title: Local discrepancies in measles vaccination opportunities: results of population-based surveys in Sub-Saharan Africa.
abstract: BACKGROUND
  The World Health Organization recommends African children receive two doses of measles containing vaccine (MCV) through routine programs or supplemental immunization activities (SIA). Moreover, children have an additional opportunity to receive MCV through outbreak response immunization (ORI) mass campaigns in certain contexts. Here, we present the results of MCV coverage by dose estimated through surveys conducted after outbreak response in diverse settings in Sub-Saharan Africa.
  
  
  METHODS
  We included 24 household-based surveys conducted in six countries after a non-selective mass vaccination campaign. In the majority (22/24), the survey sample was selected using probability proportional to size cluster-based sampling. Others used Lot Quality Assurance Sampling.
  
  
  RESULTS
  In total, data were collected on 60,895 children from 2005 to 2011. Routine coverage varied between countries (>95% in Malawi and Kirundo province (Burundi) while <35% in N'Djamena (Chad) in 2005), within a country and over time. SIA coverage was <75% in most settings. ORI coverage ranged from >95% in Malawi to 71.4% [95% CI: 68.9-73.8] in N'Djamena (Chad) in 2005.In five sites, >5% of children remained unvaccinated after several opportunities. Conversely, in Malawi and DRC, over half of the children eligible for the last SIA received a third dose of MCV.
  
  
  CONCLUSIONS
  Control pre-elimination targets were still not reached, contributing to the occurrence of repeated measles outbreak in the Sub-Saharan African countries reported here. Although children receiving a dose of MCV through outbreak response benefit from the intervention, ensuring that programs effectively target hard to reach children remains the cornerstone of measles control.
authors.affiliation: Epicentre, 8, rue St Sabin, 75011 Paris, France. lise.grout@hotmail.fr.
authors.forename: Lise
authors.initials: L
authors.lastname: Grout
authors.forename: Nolwenn
authors.initials: N
authors.lastname: Conan
authors.forename: Aitana
authors.initials: A
authors.lastname: Juan Giner
authors.forename: Northan
authors.initials: N
authors.lastname: Hurtado
authors.forename: Florence
authors.initials: F
authors.lastname: Fermon
authors.forename: Alexandra
authors.initials: A
authors.lastname: N'Goran
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Grellety
authors.forename: Andrea
authors.initials: A
authors.lastname: Minetti
authors.forename: Klaudia
authors.initials: K
authors.lastname: Porten
authors.forename: Rebecca F
authors.initials: RF
authors.lastname: Grais
mesh_terms: D000293:Adolescent; D017954:Africa South of the Sahara; D002648:Child; D002675:Child, Preschool; D004196:Disease Outbreaks / Q000517:prevention & control; D005260:Female; D006801:Humans; D017589:Immunization Programs; D007223:Infant; D008297:Male; D032541:Mass Vaccination / Q000592:standards*; D008457:Measles / Q000517:prevention & control*; D008458:Measles Vaccine / Q000008:administration & dosage*; D017063:Outcome Assessment, Health Care; D015397:Program Evaluation; D011795:Surveys and Questionnaires
chemical_list: D008458:Measles Vaccine