Measles Outbreak Associated with Vaccine Failure in Adults — Federated States of Micronesia, February–August 2014

Background: Vaccination coverage is typically measured as the proportion of individuals who have received recommended vaccine doses by the date of assessment. This approach does not provide information about receipt of vaccines by the recommended age, which is critical for ensuring optimal protection from vaccine-preventable diseases (VPDs). Objective: To assess vaccination timeliness in the Federated States of Micronesia (FSM), and the projected impact of suboptimal vaccination in the event of an outbreak. Methods: Timeliness of the 4th dose of diphtheria, tetanus, and acellular pertussis vaccine (DTaP) and 1st dose of measles, mumps, and rubella vaccine (MMR) among children 24–35 months was assessed in FSM. Both doses are defined as on time if administered from 361 through 395 days in age. Timeliness was calculated by one-way frequency analysis, and dose delays, measured in months after recommended age, were described using inverse Kaplan-Meier analysis. A time-series susceptible-exposed-infected-recov ery (TSEIR) model simulated measles outbreaks in populations with on time and late vaccination. Results: Total coverage for the 4th dose of DTaP ranged from 36.6% to 98.8%, and for the 1st dose of MMR ranged from 80.9% to 100.0% across FSM states. On time coverage for the 4th dose of DTaP ranged from 3.2% to 52.3%, and for the 1st dose of MMR ranged from 21.1% to 66.9%. Maximum and median dose delays beyond the recommended age varied by state. TSEIR models predicted 10.8–13.7% increases in measles cases during an outbreak based on these delays. Conclusions: In each of the FSM states, a substantial proportion of children received DTaP and MMR doses outside the recommended timeframe. Children who receive vaccinations later than recommended remain susceptible to VPDs during the period they remain unvaccinated, which may have a substantial impact on health systems during an outbreak. Immunization programs should consider vaccination timeliness in addition to coverage as a measure of susceptibility to VPDs in young children.

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“…The computed incidence for this outbreak was 2226.6 per million individuals. There was one death attributed to measles in 2014 [36]. …”

Section: Discussionmentioning

confidence: 99%

Timeliness of childhood vaccination in the Federated States of Micronesia

Tippins

Leidner

Meghani

et al. 2017

Vaccine

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“…In recent times, similar factors have accounted for the occurrence of outbreaks in both developing and underdeveloped countries. 10,11,[16][17][18][19] Comparing the risk of measles among vaccinated population over time was limited by possible recall bias since vaccination status of cases was not evidenced by card and detailed history of vaccine handling. Therefore, the extent of variation of trends that could be attributed to vaccine failure may be deficient but possibly cannot be discounted considering the weak health system.…”

Section: Discussionmentioning

confidence: 99%

Targeted Measles Outbreak Response Vaccination In The Context of Measles Control and Elimination: Experiences From South Sudan

Boateng¹,

Usman²,

Laku³

et al. 2016

Epidemiol Open J

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Introduction: Measles elimination interventions in South Sudan have relied on mass campaigns due to reoccurring humanitarian crisis over decades. This paper examines the effects of targeted measles vaccinations on efforts at eliminating measles in the country. Methods: Time trend and an analytical cross-sectional design were applied on South Sudan Measles case-based surveillance dataset 2011-2015. Logistic regression of IgM positive cases against vaccination status and adjusted for age and unknown vaccination status were used to determine the likelihood of reduced risk of measles at 95% CI. Results: Routine immunization, follow-up and outbreak response coverage for measles vaccination over the period were sub-optimal. Even though the proportion of confirmed measles cases among vaccinated population was irregular ranging 14.2% to 61.9% within the period reviewed, measles vaccination generally reduced the risk of the disease in the population by 30% (odds 0.7, 95% CI 0.4, 1.0) from 2011-2015. A trend analysis showed that the likelihood of reduction of measles burden varied per year, but a higher reduction of risk was observed in 2015 (odds 0.05 (95% CI <0.01, 0.35) preceded by follow-up campaigns. Adjusting for age and unknown vaccination status, there were no statistically significant difference for the trends of odds, however the significant decrease in odds in 2015 (OR 0.01 (95% CI [0.01, 0.35]) R 2 0.45) is due to a unit change in age. Conclusions: Targeted measles outbreak vaccinations generally reduce the burden of measles however the extent of reduction is more reflected in a year following a mass measles campaign as compared to outbreak response vaccination. Thus measles follow-up campaigns are necessary for sustained measles control and elimination.

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“…FSM is made up of four groups of island states in geographic sequence from west to east: Yap, Chuuk, Pohnpei and Kosrae. According to the 2010 census, the population of 102,843 is distributed as follows: Chuuk (48,654 residents), Pohnpei (36,196), Yap (11,377), and Kosrae (6616) [5,7,9]. …”

Section: Methodsmentioning

confidence: 99%

“…Although 16 suspected cases were investigated in Yap, these cases were ruled out following negative laboratory results. Cases were identified by febrile rash illness surveillance at the hospital, contact tracing, and a retrospective investigation of earlier fever and rash cases [7,10]. …”

Section: Methodsmentioning

confidence: 99%

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Cost of a measles outbreak in a remote island economy: 2014 Federated States of Micronesia measles outbreak

Pike

Tippins

Nyaku

et al. 2017

Vaccine

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After 20 years with no reported measles cases, on May 15, 2014 the Centers for Disease Control and Prevention (CDC) was notified of two cases testing positive for measles-specific immunoglobulin M (IgM) antibodies in the Federated States of Micronesia (FSM). Under the Compact of Free Association, FSM receives immunization funding and technical support from the United States (US) domestic vaccination program managed by the Centers for Disease Control and Prevention (CDC). In a collaborative effort, public health officials and volunteers from FSM and the US government worked to respond and contain the measles outbreak through an emergency mass vaccination campaign, contact tracing, and other outbreak investigation activities. Contributions were also made by United Nations Children’s Emergency Fund (UNICEF) and World Health Organization (WHO). Total costs incurred as a result of the outbreak were nearly $4,000,000; approximately $10,000 per case. Direct medical costs (≈$141,000) were incurred in the treatment of those individuals infected, as well as lost productivity of the infected and informal caregivers (≈$250,000) and costs to contain the outbreak (≈$3.5 million). We assessed the economic burden of the 2014 measles outbreak to FSM, as well as the economic responsibilities of the US. Although the US paid the majority of total costs of the outbreak (≈67%), examining each country’s costs relative to their respective economy illustrates a far greater burden to FSM. We demonstrate that while FSM was heavily assisted by the US in responding to the 2014 Measles Outbreak, the outbreak significantly impacted their economy. FSM’s economic burden from the outbreak is approximately equivalent to their entire 2016 Fiscal Year budget dedicated to education.

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Measles Outbreak Associated with Vaccine Failure in Adults — Federated States of Micronesia, February–August 2014

Cited by 50 publications

References 3 publications

Timeliness of childhood vaccination in the Federated States of Micronesia

Timeliness of childhood vaccination in the Federated States of Micronesia

Targeted Measles Outbreak Response Vaccination In The Context of Measles Control and Elimination: Experiences From South Sudan

Cost of a measles outbreak in a remote island economy: 2014 Federated States of Micronesia measles outbreak

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