title: The impact of supplementary immunization activities on the epidemiology of measles in Tianjin, China.
abstract: OBJECTIVE
  China has repeatedly used supplemental immunization activities (SIAs) to work towards measles elimination, but it is unknown if the SIAs are reaching non-locals - migrants from rural to urban areas. This study characterized temporal trends in measles incidence by local and non-local residency and evaluated the impact of SIAs on measles incidence in Tianjin, China.
  
  
  METHODS
  Daily measles case-counts were tabulated separately by residency. These two datasets were combined so that each day had two observations. Poisson regression was conducted using generalized estimating equations with an exchangeable working correlation structure to estimate rate ratios (RRs).
  
  
  RESULTS
  There were 12465 measles cases in Tianjin over the 10-year period. The rate of measles was higher in non-locals than locals before the 2008 SIA (RR 3.60, 95% confidence interval (CI) 3.27-3.96), but this attenuated to a RR of 1.22 between the 2008 and 2010 SIAs (95% CI 1.02-1.45). Following the 2010 SIA, non-locals had a lower rate of measles (RR 0.78, 95% CI 0.69-0.87).
  
  
  CONCLUSIONS
  The disparity in measles incidence between locals and non-locals was reduced following two SIAs. Sustained public health interventions will be needed to maintain low measles incidence among non-locals given the ongoing migration of people throughout China.
authors.affiliation: University of Michigan, Ann Arbor, Department of Epidemiology, 1415 Washington Heights, Ann Arbor, MI 48109, USA. Electronic address: awag@umich.edu.
authors.forename: Abram L
authors.initials: AL
authors.lastname: Wagner
authors.affiliation: Division of Expanded Programs on Immunization, Tianjin Centers for Disease Control and Prevention, Hedong District, Tianjin, China.
authors.forename: Ying
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: University of Michigan, Ann Arbor, Department of Biostatistics, Ann Arbor, Michigan, USA.
authors.forename: Bhramar
authors.initials: B
authors.lastname: Mukherjee
authors.affiliation: Division of Expanded Programs on Immunization, Tianjin Centers for Disease Control and Prevention, Hedong District, Tianjin, China.
authors.forename: Yaxing
authors.initials: Y
authors.lastname: Ding
authors.affiliation: University of Michigan, Ann Arbor, Department of Epidemiology, 1415 Washington Heights, Ann Arbor, MI 48109, USA.
authors.forename: Eden V
authors.initials: EV
authors.lastname: Wells
authors.affiliation: University of Michigan, Ann Arbor, Department of Epidemiology, 1415 Washington Heights, Ann Arbor, MI 48109, USA.
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Boulton
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D002681:China / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D008457:Measles / Q000453:epidemiology* / Q000517:prevention & control; D008875:Middle Aged; D014611:Vaccination
keywords: China; Mass vaccination; Measles