title: The impact of immunization control activities on measles outbreaks in middle and low income countries.
abstract: BACKGROUND
  The World Health Organization recommended strategy for responding to measles outbreaks in developing countries does not promote the use of immunization campaigns due to their high cost, disruptive nature and limited impact. Given the substantial morbidity and mortality associated with such outbreaks, a literature review was conducted as a basis for re-evaluating this policy.
  
  
  METHODS
  Reports of supplementary immunization activities that were performed to control measles outbreaks in middle or low income countries were identified. The impact of the immunization activities on the course of each outbreak was evaluated by examining the data provided.
  
  
  RESULTS
  Of 66 reports detailing a measles outbreak in a middle or low income country, 17 described supplementary immunization activities which included seven 'non-selective' immunization campaigns, three 'selective' campaigns and one use of an early 2-dose schedule. Eight of the reports commented on the impact of the response, five of which reported a reduction in outbreak morbidity. Only one of the reports, from an isolated island outbreak, provided sufficient data to support a possible reduction in outbreak-associated morbidity.
  
  
  CONCLUSIONS
  There are limited data on the impact of measles outbreak immunization activities from developing countries. The available data do not support a change in the WHO recommended strategy for conducting a limited, if any, immunization response to such outbreaks. Immunization strategies which aim to prevent outbreaks may be more effective than campaigns to interrupt transmission of an outbreak which has already begun.
authors.affiliation: Global Programme for Vaccines and Immunization, World Health Organization, Geneva, Switzerland.
authors.forename: R B
authors.initials: RB
authors.lastname: Aylward
authors.forename: J
authors.initials: J
authors.lastname: Clements
authors.forename: J M
authors.initials: JM
authors.lastname: Olivé
mesh_terms: D002648:Child; D002675:Child, Preschool; D003906:Developing Countries / Q000145:classification / Q000191:economics / Q000706:statistics & numerical data; D004196:Disease Outbreaks / Q000517:prevention & control* / Q000706:statistics & numerical data*; D005069:Evaluation Studies as Topic; D014943:Global Health; D006801:Humans; D017589:Immunization Programs / Q000145:classification / Q000592:standards / Q000706:statistics & numerical data*; D007223:Infant; D008457:Measles / Q000453:epidemiology* / Q000517:prevention & control*; D009017:Morbidity; D009026:Mortality; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data*