title: Accelerating measles elimination and strengthening routine immunization services in Guizhou Province, China, 2003-2009.
abstract: BACKGROUND
  To develop a successful model for accelerating measles elimination in poor areas of China, we initiated a seven-year project in Guizhou, one of the poorest provinces, with reported highest measles incidence of 360 per million population in 2002.
  
  
  METHODS
  Project strategies consisted of strengthening routine immunization services, enforcement of school entry immunization requirements at kindergarten and school, conducting supplemental measles immunization activities (SIAs), and enhancing measles surveillance. We measured coverage of measles containing vaccines (MCV) by administrative reporting and population-based sample surveys, systematic random sampling surveys, and convenience sampling surveys for routine immunization services, school entry immunization, and SIAs respectively. We measured impact using surveillance based measles incidence.
  
  
  RESULTS
  Routine immunization coverage of the 1st dose of MCV (MCV1) increased from 82% to 93%, while 2nd dose of MCV (MCV2) coverage increased from 78% to 91%. Enforcement of school entry immunization requirements led to an increase in MCV2 coverage from 36% on primary school entry in 2004 to 93% in 2009. Province-wide SIAs achieved coverage greater than 90%. The reported annual incidence of measles dropped from 200 to 300 per million in 2003 to 6 per million in 2009, and sustained at 0.9-2.2 per million in 2010-2013.
  
  
  CONCLUSIONS
  This project found that a package of strategies including periodic SIAs, strengthened routine immunization, and enforcing school entry immunization requirements, was an effective approach toward achieving and sustaining measles elimination in less-developed area of China.
authors.affiliation: Office of the WHO Representative, People's Republic of China, Beijing, China. Electronic address: zuosh@wpro.who.int.
authors.forename: Shuyan
authors.initials: S
authors.lastname: Zuo
authors.affiliation: Office of the WHO Representative, People's Republic of China, Beijing, China.
authors.forename: Lisa
authors.initials: L
authors.lastname: Cairns
authors.affiliation: Office of the WHO Representative, People's Republic of China, Beijing, China.
authors.forename: Yvan
authors.initials: Y
authors.lastname: Hutin
authors.affiliation: Chinese Center for Disease Control and Prevention, Beijing, China.
authors.forename: Xiaofeng
authors.initials: X
authors.lastname: Liang
authors.affiliation: Guizhou Provincial Health Bureau, Guiyang, China.
authors.forename: Yibing
authors.initials: Y
authors.lastname: Tong
authors.affiliation: Guizhou Provincial Center for Disease Control and Prevention, Guiyang, China.
authors.forename: Qing
authors.initials: Q
authors.lastname: Zhu
authors.affiliation: Guizhou Provincial Center for Disease Control and Prevention, Guiyang, China.
authors.forename: Dayong
authors.initials: D
authors.lastname: Zhang
authors.affiliation: Office of the WHO Representative, People's Republic of China, Beijing, China.
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Lee
authors.affiliation: WHO, Geneva, Switzerland.
authors.forename: Peter
authors.initials: P
authors.lastname: Strebel
authors.affiliation: United States Centers for Disease Control and Prevention, Atlanta, USA.
authors.forename: Linda
authors.initials: L
authors.lastname: Quick
mesh_terms: D002648:Child; D002675:Child, Preschool; D002681:China / Q000453:epidemiology; D060740:Disease Eradication / Q000379:methods* / Q000592:standards; D005260:Female; D006801:Humans; D017589:Immunization Programs / Q000592:standards* / Q000706:statistics & numerical data*; D015994:Incidence; D008297:Male; D008457:Measles / Q000517:prevention & control*; D008458:Measles Vaccine / Q000008:administration & dosage; D011159:Population Surveillance; D012424:Rural Population; D011795:Surveys and Questionnaires; D013997:Time Factors
chemical_list: D008458:Measles Vaccine
keywords: Child; China; Epidemiology; Immunization programs; Immunization schedule; Measles; Measles: elimination; Measles: epidemiology; Measles: prevention and control; School entry requirement; Surveillance