title: Should outbreak response immunization be recommended for measles outbreaks in middle- and low-income countries? An update.
abstract: BACKGROUND
  Measles caused mortality in >164,000 children in 2008, with most deaths occurring during outbreaks. Nonetheless, the impact and desirability of conducting measles outbreak response immunization (ORI) in middle- and low-income countries has been controversial. World Health Organization guidelines published in 1999 recommended against ORI in such settings, although recently these guidelines have been reversed for countries with measles mortality reduction goals.
  
  
  METHODS
  We searched literature published during 1995-2009 for papers reporting on measles outbreaks. Papers identified were reviewed by 2 reviewers to select those that mentioned ORI. World Bank classification of country income was used to identify reports of outbreaks in middle- and low-income countries.
  
  
  RESULTS
  We identified a total of 485 articles, of which 461 (95%) were available. Thirty-eight of these papers reported on a total of 38 outbreaks in which ORI was used. ORI had a clear impact in 16 (42%) of these outbreaks. In the remaining outbreaks, we were unable to independently assess the impact of ORI.
  
  
  CONCLUSIONS
  These findings generally support ORI in middle- and low-income countries. However, the decision to conduct ORI and the nature and extent of the vaccination response need to be made on a case-by-case basis.
authors.affiliation: Global Immunization Division, US Centers for Disease Control and Prevention, Atlanta, Georgia 30306, USA. kfc4@cdc.gov
authors.forename: K Lisa
authors.initials: KL
authors.lastname: Cairns
authors.forename: Robert T
authors.initials: RT
authors.lastname: Perry
authors.forename: Tove K
authors.initials: TK
authors.lastname: Ryman
authors.forename: Robin K
authors.initials: RK
authors.lastname: Nandy
authors.forename: Rebecca F
authors.initials: RF
authors.lastname: Grais
mesh_terms: D000293:Adolescent; D000349:Africa / Q000453:epidemiology; D000569:Americas / Q000453:epidemiology; D001208:Asia / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D003906:Developing Countries / Q000191:economics*; D004196:Disease Outbreaks / Q000517:prevention & control*; D005060:Europe / Q000453:epidemiology; D014943:Global Health; D006801:Humans; D007114:Immunization; D007223:Infant; D008457:Measles / Q000453:epidemiology / Q000517:prevention & control*; D008458:Measles Vaccine / Q000008:administration & dosage / Q000191:economics; D008877:Middle East / Q000453:epidemiology
chemical_list: D008458:Measles Vaccine