title: Antecedent causes of a measles resurgence in the Democratic Republic of the Congo.
abstract: BACKGROUND
  Despite accelerated measles control efforts, a massive measles resurgence occurred in the Democratic Republic of the Congo (DRC) starting in mid-2010, prompting an investigation into likely causes.
  
  
  METHODS
  We conducted a descriptive epidemiological analysis using measles immunization and surveillance data to understand the causes of the measles resurgence and to develop recommendations for elimination efforts in DRC.
  
  
  RESULTS
  During 2004-2012, performance indicator targets for case-based surveillance and routine measles vaccination were not met. Estimated coverage with the routine first dose of measles-containing vaccine (MCV1) increased from 57% to 73%. Phased supplementary immunization activities (SIAs) were conducted starting in 2002, in some cases with sub-optimal coverage (≤95%). In 2010, SIAs in five of 11 provinces were not implemented as planned, resulting in a prolonged interval between SIAs, and a missed birth cohort in one province. During July 1, 2010-December 30, 2012, high measles attack rates (>100 cases per 100,000 population) occurred in provinces that had estimated MCV1 coverage lower than the national estimate and did not implement planned 2010 SIAs. The majority of confirmed case-patients were aged <10 years (87%) and unvaccinated or with unknown vaccination status (75%). Surveillance detected two genotype B3 and one genotype B2 measles virus strains that were previously identified in the region.
  
  
  CONCLUSIONS
  The resurgence was likely caused by an accumulation of unvaccinated, measles-susceptible children due to low MCV1 coverage and suboptimal SIA implementation. To achieve the regional goal of measles elimination by 2020, efforts are needed in DRC to improve case-based surveillance and increase two-dose measles vaccination coverage through routine services and SIAs.
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia, USA ; Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta.
authors.forename: Heather Melissa
authors.initials: HM
authors.lastname: Scobie
authors.affiliation: Ministry of Public Health, Kinshasa, Democratic Republic of the Congo.
authors.forename: Benoît Kebela
authors.initials: BK
authors.lastname: Ilunga
authors.affiliation: Ministry of Public Health, Kinshasa, Democratic Republic of the Congo.
authors.forename: Audry
authors.initials: A
authors.lastname: Mulumba
authors.affiliation: Ministry of Public Health, Kinshasa, Democratic Republic of the Congo.
authors.forename: Calixte
authors.initials: C
authors.lastname: Shidi
authors.affiliation: World Health Organization, Kinshasa.
authors.forename: Tiekoura
authors.initials: T
authors.lastname: Coulibaly
authors.affiliation: World Health Organization, Kinshasa.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Obama
authors.affiliation: National Institute for Biomedical Research, Kinshasa.
authors.forename: Jean-Jacques Muyembe
authors.initials: JJ
authors.lastname: Tamfum
authors.affiliation: National Institute for Biomedical Research, Kinshasa.
authors.forename: Elisabeth Pukuta
authors.initials: EP
authors.lastname: Simbu
authors.affiliation: National Institute for Communicable Diseases, Johannesburg, South Africa.
authors.forename: Sheilagh Brigitte
authors.initials: SB
authors.lastname: Smit
authors.affiliation: World Health Organization African Regional Office, Brazzaville, Republic of the Congo.
authors.forename: Balcha
authors.initials: B
authors.lastname: Masresha
authors.affiliation: World Health Organization, Geneva, Switzerland.
authors.forename: Robert Tyrrell
authors.initials: RT
authors.lastname: Perry
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
authors.forename: Mary Margaret
authors.initials: MM
authors.lastname: Alleman
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
authors.forename: Katrina
authors.initials: K
authors.lastname: Kretsinger
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
authors.forename: James
authors.initials: J
authors.lastname: Goodson
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015023:Democratic Republic of the Congo / Q000453:epidemiology; D004196:Disease Outbreaks; D005838:Genotype; D006801:Humans; D007114:Immunization / Q000706:statistics & numerical data; D007223:Infant; D008457:Measles / Q000453:epidemiology* / Q000517:prevention & control / Q000821:virology; D008458:Measles Vaccine / Q000008:administration & dosage*; D008459:Measles virus / Q000235:genetics / Q000302:isolation & purification*; D011159:Population Surveillance
chemical_list: D008458:Measles Vaccine
keywords: DRC; Measles; RDC; elimination; immunization; outbreak; surveillance; vaccination