Progress Toward Measles Elimination — Nepal, 2007–2014

Khanal, Sudhir; Sedai, Tika; Choudary, Ganga Ram; Giri, Jagat Narain; Bohara, Rajendra; Pant, R. P.; Gautam, Mukunda; Sharapov, Umid M.; Goodson, James L.; Alexander, James P.; Dabbagh, Alya; Strebel, Peter M.; Perry, Robert T.; Bah, Sunil; Abeysinghe, Nihal; Thapa, Arun

doi:10.15585/mmwr.mm6508a3

Cited by 11 publications

(9 citation statements)

References 1 publication

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“…Sensitivity never met the recommended target throughout the entire period and seemed to decline even further from 2015. This was vastly different from other studies in Nepal and another study carried out in South-West geopolitical zone of Nigeria that showed steady progress with sensitivity increasing over time and another study in Kenya that met the target in all years under review 11,13,14 . The decline in 2015 was in part due to a 6-month strike action by health workers at the LGA level leading to a failure to report cases.…”

Section: Discussioncontrasting

confidence: 81%

“…Representativeness, which was measured by the proportion of LGAs reporting >2 non-measles febrile rash illness cases/year, showed some improvement in the early years but declined in the succeeding years of the study 2 . The results obtained in this study for representativeness were much lower than another study in the country but similar to a national study of Nepal and Kenya 11,13,14 . The target for representativeness was met for four out of the eight years and declined after 2016.…”

Section: Discussionsupporting

confidence: 52%

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Performance of Measles Case-based Surveillance System in Rivers State, Nigeria 2011-2018

Utulu¹,

Urang²,

Usman³

et al. 2020

J Immunological Sci

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Background: WHO African region set a target for elimination of measles by 2020 and recommended member states adopt a case-based surveillance system. WHO AFRO guidelines for measles surveillance state that an optimally performing surveillance system is crucial to elimination of measles. Rivers State is one of the high burden states for measles in southern Nigeria.Objective: This study assessed the performance of the measles case-based surveillance in Rivers state, Nigeria. Methods:We reviewed measles case-based surveillance data in Rivers state, Nigeria from year 2011-2018.Results: A total of 1,731 suspected cases were reported with 1,128 (65.2%) confirmed cases of measles. Majority were confirmed by epidemiologic linkage 907 (80.4%) while laboratory confirmed cases constituted 206 (18.3%). Age group 1-4 years was the most affected 443 (42.6%). For cases with vaccination status available 425 (53.1%) were unvaccinated. No discarded cases were reported from 2016 to 2018. Non-measles febrile rash illness rate target of ≥2 per 100,000 was not achieved at any point in the eight-year period. The proportion of districts/LGAs reporting >2 Non Measles-Non Rubella Febrile Rash Illness cases/year was above the minimum target of 80% in just four years. Conclusion:The surveillance system performed poorly with sensitivity and representativeness less than optimal. Measles elimination must leverage upon existing structures for polio elimination to improve surveillance. A more detailed analysis of the system is essential to identify all the gaps that may retard elimination efforts.

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Section: Discussioncontrasting

confidence: 81%

Section: Discussionsupporting

confidence: 52%

Performance of Measles Case-based Surveillance System in Rivers State, Nigeria 2011-2018

Utulu¹,

Urang²,

Usman³

et al. 2020

J Immunological Sci

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“…The experience from various countries shows that to bring down and sustain the incidence at less than 1 per million population and undertake verification of elimination, countries will need to maintain high population immunity to measles; increase the sensitivity of the measles surveillance system, including the characterisation of measles virus genotypes11–13. Moreover, all countries should develop plans to be able to detect and rapidly respond to measles importations, which can easily occur across international borders.…”

Section: Discussionmentioning

confidence: 99%

Status of Measles Elimination in Eleven Countries with High Routine Immunisation Coverage in The WHO African Region

Masresha

Luce²,

Shibeshi

et al. 2018

J Immunological Sci

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Background Measles elimination is defined as the absence of endemic measles virus transmission in a defined geographic area for at least 12 months in the presence of a well-performing surveillance system. The WHO framework for verification of measles elimination indicates that the achievement of measles and/or rubella elimination should be verified for individual countries. Objective We identified 11 high performing countries based on their first dose measles vaccination coverage, and looked at their performance across the various programmatic parameters, to see if they are ready to undertake the verification of measles elimination. Methods We identified 11 countries with >90% measles first dose coverage for the most recent 5 years according to the WHO UNICEF estimates of national immunisation coverage. We analysed vaccination coverage and surveillance performance in these countries. Results Algeria, Botswana, Gambia, Mauritius, Rwanda, Seychelles have maintained measles first dose (MCV1) coverage of 95% or more since 2011. In 2015, only Algeria, Cape Verde and Seychelles had coverage of 95% or more for the second dose of measles vaccine (MCV2). Of the 22 supplemental immunisation activities (SIAs) among the 11 countries, only 6 had administrative coverage of less than 95%. Only Rwanda and Lesotho attained the case-based surveillance performance targets in all the five years. Conclusion Despite their high routine first dose measles immunisation coverage, all of the 11 countries have some program gaps indicating that they do not meet all the criteria to undergo verification of elimination at this point. It is recommended for these countries to set up national verification committees as per the WHO framework for verification of measles elimination, in order to initiate the documentation and monitoring of progress, and to address programmatic gaps in the coming years.

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“…5 In 2008, an increase in measles cases, a total of 394 confirmed cases, prompted a follow-up vaccination campaign in 2008, targeting children aged 9 months to 4 years. 8 The detection of additional measles cases in 2011, along with several years of data indicating a substantial burden of rubella, led to a combined measles–rubella vaccination campaign in 2012–2013 targeting all children between the ages of 9 months and 14 years. Afterwards, EPI introduced rubella vaccine into the country’s routine immunization schedule.…”

Section: Relevant Changesmentioning

confidence: 99%

Adapting Nepal’s polio eradication programme

Paudel

Hampton

Gurung

et al. 2016

Bull. World Health Organ.

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ProblemMany countries have weak disease surveillance and immunization systems. The elimination of polio creates an opportunity to use staff and assets from the polio eradication programme to control other vaccine-preventable diseases and improve disease surveillance and immunization systems.ApproachIn 2003, the active surveillance system of Nepal’s polio eradication programme began to report on measles and neonatal tetanus cases. Japanese encephalitis and rubella cases were added to the surveillance system in 2004. Staff from the programme aided the development and implementation of government immunization policies, helped launch vaccination campaigns, and trained government staff in reporting practices and vaccine management.Local settingNepal eliminated indigenous polio in 2000, and controlled outbreaks caused by polio importations between 2005 and 2010.Relevant changesIn 2014, the surveillance activities had expanded to 299 sites, with active surveillance for measles, rubella and neonatal tetanus, including weekly visits from 15 surveillance medical officers. Sentinel surveillance for Japanese encephalitis consisted of 132 sites. Since 2002, staff from the eradication programme have helped to introduce six new vaccines and helped to secure funding from Gavi, the Vaccine Alliance. Staff have also assisted in responding to other health events in the country.Lesson learntBy expanding the activities of its polio eradication programme, Nepal has improved its surveillance and immunization systems and increased vaccination coverage of other vaccine-preventable diseases. Continued donor support, a close collaboration with the Expanded Programme on Immunization, and the retention of the polio eradication programme’s skilled workforce were important for this expansion.

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Progress Toward Measles Elimination — Nepal, 2007–2014

Cited by 11 publications

References 1 publication

Performance of Measles Case-based Surveillance System in Rivers State, Nigeria 2011-2018

Performance of Measles Case-based Surveillance System in Rivers State, Nigeria 2011-2018

Status of Measles Elimination in Eleven Countries with High Routine Immunisation Coverage in The WHO African Region

Adapting Nepal’s polio eradication programme

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