title: Measles seroprevalence, outbreaks, and vaccine coverage in Rwanda.
abstract: BACKGROUND
  Measles outbreaks are reported after insufficient vaccine coverage, especially in countries recovering from natural disaster or conflict. We compared seroprevalence to measles in blood donors in Rwanda and Sweden and explored distribution of active cases of measles and vaccine coverage in Rwanda.
  
  
  METHODS
  516 Rwandan and 215 Swedish blood donors were assayed for measles-specific immunoglobulin G (IgG) by enzyme-linked immunosorbent assay (ELISA). Data on vaccine coverage and acute cases in Rwanda from 1980 to 2014 were collected, and IgM on serum samples and polymerase chain reaction (PCR) on nasopharyngeal (NPH) swabs from suspected measles cases during 2010-2011 were analysed.
  
  
  RESULTS
  The seroprevalence of measles IgG was significantly higher in Swedish blood donors (92.6%; 95% CI: 89.1-96.1%) compared to Rwandan subjects (71.5%; 95% CI: 67.6-75.4%) and more pronounced <35 years of age. The OD values were significantly lower in the Rwandan blood donors as compared to Swedish subjects (p < 0.00001). However, effective measles vaccine coverage was concomitant with decrease in measles cases in Rwanda, with the exception of an outbreak in 1995 following the 1994 genocide. 76/544 serum samples were IgM positive and 21/31 NPH swabs were PCR positive for measles, determined by sequencing to be of genotype B3.
  
  
  CONCLUSIONS
  Measles seroprevalence was lower in Rwandan blood donors compared to Swedish subjects. Despite this, the number of reported measles cases in Rwanda rapidly decreased during the study period, concomitant with increased vaccine coverage. Taken together, the circulation of measles was limited in Rwanda and vaccine coverage was favourable, but seroprevalence and IgG levels were low especially in younger age groups.
authors.affiliation: a College of Medicine and Health Sciences , University of Rwanda , Rwanda ;|b Rwanda Military Hospital , Kigali , Rwanda ;|c Department of Infectious Diseases , Institute of Biomedicine, University of Gothenburg , Sweden ;
authors.forename: Eric
authors.initials: E
authors.lastname: Seruyange
authors.affiliation: a College of Medicine and Health Sciences , University of Rwanda , Rwanda ;
authors.forename: Jean-Bosco
authors.initials: JB
authors.lastname: Gahutu
authors.affiliation: a College of Medicine and Health Sciences , University of Rwanda , Rwanda ;
authors.forename: Claude
authors.initials: C
authors.lastname: Mambo Muvunyi
authors.affiliation: d National Reference Laboratory , Rwanda Biomedical Centre , Kigali , Rwanda ;
authors.forename: Zena G
authors.initials: ZG
authors.lastname: Uwimana
authors.affiliation: e Expanded Program on Immunization , Rwanda Biomedical Centre , Kigali , Rwanda ;
authors.forename: Maurice
authors.initials: M
authors.lastname: Gatera
authors.affiliation: a College of Medicine and Health Sciences , University of Rwanda , Rwanda ;|c Department of Infectious Diseases , Institute of Biomedicine, University of Gothenburg , Sweden ;
authors.forename: Theogene
authors.initials: T
authors.lastname: Twagirumugabe
authors.affiliation: f National Centre for Blood Transfusion , Rwanda Biomedical Centre , Kigali , Rwanda.
authors.forename: Swaibu
authors.initials: S
authors.lastname: Katare
authors.affiliation: b Rwanda Military Hospital , Kigali , Rwanda ;
authors.forename: Ben
authors.initials: B
authors.lastname: Karenzi
authors.affiliation: c Department of Infectious Diseases , Institute of Biomedicine, University of Gothenburg , Sweden ;
authors.forename: Tomas
authors.initials: T
authors.lastname: Bergström
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000914:Antibodies, Viral / Q000097:blood; D002648:Child; D002675:Child, Preschool; D004196:Disease Outbreaks; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D007075:Immunoglobulin M / Q000097:blood; D007223:Infant; D008297:Male; D008457:Measles / Q000453:epidemiology* / Q000517:prevention & control*; D008458:Measles Vaccine / Q000008:administration & dosage*; D008459:Measles virus / Q000235:genetics / Q000276:immunology; D008875:Middle Aged; D009305:Nasopharynx / Q000821:virology; D016133:Polymerase Chain Reaction; D012432:Rwanda / Q000453:epidemiology; D016036:Seroepidemiologic Studies; D013548:Sweden / Q000453:epidemiology; D014611:Vaccination / Q000706:statistics & numerical data*; D055815:Young Adult
chemical_list: D000914:Antibodies, Viral; D007074:Immunoglobulin G; D007075:Immunoglobulin M; D008458:Measles Vaccine
keywords: ELISA; Rwanda; measles; seroprevalence; vaccination