title: Improved measles surveillance in Cameroon reveals two major dynamic patterns of incidence.
abstract: OBJECTIVE
  To characterize the province-specific incidence patterns of measles in Cameroon and determine if an increase in measles incidence during the period January 2000-June 2001 is consistent with coincident epidemics in several regions with different inter-epidemic periods.
  
  
  METHODS
  Periodic behavior of the monthly measles incidence time-series from each province of Cameroon was analyzed using time-series analysis and cluster techniques. Cumulative incidence in each province of Cameroon over a five-year period was associated with birth rates, and vaccination coverage.
  
  
  RESULTS
  Distinct patterns of measles incidence were found in two different areas of Cameroon. The three northern-most provinces experience major epidemics every year. Seven southern provinces show evidence of experiencing major epidemics every third year. In January 2000, Cameroon experienced coincident peaks in these two cycles and thus an increase in measles incidence countrywide over the previous year. Higher cumulative province-specific incidence rates were associated with higher birth rates and lower routine vaccination coverage rates.
  
  
  CONCLUSIONS
  Within one country, two dramatically different dynamic patterns of measles incidence were observed. Long-term surveillance data is crucial to the evaluation of measles immunization campaigns. The availability of a five-year record of measles incidence in Cameroon reveals an interesting dynamic pattern of measles incidence that accounts for the increase in countrywide incidence in 2000-2001.
authors.affiliation: Department of International Health, the Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205-5748, USA.
authors.forename: Derek A T
authors.initials: DA
authors.lastname: Cummings
authors.forename: William J
authors.initials: WJ
authors.lastname: Moss
authors.forename: Kanya
authors.initials: K
authors.lastname: Long
authors.forename: Charles S
authors.initials: CS
authors.lastname: Wiysonge
authors.forename: Ticha Johnson
authors.initials: TJ
authors.lastname: Muluh
authors.forename: Basile
authors.initials: B
authors.lastname: Kollo
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Nomo
authors.forename: Nathan D
authors.initials: ND
authors.lastname: Wolfe
authors.forename: Donald S
authors.initials: DS
authors.lastname: Burke
mesh_terms: D002163:Cameroon / Q000453:epidemiology; D016000:Cluster Analysis; D004196:Disease Outbreaks / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D016014:Linear Models; D008457:Measles / Q000453:epidemiology*; D008458:Measles Vaccine / Q000008:administration & dosage; D008954:Models, Biological; D010507:Periodicity; D011157:Population Dynamics; D011159:Population Surveillance; D012307:Risk Factors
chemical_list: D008458:Measles Vaccine