Measles surveillance and control in Tunisia: 1979-2000.
BACKGROUND
The aim of this study was to analyze measles epidemiology in Tunisia after the introduction of specific vaccine in 1979 and the results of the serological investigation of suspected cases, introduced as part of the National Program for Measles Elimination recently implemented.


METHODS
Available data were used to examine trends in measles epidemiology from 1979 to 2000: number of reported cases, patient's age, reporting date, epidemiological link with similar cases and laboratory confirmation. Serological investigation included the detection, by ELISA, of measles and rubella IgMs in 542 suspected measles cases sampled from 1997 to 2000.


RESULTS
Measles coverage level increased gradually and was maintained to over 90% since 1992. In parallel, the annual incidence of reported cases declined and outbreaks became less frequent, the latest occurred in 1992. Measles-specific IgMs were detected in only nine patients who received measles vaccine few days before blood collection, anti-rubella IgMs were detected in 52% of cases.


CONCLUSIONS
Vaccination strategies including routine and supplemental immunizations, implemented in Tunisia, achieved a substantial decrease in measles incidence. Virological results highlight frequent confusion, at the clinical level, with the other etiologies of rash and fever and the importance of systematic serological confirmation of cases.
Bahri
Olfa
O
Laboratory of Clinical Virology, WHO Regional Reference Laboratory for Poliomyelitis and Measles, Institut Pasteur de Tunis, Tunis 1002, Tunisia. olfa.bahri@pasteur.rns.tn
Ben Halima
Myriam
M
Ben Ghorbal
Mohamed
M
Dali
Kaouther
K
Arrouji
Zakia
Z
Khammassi
Selma
S
Triki
Hinda
H
Slim
Amine
A
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D004196:Disease Outbreaks; D005260:Female; D006801:Humans; D007124:Immunoenzyme Techniques; D007075:Immunoglobulin M / Q000032:analysis; D007223:Infant; D008297:Male; D008457:Measles / Q000453:epidemiology* / Q000821:virology; D011159:Population Surveillance; D012409:Rubella / Q000453:epidemiology; D012621:Seasons; D014416:Tunisia / Q000453:epidemiology
D007075:Immunoglobulin M