title: Measles resurgence in southern Africa: challenges to measles elimination.
abstract: BACKGROUND
  In seven southern African countries (Botswana, Lesotho, Malawi, Namibia, South Africa, Swaziland and Zimbabwe), following implementation of a measles mortality reduction strategy starting in 1996, the number of annually reported measles cases decreased sharply to less than one per million population during 2006-2008. However, during 2009-2010, large outbreaks occurred in these countries. In 2011, a goal for measles elimination by 2020 was set in the World Health Organization (WHO) African Region (AFR). We reviewed the implementation of the measles control strategy and measles epidemiology during the resurgence in the seven southern African countries.
  
  
  METHODS
  Estimated coverage with routine measles vaccination, supplemental immunization activities (SIA), annually reported measles cases by country, and measles surveillance and laboratory data were analyzed using descriptive analysis.
  
  
  RESULTS
  In the seven countries, coverage with the routine first dose of measles-containing vaccine (MCV1) decreased from 80% to 65% during 1996-2004, then increased to 84% in 2011; during 1996-2011, 79,696,523 people were reached with measles vaccination during 45 SIAs. Annually reported measles cases decreased from 61,160 cases to 60 cases and measles incidence decreased to <1 case per million during 1996-2008. During 2009-2010, large outbreaks that included cases among older children and adults were reported in all seven countries, starting in South Africa and Namibia in mid-2009 and in the other five countries by early 2010. The measles virus genotype detected was predominantly genotype B3.
  
  
  CONCLUSIONS
  The measles resurgence highlighted challenges to achieving measles elimination in AFR by 2020. To achieve this goal, high two-dose measles vaccine coverage by strengthening routine immunization systems and conducting timely SIAs targeting expanded age groups, potentially including young adults, and maintaining outbreak preparedness to rapidly respond to outbreaks will be needed.
authors: Immunization and Vaccines Development, East and South Africa Inter-Country Support Team, World Health Organization, Harare, Zimbabwe.
authors: Messeret E
authors: ME
authors: Shibeshi
authors: Immunization and Vaccines Development, African Regional Office, World Health Organization, Brazzaville, Congo.
authors: Balcha G
authors: BG
authors: Masresha
authors: Measles and Rubella Regional Reference Laboratory, National Institute of Communicable Diseases, Johannesburg, South Africa.
authors: Sheilagh B
authors: SB
authors: Smit
authors: Consultant Epidemiologist, Geneva, Switzerland.
authors: Robin J
authors: RJ
authors: Biellik
authors: Department of Epidemiology, Rollins School of Public Health and Laney Graduate School, Emory University, Atlanta, GA, United States.
authors: Jennifer L
authors: JL
authors: Nicholson
authors: Immunization and Vaccines Development, East and South Africa Inter-Country Support Team, World Health Organization, Harare, Zimbabwe.
authors: Charles
authors: C
authors: Muitherero
authors: Immunization and Vaccines Development, East and South Africa Inter-Country Support Team, World Health Organization, Harare, Zimbabwe.
authors: Nestor
authors: N
authors: Shivute
authors: Immunization and Vaccines Development, West Africa Inter-Country Support Team, World Health Organization, Ouagadougou, Burkina Faso.
authors: Oladapo
authors: O
authors: Walker
authors: Immunization and Vaccines Development, African Regional Office, World Health Organization, Brazzaville, Congo.
authors: Katsande
authors: K
authors: Reggis
authors: Global Immunization Division, United States Centers for Disease Control and Prevention, Atlanta, GA, United States. Electronic address: JGoodson@cdc.gov.
authors: James L
authors: JL
authors: Goodson
mesh_terms: D000293:Adolescent; D000328:Adult; D000353:Africa, Southern / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D060740:Disease Eradication; D004196:Disease Outbreaks / Q000517:prevention & control; D005260:Female; D006801:Humans; D017589:Immunization Programs; D015994:Incidence; D007223:Infant; D008297:Male; D008457:Measles / Q000453:epidemiology*; D008458:Measles Vaccine / Q000627:therapeutic use*; D011159:Population Surveillance; D014611:Vaccination / Q000706:statistics & numerical data*; D055815:Young Adult
chemical_list: D008458:Measles Vaccine
keywords: Africa; Elimination; Immunization; Measles; Vaccination