Evaluation of Urban Measles Mass Campaigns for Children Aged 9–59 Months in Mali

Abstract

There are an estimated 234,000 cases of measles and 13,851 measles-related deaths per year in Mali. In 1998 and 1999, 548,309 children aged 9-59 months were vaccinated against measles during mass campaigns in urban centers across Mali. After the first campaign, measles incidence decreased by 95% in districts encompassing vaccinated urban centers and by 41% in nonvaccinated districts. There was no shift in the proportion of cases by age group in vaccinated centers. Measles in vaccinated districts after the campaign was likely related to persistent transmission in age groups not targeted for vaccination and among children living in nonvaccinated districts. The second campaign (1999) did not change the incidence of measles in vaccinated compared with nonvaccinated centers. Urban mass measles vaccination probably did not affect overall measles transmission in Mali. Mass vaccination of all children in Mali, targeting a larger age group, will be necessary to reach measles control objectives.Measles kills 1500,000 children !5 years of age each year in Africa [1]. In Mali, routine measles vaccination for children 9 months of age began in 1986 with the Expanded Program on Immunization (EPI). EPI coverage between 1990 and 1999 for children !12 months of age ranged from 35.2% (1992) to 60.3% (1998) according to administrative data. A 1998 independent evaluation of the Malian EPI reported measles vaccine coverage of 23.8% for children !12 months of age. Measles is underreported in Mali because much of the population lacks access to health services and because of incomplete epidemiologic surveillance. The World Health Organization (WHO) therefore estimates that there are actually 230,850 cases and 13,850 measles deaths each year in Mali, assuming a birth cohort of 450,000, vaccine efficacy of 85%, routine coverage of 54%, and a case-fatality rate of 6% [2,3] and that 100% of non-immunized children will be infected.

A Serosurvey to Identify the Window of Vulnerability to Wild-Type Measles Among Infants in Rural Mali

“…By drastically diminishing the incidence in this population, it is hoped that young infants will be indirectly protected. In Mali, where during the early 1990s approxi-mately 231,000 measles cases and approximately 13,850 deaths occurred annually, 21 the Ministry of Health of Mali and the WHO in 1998 and 1999 organized mass immunization campaigns with parenteral measles vaccine for urban children 9-59 months of age. These campaigns, which were carried out in association with National Immunization Days performed as part of the Polio Eradication Initiative, diminished the incidence of measles by 95% in vaccinated areas.…”

“…These campaigns, which were carried out in association with National Immunization Days performed as part of the Polio Eradication Initiative, diminished the incidence of measles by 95% in vaccinated areas. 21 Another measles vaccination campaign conducted in 2001 included children up to 14 years of age, and a national campaign conducted in late 2004 targeted children 9-59 months of age. While effective, such campaigns are expensive and temporarily tie up many immunization service resources.…”

Characterization of Immune Responses Induced by Intramuscular Vaccination with DNA Vaccines Encoding Measles Virus Hemagglutinin and/or Fusion Proteins

“…The second strategy, undertaken by various international and national agencies (e.g., the World Health Organization, UNICEF, Centers for Diseases Control and Prevention, American Red Cross, U.S. Agency for International Development, etc.) focuses on mass immunization campaigns against measles among children 9 months to 15 years of age in developing countries in Africa where measles is endemic (6,10,21,22,34). These two strategies indirectly diminish the measles risk for young infants by reducing the overall transmission of measles within communities.…”

The interface between health systems and vertical programmes in Francophone Africa: the managers’ perceptions

“…Our results are consistent with the increasingly common view in international health policy circles that VPs create powerful opportunities for a health system. While many authors have described the strengthening effects of VPs (Dietz & Cutts 1997; Kertesz et al. 2003; Oliveira‐Cruz et al.…”