title: Measles surveillance and control in Tunisia: 1979-2000.
abstract: 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.
authors.affiliation: Laboratory of Clinical Virology, WHO Regional Reference Laboratory for Poliomyelitis and Measles, Institut Pasteur de Tunis, Tunis 1002, Tunisia. olfa.bahri@pasteur.rns.tn
authors.forename: Olfa
authors.initials: O
authors.lastname: Bahri
authors.forename: Myriam
authors.initials: M
authors.lastname: Ben Halima
authors.forename: Mohamed
authors.initials: M
authors.lastname: Ben Ghorbal
authors.forename: Kaouther
authors.initials: K
authors.lastname: Dali
authors.forename: Zakia
authors.initials: Z
authors.lastname: Arrouji
authors.forename: Selma
authors.initials: S
authors.lastname: Khammassi
authors.forename: Hinda
authors.initials: H
authors.lastname: Triki
authors.forename: Amine
authors.initials: A
authors.lastname: Slim
mesh_terms: 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
chemical_list: D007075:Immunoglobulin M