Subacute sclerosing panencephalitis in papua new guinean children: the cost of continuing inadequate measles vaccine coverage.
BACKGROUND
subacute sclerosing panencephalitis (SSPE) is a late, rare and usually fatal complication of measles infection. Although a very high incidence of SSPE in Papua New Guinea (PNG) was first recognized 20 years ago, estimated measles vaccine coverage has remained at ≤ 70% since and a large measles epidemic occurred in 2002. We report a series of 22 SSPE cases presenting between November 2007 and July 2009 in Madang Province, PNG, including localized clusters with the highest ever reported annual incidence.


RESULTS
as part of a prospective observational study of severe childhood illness at Modilon Hospital, the provincial referral center, children presenting with evidence of meningo-encephalitis were assessed in detail including lumbar puncture in most cases. A diagnosis of SSPE was based on clinical features and presence of measles-specific IgG in cerebrospinal fluid and/or plasma. The estimated annual SSPE incidence in Madang province was 54/million population aged <20 years, but four sub-districts had an incidence >100/million/year. The distribution of year of birth of the 22 children with SSPE closely matched the reported annual measles incidence in PNG, including a peak in 2002.


CONCLUSIONS
SSPE follows measles infections in very young PNG children. Because PNG children have known low seroconversion rates to the first measles vaccine given at 6 months of age, efforts such as supplementary measles immunisation programs should continue in order to reduce the pool of non-immune people surrounding the youngest and most vulnerable members of PNG communities.
School of Medicine and Pharmacology, University of Western Australia, Fremantle Hospital, Fremantle, Western Australia, Australia.
Laurens
L
Manning
Moses
M
Laman
Henry
H
Edoni
Ivo
I
Mueller
Harin A
HA
Karunajeewa
David
D
Smith
Ilomo
I
Hwaiwhanje
Peter M
PM
Siba
Timothy M E
TM
Davis
D000293:Adolescent; D000818:Animals; D000914:Antibodies, Viral / Q000097:blood / Q000134:cerebrospinal fluid; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood / Q000134:cerebrospinal fluid; D015994:Incidence; D008297:Male; D008458:Measles Vaccine / Q000008:administration & dosage* / Q000276:immunology*; D010219:Papua New Guinea / Q000453:epidemiology; D011446:Prospective Studies; D013344:Subacute Sclerosing Panencephalitis / Q000453:epidemiology*; D014611:Vaccination / Q000379:methods* / Q000706:statistics & numerical data*
D000914:Antibodies, Viral; D007074:Immunoglobulin G; D008458:Measles Vaccine
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