Public-health impact of accelerated measles control in the WHO African Region 2000-03.
BACKGROUND
In 2000, the WHO African Region adopted a plan to accelerate efforts to lower measles mortality with the goal of decreasing the number of measles deaths to near zero. By June, 2003, 19 African countries had completed measles supplemental immunisation activities (SIA) in children aged 9 months to 14 years as part of a comprehensive measles-control strategy. We assessed the public-health impact of these control measures by use of available surveillance data.


METHODS
We calculated percentage decline in reported measles cases during 1-2 years after SIA, compared with 6 years before SIA. On the basis of data from 13 of the 19 countries, we assumed that the percentage decline in measles deaths equalled that in measles cases. We also examined data on routine and SIA measles vaccine coverage, measles case-based surveillance, and suspected measles outbreaks.


RESULTS
Between 2000 and June, 2003, 82.1 million children were targeted for vaccination during initial SIA in 12 countries and follow-up SIA in seven countries. The average decline in the number of reported measles cases was 91%. In 17 of the 19 countries, measles case-based surveillance confirmed that transmission of measles virus, and therefore measles deaths, had been reduced to low or very low rates. The total estimated number of deaths averted in the year 2003 was 90,043. Between 2000 and 2003 in the African Region as a whole, we estimated that the percentage decline in annual measles deaths was around 20% (90,043 of 454,000).


CONCLUSIONS
The burden of measles in sub-Saharan Africa can be reduced to very low levels by means of appropriate strategies, resources, and personnel.
Otten
M
M
Global Measles Branch, Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. motten@cdc.gov
Kezaala
R
R
Fall
A
A
Masresha
B
B
Martin
R
R
Cairns
L
L
Eggers
R
R
Biellik
R
R
Grabowsky
M
M
Strebel
P
P
Okwo-Bele
J-M
JM
Nshimirimana
D
D
D000293:Adolescent; D017954:Africa South of the Sahara / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D004196:Disease Outbreaks; D006801:Humans; D017589:Immunization Programs; D007223:Infant; D008457:Measles / Q000453:epidemiology / Q000517:prevention & control*; D011159:Population Surveillance; D014944:World Health Organization