Clinical and epidemiological findings during a measles outbreak occurring in a population with high vaccination coverage

Oliveira, Solange Artimos de; Soares, Walquíria Nascimento; Dalston, Marcos Olivier; Almeida, Maria Teresa G. N. de; Costa, Antônio José Leal

doi:10.1590/s0037-86821995000400006

Cited by 5 publications

(5 citation statements)

References 17 publications

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“…While the zone made some prominent progress in improving routine immunization, there is still pocket and hard to reach areas that are difficult to reach and provide routine immunization despite the introduction of routine immunization for over three decades. The number of unvaccinated children in our findings was higher than (75%) the studies reported from Marshall Islands (59%), and the study conducted in Rio de Janeiro, which was 7.2% in < 1 years old [ 5 – 7 ].…”

Section: Discussioncontrasting

confidence: 83%

Measles outbreak investigation in Guji zone of Oromia Region, Ethiopia

Belda¹,

Tegegne²,

Mersha³

et al. 2017

Pan Afr Med J

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IntroductionDespite the increase of immunization coverage (administrative) of measles in the country, there are widespread outbreaks of measles. In this respect, we investigated one of the outbreaks that occurred in hard to reach kebeles of Guji Zone, Oromia region, to identify the contributing factors that lead to the protracted outbreak of measles.MethodsWe used a cross-sectional study design to investigate a measles outbreak in Guji zone, Oromia region. Data entry and analysis was performed using EPI-Info version 7.1.0.6 and MS-Microsoft Excel.ResultsIn three months' time a total of 1059 suspected cases and two deaths were reported from 9 woredas affected by a measles outbreak in Guji zone. The cumulative attack rate of 81/100,000 population and case fatality ratio of 0.2% was recorded. Of these, 821 (77.5%) cases were < 15 years of age, and 742 (70%) were zero doses of measles vaccine. Although, all age groups were affected under five years old were more affected 495 (48%) than any other age groups. In response to the outbreak, an outbreak response immunization was organized at the 11th week of the epidemic, when the epidemic curve started to decline. 6 months to14 years old were targeted for outbreak response immunization and the overall coverage was 97 % (range: 90-103%). Case management with vitamin A supplementation, active case search, and health education was some of the activities carried out to curb the outbreak.ConclusionWe conclude that low routine immunization coverage in conjunction with low access to routine immunization in hard to reach areas, low community awareness in utilization of immunization service, inadequate cold chain management and delivery of a potent vaccine in hard to reach woredas/kebeles were likely contributed to the outbreak that's triggered a broad spread epidemic affecting mostly children without any vaccination. We also figured that the case-based surveillance lacks sensitivity and timely confirmation of the outbreak, which as a result outbreak response immunization were delayed. We recommend establishing reaching every child (REC) strategy in Guji zone with particular emphasis too hard reach areas to enhance the current immunization service, and furthermore to conduct data quality self-assessment or cluster coverage survey to verify the reported high vaccination coverage in some kebeles. We also recommend conducting the second opportunity as a form of supplemental immunization activities in 2-3 year interval or consider the national second dose introduction in the routine immunization system to improve population immunity. We further recommend that there is a need to boost the sensitivity of case-based surveillance system to be able to early detect, confirm and react to future epidemics.

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Section: Discussioncontrasting

confidence: 83%

Measles outbreak investigation in Guji zone of Oromia Region, Ethiopia

Belda¹,

Tegegne²,

Mersha³

et al. 2017

Pan Afr Med J

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“…The results indicate that although measles is mainly a disease of childhood, there were some individuals who suffered from measles beyond 15 years of age and others up to the age of 59 years which was consistent with findings reported from elsewhere (4)(5)(6). This observation suggests changing pattern in the epidemiology of measles in Tanzania.…”

Section: Discussionsupporting

confidence: 91%

“…The occurrence of measles cases in Arusha, Dodoma, Iringa, Singida and Tabora regions during 2001 seemed to have reached epidemic proportions in populations believed to have high measles immunisation coverage. Nonetheless the occurrence of measles cases in populations with high immunisation coverage was consistent with findings reported from other studies (5). The findings suggest that immunity following measles vaccination may have waned to the extent that the heard immunity of the population was very low and therefore rendered the populations susceptible to measles outbreak (14)(15)(16).…”

Section: Discussionsupporting

confidence: 87%

Epidemiology of measles in Tanzania: A hospital-based survey of measles morbidity and mortality

Mnyika

Akim

2007

East Afr. J. Pub. Health

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Objective: To estimate measles morbidity and mortality in selected regions on mainland Tanzania Design: Cross-sectional study Setting: Hospital-based review of existing records on measles morbidity and mortality in the selected district hospitals on mainland Tanzania. Methods: Review of records on measles morbidity and mortality was performed using a standard instrument adopted from the Ministry of Health. The instrument was pre-tested before use. Researchers were recruited from the Muhimbili University College of Health Sciences and were trained on how to collect data from the hospital records. Ethical clearance was obtained from the Ministry of Health in Dar es Salaam. Upon arrival in the respective regions, the researchers recruited and trained local research assistants on methods of data collection. Completed questionnaire forms were entered into a computer and data cleaning was done before data analysis. Results: Measles was found to occur in individuals of over 15 years of age and beyond. Overall 35% (N=2277) of all measles cases were reported from the Iringa region while Mara region had the lowest number of cases. On the other hand Shinyanga had the highest case fatality rate (6%) compared with other regions. Mortality was higher in children below two years of age and among individuals who had no history of measles vaccination. Conclusion: We conclude that despite high measles vaccination coverage, measles is still a public health problem in Tanzania. Efforts should be made to give several booster doses up to the age of 15 years.

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“…Some popular methods currently used in prediction for infectious disease morbidity, such as linear regression method [4,5,6], gray model method [7,8,9], artificial neural network method [10,11,12], specifically the autoregressive integrated moving average (ARIMA) method [13,14,15,16,17,18,19], etc. ARIMA method is a reflection of the time dynamic dependency; it can reveal the quantitative relationship between the research object and other objects with the development and change of time.…”

Section: Introductionmentioning

confidence: 99%

Forecast Model Analysis for the Morbidity of Tuberculosis in Xinjiang, China

Zheng

Zhang

et al. 2015

PLoS ONE

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Tuberculosis is a major global public health problem, which also affects economic and social development. China has the second largest burden of tuberculosis in the world. The tuberculosis morbidity in Xinjiang is much higher than the national situation; therefore, there is an urgent need for monitoring and predicting tuberculosis morbidity so as to make the control of tuberculosis more effective. Recently, the Box-Jenkins approach, specifically the autoregressive integrated moving average (ARIMA) model, is typically applied to predict the morbidity of infectious diseases; it can take into account changing trends, periodic changes, and random disturbances in time series. Autoregressive conditional heteroscedasticity (ARCH) models are the prevalent tools used to deal with time series heteroscedasticity. In this study, based on the data of the tuberculosis morbidity from January 2004 to June 2014 in Xinjiang, we establish the single ARIMA (1, 1, 2) (1, 1, 1)12 model and the combined ARIMA (1, 1, 2) (1, 1, 1)12-ARCH (1) model, which can be used to predict the tuberculosis morbidity successfully in Xinjiang. Comparative analyses show that the combined model is more effective. To the best of our knowledge, this is the first study to establish the ARIMA model and ARIMA-ARCH model for prediction and monitoring the monthly morbidity of tuberculosis in Xinjiang. Based on the results of this study, the ARIMA (1, 1, 2) (1, 1, 1)12-ARCH (1) model is suggested to give tuberculosis surveillance by providing estimates on tuberculosis morbidity trends in Xinjiang, China.

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Clinical and epidemiological findings during a measles outbreak occurring in a population with high vaccination coverage

Cited by 5 publications

References 17 publications

Measles outbreak investigation in Guji zone of Oromia Region, Ethiopia

Measles outbreak investigation in Guji zone of Oromia Region, Ethiopia

Epidemiology of measles in Tanzania: A hospital-based survey of measles morbidity and mortality

Forecast Model Analysis for the Morbidity of Tuberculosis in Xinjiang, China

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