First 5 years of measles elimination in southern Africa: 1996-2000.
BACKGROUND
Measles is the leading cause of vaccine-preventable death in Africa. Regional measles elimination is considered feasible using current vaccines and a series of WHO-recommended strategies. We aimed to interrupt transmission of measles, and to use case-based surveillance to show the effect of such interruption.


METHODS
In southern Africa from 1996, seven countries with a total population of approximately 70 million and with relatively high routine vaccination coverage implemented measles elimination strategies. In addition to routine measles immunisation at 9 months of age, these included nationwide catch-up campaigns among children aged 9 months to 14 years, then follow-up campaigns every 3-4 years among children aged 9-59 months, and the establishment of case-based measles surveillance with serological diagnostic confirmation.


RESULTS
Nearly 24 million children aged 9 months to 14 years were vaccinated, with overall vaccination coverage of 91%. Reported clinical measles cases declined from 60000 in 1996 to 117 laboratory-confirmed measles cases in 2000. Reported measles deaths declined from 166 in 1996 to zero in 2000. No increase in adverse events was noted after the measles vaccination campaign.


CONCLUSIONS
A reduction in measles mortality and morbidity can be achieved in very low-income countries, in countries that split their vaccination campaigns by geographical area or by age-group of the target population, and where initial routine measles vaccination coverage among infants was <90%, even when prevalence of HIV/AIDS was extremely high. Continued high-level national commitment will be crucial to implementation and maintenance of proven strategies in southern Africa.
Biellik
Robin
R
WHO, Harare, Zimbabwe. biellikr@who.co.zw
Madema
Simon
S
Taole
Anne
A
Kutsulukuta
Agnes
A
Allies
Ernestina
E
Eggers
Rudi
R
Ngcobo
Ntombenhle
N
Nxumalo
Mavis
M
Shearley
Adelaide
A
Mabuzane
Egleah
E
Kufa
Erica
E
Okwo-Bele
Jean-Marie
JM
D000293:Adolescent; D000353:Africa, Southern / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D004196:Disease Outbreaks / Q000517:prevention & control; D006801:Humans; D017589:Immunization Programs; D007223:Infant; D008457:Measles / Q000453:epidemiology* / Q000517:prevention & control*; D008458:Measles Vaccine / Q000008:administration & dosage*; D014611:Vaccination
D008458:Measles Vaccine