title: Measles epidemic in Brazil in the post-elimination period: Coordinated response and containment strategies.
abstract: The measles virus circulation was halted in Brazil in 2001 and the country has a routine vaccination coverage against measles, mumps and rubella higher than 95%. In Ceará, the last confirmed case was in 1999. This article describes the strategies adopted and the effectiveness of surveillance and control measures implemented during a measles epidemic in the post-elimination period. The epidemic started in December 2013 and lasted 20 months, reaching 38 cities and 1,052 confirmed cases. The D8 genotype was identified. More than 50,000 samples were tested for measles and 86.4% of the confirmed cases had a laboratory diagnosis. The beginning of an campaign vaccination was delayed in part by the availability of vaccine. The classic control measures were not enough to control the epidemic. The creation of a committee of experts, the agreement signed between managers of the three spheres of government, the conducting of an institutional active search of suspected cases, vaccination door to door at alternative times, the use of micro planning, a broad advertising campaign at local media and technical operative support contributed to containing the epidemic. It is important to recognize the possibility of epidemics at this stage of post-elimination and prepare a sensitive surveillance system for timely response.
authors.affiliation: Secretaria da Saúde do Estado do Ceará, Fortaleza, Ceará, Brazil; Programa de pós-graduação em Saúde Coletiva da Universidade Estadual do Ceará, Fortaleza, Ceará, Brazil; Centro Universitário Christus, Fortaleza, Ceará, Brazil. Electronic address: daniele.rq@gmail.com.
authors.forename: Daniele Rocha Queiroz
authors.initials: DR
authors.lastname: Lemos
authors.affiliation: Organização Panamericana da Saúde, Washington, DC, United States. Electronic address: aideepy2001@gmail.com.
authors.forename: Aidée Ramirez
authors.initials: AR
authors.lastname: Franco
authors.affiliation: Laboratório Central de Saúde Pública do Ceará, Fortaleza, Ceará, Brazil. Electronic address: lucia.feitosa@lacen.ce.gov.br.
authors.forename: Maria Lúcia Feitosa
authors.initials: ML
authors.lastname: de Sá Roriz
authors.affiliation: Secretaria da Saúde do Estado do Ceará, Fortaleza, Ceará, Brazil. Electronic address: anakarinebc@hotmail.com.
authors.forename: Ana Karine Borges
authors.initials: AK
authors.lastname: Carneiro
authors.affiliation: Secretaria da Saúde do Estado do Ceará, Fortaleza, Ceará, Brazil; Centro Universitário Christus, Fortaleza, Ceará, Brazil. Electronic address: marciogarcia.saude@gmail.com.
authors.forename: Márcio Henrique
authors.initials: MH
authors.lastname: de Oliveira Garcia
authors.affiliation: Secretaria da Saúde do Estado do Ceará, Fortaleza, Ceará, Brazil. Electronic address: flidianas@gmail.com.
authors.forename: Fábia Lidiana
authors.initials: FL
authors.lastname: de Souza
authors.affiliation: Organização Panamericana da Saúde, Washington, DC, United States. Electronic address: rdalaa2005@yahoo.com.
authors.forename: Regina
authors.initials: R
authors.lastname: Duron Andino
authors.affiliation: Departamento de Saúde Comunitária da Universidade Federal do Ceará, Fortaleza, Ceará, Brazil. Electronic address: pamplona.luciano@gmail.com.
authors.forename: Luciano Pamplona
authors.initials: LP
authors.lastname: de Góes Cavalcanti
mesh_terms: D000293:Adolescent; D000328:Adult; D001938:Brazil / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D002947:Cities / Q000453:epidemiology; D003140:Communicable Disease Control / Q000379:methods* / Q000458:organization & administration*; D018562:Disease Transmission, Infectious / Q000517:prevention & control*; D058872:Epidemics; D005260:Female; D005838:Genotype; D006801:Humans; D007223:Infant; D008297:Male; D008457:Measles / Q000453:epidemiology*; D008459:Measles virus / Q000145:classification / Q000235:genetics / Q000302:isolation & purification; D022542:Measles-Mumps-Rubella Vaccine / Q000008:administration & dosage; D008875:Middle Aged; D055815:Young Adult
chemical_list: D022542:Measles-Mumps-Rubella Vaccine
keywords: Epidemic; Epidemiology; Measles; Public health