recognized as a practical possibility until 1974, when WHO launched its Expanded Programme on Immunization. Today, 80% of the world's children receive this form of protection against childhood diseases during their first year of life. Coverage can reach 90% by the year 2000, the effectiveness of the vaccines used is improving, and vaccines against additional diseases are being added to the programme.
PIP: In 1796, English country doctor Edward Jenner demonstrated that scratching cowpox virus onto the skin produced immunity against smallpox. Following this scientific demonstration, the practice of vaccination gradually became widespread during the 19th century, and began to be applied to other infections. However, the use of vaccines was largely confined to the industrialized countries. Immunization played no significant role in the World Health Organization's (WHO) early activities. In 1974, however, WHO launched its Expanded Program on Immunization (EPI) with the goal of immunizing all of the world's children against diphtheria, pertussis, tetanus, measles, poliomyelitis, and tuberculosis. At that time, only less than 5% of all children had been immunized against the diseases. The word "expanded" referred to the addition of measles and poliomyelitis to the vaccines then being used in the immunization program. Now, 80% of the world's children receive such protection against childhood diseases during their first year of life, coverage could reach 90% by 2000, vaccines are becoming more effective, and vaccines against additional diseases are being added to the program.
Asunto(s)
Control de Enfermedades Transmisibles/historia , Programas de Inmunización/historia , Control de Enfermedades Transmisibles/organización & administración , Historia del Siglo XX , Humanos , Programas de Inmunización/organización & administración , Lactante , Vacunas/historia , Organización Mundial de la Salud/historiaRESUMEN
In 1994, the Pan American Health Organization (PAHO) established the goal of eliminating measles from the Western Hemisphere by 2000. To reach this goal, PAHO developed a measles-elimination strategy that includes three vaccination components ("catch-up," "keep-up," and "follow-up") and integrated epidemiologic and laboratory surveillance. The aim of the strategy is to achieve and maintain high levels of measles immunity among infants and children and detect all chains of transmission of measles virus through careful surveillance. This report updates measles surveillance data through February 1998 and summarizes the impact of elimination strategies on measles in the Americas.
PIP: In 1994, the Pan American Health Organization (PAHO) established the goal of eliminating measles from the Western Hemisphere by 2000. To reach that goal, PAHO developed a measles-elimination strategy comprised of 3 vaccination components and integrated epidemiologic and laboratory surveillance. The strategy aims to achieve and maintain high levels of measles immunity among infants and children, and detect all chains of measles virus transmission through surveillance. This paper updates measles surveillance data through February 1998 and summarizes the impact of elimination strategies upon measles in the Americas. Each country in the Americas except the US, the French Antilles, and the Netherlands Antilles conducted measles "catch-up" campaigns during 1987-94. Vaccination coverage achieved during these campaigns was 94% region-wide, while country-specific coverage was 71-99%. Since 1994, 26 of the 47 countries and territories in the region have also conducted "follow-up" vaccination campaigns. In 1996, a record low of 2109 confirmed measles cases was reported from the region, with most of the region free of circulating measles. However, provisional data from January 1997 through February 1998 indicate that 88,485 suspected measles cases were reported in the region, of which 31% have been confirmed, 37% have been discarded, and 31% are being investigated. Brazil and Canada, with 26,348 and 570 confirmed cases, respectively, accounted for 97% of all confirmed cases region-wide. Details on the outbreaks in Brazil and Canada, as well as the presence of measles in the US are reported.
Asunto(s)
Sarampión/epidemiología , Sarampión/prevención & control , Américas/epidemiología , Humanos , Programas de Inmunización , Vacuna Antisarampión/administración & dosificación , Organización Panamericana de la SaludRESUMEN
A Comparative study of three types of measles vaccines was undertaken among 1005 children. Of these 527 were vaccinated with the Serum Institute of India (SII) vaccine, 230 with Schwarz (SC) and 248 were vaccinated with Edmonston-Zegreb (EZ) vaccine (imported from Zegreb). Though the majority of children reacted favourably with all the three vaccines (SII: 98.43%; SC: 93.40%; EZ: 93.0%) with a rise in titre, but the percentage of seroconversion was significantly higher with the SII vaccine (p < 0.01). The Schwarz and Edmonston Zagreb vaccines showed significantly less GM titre as compared with the other age group i.e. 9-12 months (p < 0.05). With Serum Institute of India (SII) vaccine the GM titres were almost similar in the different age groups. The overall GM titre obtained with the SII vaccine was significantly higher than the SC vaccine (p > 0.001) as well as the EZ vaccine (p > 0.001). It is of interest to note that among the infants, 22.5% children had measles antibody in them before vaccination.
PIP: This study compares the efficacy of the three types of measles vaccines undertaken among 1005 children at the General Hospital pediatrics department in Pune, India. Of these children, 527 were vaccinated with the Serum Institute of India (SII) vaccine, 230 with Schwarz (SC), and 258 were vaccinated with Edmonston-Zagreb (EZ) vaccine. Results showed that the percentage of seroconversion was significantly higher with SII vaccine (98.43%) when compared with the SC (93.40%) or the EZ vaccines (93.0%). Majority of the children reacted favorably with the 3 vaccines after the rise in titer. The GM titer in the age group less than 9 months of the Schawarz vaccine was significantly less as compared with 9-12 months. The EZ vaccine also showed significantly less GM titer in the age group less than 9 months compared with the 13-18 month group. The SII vaccine and the GM titer were almost similar in different age groups. The overall GM titer obtained in the SII vaccine was significantly higher than the SC and the EZ vaccines. From this study, a direction to the strategy of measles vaccination was enlightened.
Asunto(s)
Anticuerpos Antivirales/aislamiento & purificación , Vacuna Antisarampión/inmunología , Preescolar , Humanos , India , Lactante , Vacuna Antisarampión/clasificación , Virus del Sarampión/inmunologíaRESUMEN
PIP: Just as all teams from the region of the Americas have an excellent opportunity to be among the winners of the World Cup to be held from June 10 to July 12, 1998, all countries in the Americas can be winners by eradicating measles from the region by 2000. In the spirit of the global event, people should unite to deal measles its death knell. To that end, the Americas need to have the same commitment to eradicating measles that they had in the campaign to eradicate poliomyelitis. Specifically, countries need to allocate enough resources to ensure the availability of adequate supplies of measles vaccines, give high priority to measles surveillance, guarantee high coverage levels of measles vaccination for infants at their first birthday throughout target countries, conduct follow-up measles vaccination at least every 4 years to ensure the highest possible level of measles population immunity, and prevent outbreaks by targeting at-risk young adults for vaccination. Groups considered at risk include health workers, military personnel, university students, construction workers, and young adults who emigrate from rural areas to large urban centers.^ieng
Asunto(s)
Cooperación Internacional , Sarampión , Organización y Administración , Américas , Países Desarrollados , Países en Desarrollo , Enfermedad , VirosisRESUMEN
PIP: The World Health Organization (WHO) has helped children worldwide since its creation on April 7, 1948. Among its achievements is the global eradication of smallpox. Protecting children against vaccine-preventable diseases has long been at the forefront of WHO's collaboration with its member states, and it is the organization's area of greatest impact. The Pan American Health Organization (PAHO) has witnessed major improvements in immunization coverage for children under 1 year old for vaccine-preventable diseases, from 25-30% in 1977, to levels above 80% in 1997. In 1991, the Americas became the first region in the world to eradicate poliomyelitis. Following this successful eradication of polio, regional Ministers of Health adopted a resolution in 1994 calling for the eradication of measles transmission from the Americas by 2000. The partnerships established between countries during the period of polio eradication must now be revitalized.^ieng
Asunto(s)
Inmunización , Sarampión , Organización Panamericana de la Salud , Poliomielitis , Organización Mundial de la Salud , Américas , Atención a la Salud , Países Desarrollados , Países en Desarrollo , Enfermedad , Salud , Servicios de Salud , Agencias Internacionales , Organizaciones , Atención Primaria de Salud , Naciones Unidas , VirosisRESUMEN
PIP: The measles epidemic which began at the end of 1996 in Brazil and lasted through 1997, with more than 26,000 confirmed cases, affected several countries in Latin America, including Paraguay. There have been 205 confirmed measles cases in the border area between Brazil and Paraguay, which has a population of approximately 1.5 million people. On the basis of a number of problems identified in the border municipalities of both countries, it was decided to set up 3 local border committees for surveillance, information sharing, and measles eradication planning purposes. A technical meeting held February 12-13, 1998, in Curitiba, Brazil, to establish immediate strategies for controlling measles outbreaks in the border municipalities between Paraguay and Brazil resulted in the preparation of a project for technical cooperation between countries (TCC). TCC projects are a key component of the Pan American Health Organization's (PAHO) technical cooperation because they foster collaboration among countries in the region to solve certain health problems. Representatives from the Ministries of Health of Brazil and Paraguay, as well as regional and municipal officials, members of the Brazilian Cooperation Agency in the Ministry of Foreign Affairs, the Ministry of Health of Argentina, and PAHO country staff in Paraguay and Brazil attended the meeting.^ieng