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Mengistu ST, Achila OO, Tewelde AT, Hamida ME, Tekle F, Michae I, Said M, Fsahatsion D, Abai H, Mulugeta R, Tsegai T, Woldu LG, Werke WY. Epidemiology of confirmed measles virus cases, surveillance, incidence, and associated factors in Eritrea: 18-year retrospective analysis. Front Public Health 2023; 11:1218317. [PMID: 37780421 PMCID: PMC10533993 DOI: 10.3389/fpubh.2023.1218317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 08/29/2023] [Indexed: 10/03/2023] Open
Abstract
Background Despite the outstanding measles vaccine coverage (MVC) in Eritrea, sporadic outbreaks are not uncommon. Therefore, understanding the incidence of laboratory-confirmed measles virus cases, related factors, and spatial inequalities in testing and surveillance remains crucial. In this analysis, we evaluated the incidence and spatiotemporal distribution of measles in Eritrea. An evaluation of the factors associated with measles vaccination and IgM positive (+) febrile rash was also undertaken. Methods A retrospective (period: 2002-2020) study was carried out by abstracting data from the integrated disease surveillance and response database (IDSR). Data was analyzed using descriptive statistics and binary logistic regression. Spatial variability and distribution of confirmed cases was evaluated using ArcGIS Pro version 3.0.1. Results In total, 9,111 suspected cases, 2,767 [1,431 (51.7%) females] were serologically tested. The median (IQR) age, minimum-maximum age were 7 years (IQR: 4-14 years) and 1 month-97 years, respectively. Among the 608(21.9%) laboratory-confirmed cases, 534 (87.8%) were unvaccinated and 53 (9.92%) were < 1 year old. The crude incidence rate for MV was 14/100,000 persons. The age-specific positivity rate per 100,000 suspected cases tested was 21.5 with individuals >30 years presenting with the highest rates (69.9/100,000). Higher odds (OR) of MV test positivity was associated with age at onset - higher in the following age-bands [10-14 years: OR = 1.6 (95%CI, 1.1-2.2, value of p = 0.005); 15-29 years: OR = 7.0 (95%CI, 5.3-9.2, value of p = 0.005); and > =30 years: OR = 16.7 (95%CI, 11.7-24) p < 0.001]. Other associations included: Address - higher in Anseba (OR = 2.3, 95%CI: 1.7-3.1, value of p<0.001); Debub (OR = 2.7, 95%CI: 1.9-3.9, value of p < 0.001); Gash-Barka (OR = 15.4, 95%CI: 10.9-21.7, value of p < 0.001); Northern Red Sea (OR = 11.8, 95%CI: 8.5-16.2, value of p < 0.001); and Southern Red Sea (OR = 14.4, 95%CI: 8.2-25.2, value of p < 0.001). Further, test positivity was higher in health centers (OR = 2.5, 95%CI: 1.9-3.4, value of p < 0.001) and hospitals (OR = 6.8, 95%CI: 5.1-9.1, value of p < 0.001). Additional factors included vaccination status - higher in the unvaccinated (OR = 14.7, 95%CI: 11.4-19.1, value of p < 0.001); and year of onset of rash - (higher >2015: OR = 1.4, 95%CI: 1.1-1.7, value of p<0.001). Uptake of measles vaccine associated with a similar complement of factors. Conclusion In large part, efforts to eliminate measles in Eritrea are hindered by disparities in vaccine coverage, under-surveillance, and low vaccination rates in neighboring countries. Enhanced surveillance and regional micro planning targeting hard-to-reach areas can be an effective strategy to improve measles elimination efforts in Eritrea.
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Affiliation(s)
| | - Oliver Okoth Achila
- Unit of Clinical Laboratory Sciences, Orotta College of Medicine and Health Sciences, Asmara, Eritrea
| | | | | | - Freweini Tekle
- Serology Department, National Health Laboratory, Asmara, Eritrea
| | - Issaias Michae
- Serology Department, National Health Laboratory, Asmara, Eritrea
| | - Mensura Said
- Serology Department, National Health Laboratory, Asmara, Eritrea
| | - Dawit Fsahatsion
- Serology Department, National Health Laboratory, Asmara, Eritrea
| | - Haimanot Abai
- Serology Department, National Health Laboratory, Asmara, Eritrea
| | - Rahel Mulugeta
- Serology Department, National Health Laboratory, Asmara, Eritrea
| | - Tsigehana Tsegai
- Serology Department, National Health Laboratory, Asmara, Eritrea
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Demewoz A, Wubie M, Mengie MG, Kassegn EM, Jara D, Aschale A, Endalew B. Second Dose Measles Vaccination Utilization and Associated Factors in Jabitehnan District, Northwest Ethiopia. Dose Response 2023; 21:15593258231164042. [PMID: 36923301 PMCID: PMC10009019 DOI: 10.1177/15593258231164042] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 02/28/2023] [Indexed: 03/12/2023] Open
Abstract
Background Herd immunity against measles is essential to interrupt measles transmission, and this can only be attained by reaching at least 95% coverage for each of the 2 doses of measles vaccine provided in infancy and early childhood age group. It is important to provide everyone with 2 doses of the measles vaccine in order to effectively safeguard the population. Despite this, little is known about the second dosage of the measles vaccine utilization status and the factors that affect it. Therefore, this study aimed to assess second dose of measles vaccination utilization and its associated factors among children aged 24-35 months in Jabitehnan district, 2020. Methods A community-based cross-sectional study design was conducted at Jabitehnan District, Northwest Ethiopia, from September 1st, 2020 to October 1st, 2020. Systematic random sampling technique was used to select 845 mothers/caregivers who had children aged 24-35 months. Both bi-variable and multivariable logistic regression was fitted to identify the determinant factors of second dose measles vaccination utilization. Finally, the statistical significant variables were declared by using 95% CI and P value less than .05 in the multivariable logistic regression analysis. The Hosmer and Lemeshow test was used to check the model's fit to the data, and the variance inflation factor was used to assess multi-collinearity. Results The overall second dose of measles vaccination utilization was 48.1%, (95% CI: 44.7-51.6). Mothers with primary school education (AOR = 1.91, 95% CI: 1.15-3.17), information about MCV2 (AOR = 6.53, 95% CI: 4.22-10.08), distance from vaccination site (AOR = 3.56, 95% CI: 2.46-5.14), knowledge about immunization (AOR = 1.935, 95% CI: 1.29-2.90), and favorable attitude about immunization (AOR = 5.19, 95% CI: 3.25-8.29) were significantly associated factors with second dose of measles vaccination utilization. Conclusion Second dose measles vaccination utilization in the district was lower than the national target. Maternal education, distances from vaccination site, information about MCV2, and knowledge about immunization were significantly associated variables with second dose measles vaccination utilization. Therefore, in order to increase the utilization of the second dose of the measles vaccine, improved health education and service expansion to difficult-to-reach areas are required.
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Affiliation(s)
- Aynalem Demewoz
- 1West Gojjam Zone Health Department, Jabitehnan District Health Office, Amhara Region, Finote Selam, Ethiopia
| | - Moges Wubie
- 2Department of Public Health, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Muluye Gebrie Mengie
- 2Department of Public Health, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Esmelealem Mihretu Kassegn
- 3Department of Pediatrics and Child Health Nursing, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Dubie Jara
- 2Department of Public Health, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Abiot Aschale
- 2Department of Public Health, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Bekalu Endalew
- 2Department of Public Health, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia
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Persistent Socioeconomic Inequalities in Measles Vaccine Uptake in Ethiopia in the Period 2005 to 2016. Value Health Reg Issues 2021; 25:71-79. [PMID: 33819837 DOI: 10.1016/j.vhri.2020.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 12/04/2020] [Accepted: 12/10/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVE This study aims to quantify socioeconomic inequalities-and the factors contributing to these inequalities-in measles vaccine uptake among children aged 12 to 23 months in Ethiopia between 2005 and 2016. METHODS Inequalities in measles vaccine uptake were investigated based on data from the Ethiopian Demographic and Health Surveys conducted in 2005, 2011, and 2016. Concentration curves and concentration indices were used to measure the degree of inequality, and decomposition analysis was used to identify factors contributing to these inequalities. RESULTS The overall level of national measles vaccine uptake in Ethiopia exhibited an increasing trend between 2005 and 2016. As indicated by the concentration index of measles vaccine uptake, however, which was estimated at 0.202 (P < .01) in 2005, 0.226 (P < .01) in 2011, and 0.223 (P < .01) in 2016, measles vaccine uptake became consistently more concentrated among children from more affluent households. The dominance test of the concentration curve further confirmed the persistence of inequalities in measles vaccine uptake over time. Various factors-including maternal educational level, antenatal care use, institutional delivery, and exposure to media-were identified as the most important contributors to the inequalities. CONCLUSIONS Although the national measles vaccine uptake showed improvement between 2005 and 2016, socioeconomic inequalities in the uptake persisted over time. Efforts to improve the national immunization coverage should be accompanied by appropriate measures to address the inequalities.
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Nigus M, Zelalem M, Abraham K, Shiferaw A, Admassu M, Masresha B. Implementing nationwide measles supplemental immunization activities in Ethiopia in the context of COVID-19: process and lessons learnt. Pan Afr Med J 2020; 37:36. [PMID: 33456660 PMCID: PMC7796832 DOI: 10.11604/pamj.supp.2020.37.36.26614] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 11/13/2020] [Indexed: 11/11/2022] Open
Abstract
The COVID-19 pandemic has disrupted immunization activities in many countries, causing declines in the delivery of routine doses of antigens, and the postponement of scheduled supplemental immunization activities (SIAs). Following the declaration of the pandemic, Ethiopia postponed nationwide follow-up measles preventive vaccination campaign which was scheduled for April 2020. The disruptions to routine services and the postponement of the SIAs increased the risk for measles outbreaks. The national authorities, in consultation with the secretariat of the National COVID-19 Pandemic Prevention and Control Ministerial Coordination Committee, subnational level authorities, technical partner agencies and stakeholders, reviewed the risks for measles outbreaks and decided to implement the nationwide measles SIAs, with strict implementation of COVID prevention measures. The revised micro-plans accommodated the additional human resource and logistics needs for COVID prevention, for which partner resources were mobilized to fill the gaps. The key SIAs preparatory and implementation activities including training, logistics, social mobilization, service delivery and supervision were modified to take into consideration the COVID context. Infection prevention and control supplies were procured and distributed as a package with the bundled vaccines and other supplies. The SIAs were completed in July 2020 and reached 102.8% administrative coverage nationwide, with 78% of the 1123 woredas attaining the target of 95% coverage. The strong commitment of the leadership, the coordination role of the national and regional COVID prevention and control taskforces, the engagement of community leaders, the use of multi-channel communication, the timely availability of additional resources and modification of the service delivery approaches contributed to the success of the SIAs.
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Affiliation(s)
- Mulat Nigus
- Federal Ministry of Health, Addis Ababa, Ethiopia
| | | | | | - Amsalu Shiferaw
- United Nations Children's Fund (UNICEF), Addis Ababa, Ethiopia
| | | | - Balcha Masresha
- World Health Organization, Regional Office for Africa, Brazzaville, Congo
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Nigus M, Zelalem M, Abraham K, Shiferaw A, Admassu M, Masresha B. Implementing nationwide measles supplemental immunization activities in Ethiopia in the context of COVID-19: process and lessons learnt. Pan Afr Med J 2020. [PMID: 33456660 PMCID: PMC7796832 DOI: 10.11604/pamj.supp.2020.37.1.26614] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
The COVID-19 pandemic has disrupted immunization activities in many countries, causing declines in the delivery of routine doses of antigens, and the postponement of scheduled supplemental immunization activities (SIAs). Following the declaration of the pandemic, Ethiopia postponed nationwide follow-up measles preventive vaccination campaign which was scheduled for April 2020. The disruptions to routine services and the postponement of the SIAs increased the risk for measles outbreaks. The national authorities, in consultation with the secretariat of the National COVID-19 Pandemic Prevention and Control Ministerial Coordination Committee, subnational level authorities, technical partner agencies and stakeholders, reviewed the risks for measles outbreaks and decided to implement the nationwide measles SIAs, with strict implementation of COVID prevention measures. The revised micro-plans accommodated the additional human resource and logistics needs for COVID prevention, for which partner resources were mobilized to fill the gaps. The key SIAs preparatory and implementation activities including training, logistics, social mobilization, service delivery and supervision were modified to take into consideration the COVID context. Infection prevention and control supplies were procured and distributed as a package with the bundled vaccines and other supplies. The SIAs were completed in July 2020 and reached 102.8% administrative coverage nationwide, with 78% of the 1123 woredas attaining the target of 95% coverage. The strong commitment of the leadership, the coordination role of the national and regional COVID prevention and control taskforces, the engagement of community leaders, the use of multi-channel communication, the timely availability of additional resources and modification of the service delivery approaches contributed to the success of the SIAs.
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Affiliation(s)
- Mulat Nigus
- Federal Ministry of Health, Addis Ababa, Ethiopia
| | | | | | - Amsalu Shiferaw
- United Nations Children's Fund (UNICEF), Addis Ababa, Ethiopia
| | | | - Balcha Masresha
- World Health Organization, Regional Office for Africa, Brazzaville, Congo
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Shibre G, Zegeye B, Idriss-Wheeler D, Yaya S. Inequalities in measles immunization coverage in Ethiopia: a cross-sectional analysis of demographic and health surveys 2000-2016. BMC Infect Dis 2020; 20:481. [PMID: 32635891 PMCID: PMC7341655 DOI: 10.1186/s12879-020-05201-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 06/26/2020] [Indexed: 11/10/2022] Open
Abstract
Background Ethiopia has low measles immunization coverage and little is known about the disparities surrounding what coverage is provided. This study assessed disparities in measles immunization and its change over time using the four Ethiopia Demographic and Health Surveys conducted between 2000 and 2016. Methods This is a cross-sectional analysis of data using Ethiopia Demographic and Health Surveys (EDHS) conducted between 2000 and 2016. We used the World Health Organization’s (WHO) Health Equity Assessment Toolkit (HEAT) to present the inequalities. Four measures of inequality were calculated: Difference (D), Ratio (R), Population Attributable Fraction (PAF) and Population Attributable Risk (PAR). The results were disaggregated by wealth, education, residence, sex and sub-national regions and 95% Uncertainty Intervals (UIs) were computed for each point estimate to boost confidence of the findings. Results Measles immunization coverage was higher among the richest and secondary and above schools’ subgroup by nearly 30 to 31 percentage points based on point estimates (D = 31%; 95% CI; 19.48, 42.66) and 29.8 percentage points (D = 29.8%; 95% CI; 16.57, 43.06) as compared to the poorest and no education subgroup respectively in the 2016 survey. Still, in the 2016 survey, substantial economic status (PAF = 36.73; 95%CI: 29.78, 43.68), (R = 1.71; 95%CI: 1.35, 2.08), education status (PAF = 45.07; 95% CI: 41.95, 48.18), (R = 1.60; 95% CI: 1.30, 1.90), place of residence (PAF = 39.84, 95% CI: 38.40, 41.27), (R = 1.47, 95% CI: 1.20, 1. 74) and regional (PAF = 71.35, 95% CI: 31.76, 110.95), (R = 3.09, 95%CI: 2.01, 4.17) inequality were observed with both simple and complex measures. There was no statistically significant difference in the prevalence of measles immunization between male and female children in all the studied years, as indicated, for instance, by measures of PAF in 2000 (PAF = 0; 95%CI: − 6.79, 6.79), 2005 (PAF = 0; 95%CI: − 6.04, 6.04), 2011(PAF = 0; 95%CI: − 3.79, 3.79) and 2016 (PAF = 2.66; − 1.67; 6.99). Overall, the inequality of measles immunization narrowed significantly by at least some of the measures between the first and the last survey periods across all the studied subgroups. Conclusions National, regional and district levels of government should make a pledge to reduce inequalities in coverage of measles immunization. Equity-sensitive strategies, sufficient human and financial resources as well as continued research and monitoring of immunization coverage inequalities are necessary to achieve related sustainable development goals.
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Affiliation(s)
- Gebretsadik Shibre
- Department of Reproductive, Family and Population Health, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Betregiorgis Zegeye
- Shewarobit Field Office, HaSET Maternal and Child Health Research Program, Addis Ababa, Ethiopia
| | - Dina Idriss-Wheeler
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Canada
| | - Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, Canada. .,The George Institute for Global Health, The University of Oxford, Oxford, UK.
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Poletti P, Parlamento S, Fayyisaa T, Feyyiss R, Lusiani M, Tsegaye A, Segafredo G, Putoto G, Manenti F, Merler S. The hidden burden of measles in Ethiopia: how distance to hospital shapes the disease mortality rate. BMC Med 2018; 16:177. [PMID: 30333039 PMCID: PMC6193289 DOI: 10.1186/s12916-018-1171-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 09/10/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A sequence of annual measles epidemics has been observed from January 2013 to April 2017 in the South West Shoa Zone of the Oromia Region, Ethiopia. We aimed at estimating the burden of disease in the affected area, taking into account inequalities in access to health care due to travel distances from the nearest hospital. METHODS We developed a dynamic transmission model calibrated on the time series of hospitalized measles cases. The model provided estimates of disease transmissibility and incidence at a population level. Model estimates were combined with a spatial analysis to quantify the hidden burden of disease and to identify spatial heterogeneities characterizing the effectiveness of the public health system in detecting severe measles infections and preventing deaths. RESULTS A total of 1819 case patients and 36 deaths were recorded at the hospital. The mean age was 6.0 years (range, 0-65). The estimated reproduction number was 16.5 (95% credible interval (CI) 14.5-18.3) with a cumulative disease incidence of 2.34% (95% CI 2.06-2.66). Three thousand eight hundred twenty-one (95% CI 1969-5671) severe cases, including 2337 (95% CI 716-4009) measles-related deaths, were estimated in the Woliso hospital's catchment area (521,771 inhabitants). The case fatality rate was found to remarkably increase with travel distance from the nearest hospital: ranging from 0.6% to more than 19% at 20 km. Accordingly, hospital treatment prevented 1049 (95% CI 757-1342) deaths in the area. CONCLUSIONS Spatial heterogeneity in the access to health care can dramatically affect the burden of measles disease in low-income settings. In sub-Saharan Africa, passive surveillance based on hospital admitted cases might miss up to 60% of severe cases and 98% of related deaths.
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Affiliation(s)
- Piero Poletti
- Center for Information Technology, Fondazione Bruno Kessler, via Sommarive, 18, I-38123, Trento, Italy.
| | - Stefano Parlamento
- Center for Information Technology, Fondazione Bruno Kessler, via Sommarive, 18, I-38123, Trento, Italy
| | - Tafarraa Fayyisaa
- South West Shoa Zone Health Office, P.O. Box 253, Woliso, Oromia, Ethiopia
| | - Rattaa Feyyiss
- South West Shoa Zone Health Office, P.O. Box 253, Woliso, Oromia, Ethiopia
| | - Marta Lusiani
- Doctors with Africa CUAMM, Woliso Hospital, P.O. Box 250, Woliso, Oromia, Ethiopia
| | - Ademe Tsegaye
- Doctors with Africa CUAMM, Woliso Hospital, P.O. Box 250, Woliso, Oromia, Ethiopia
| | - Giulia Segafredo
- Doctors with Africa CUAMM, via S. Francesco, 126, I-35121, Padova, Italy
| | - Giovanni Putoto
- Doctors with Africa CUAMM, via S. Francesco, 126, I-35121, Padova, Italy
| | - Fabio Manenti
- Doctors with Africa CUAMM, via S. Francesco, 126, I-35121, Padova, Italy
| | - Stefano Merler
- Center for Information Technology, Fondazione Bruno Kessler, via Sommarive, 18, I-38123, Trento, Italy
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Hassen MN, Woyessa AB, Getahun M, Beyene B, Buluanger L, Ademe A, Bekele A, Addissie A, Kebede A, Jima D. Epidemiology of measles in the metropolitan setting, Addis Ababa, Ethiopia, 2005-2014: a retrospective descriptive surveillance data analysis. BMC Infect Dis 2018; 18:400. [PMID: 30107824 PMCID: PMC6092798 DOI: 10.1186/s12879-018-3305-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 08/02/2018] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Measles is a highly infectious and serious respiratory viral disease which caused by a virus. It is a significant cause of illness and death worldwide. This data analysis was conducted to describe the trend and determine the reporting rate of measles cases in Addis Ababa to make recommendation for the government of the city to strengthening measles control interventions. METHODS We obtained and extracted ten years (2005-2014) Addis Ababa city's measles surveillance data from national database. We carried out retrospective descriptive data analysis by time, place and person variables. We calculated cumulative and specific reporting rates by dividing measles cases (lab confirmed, epidemiologically linked and compatible cases) to respective population and multiplying by 100,000. We divided average of ten years measles cases to midyear population and multiplied by 100,000 to calculate annualized reporting rate. We analyzed non-measles febrile rash rate by dividing laboratory negative cases to total population and multiplying by 100,000. RESULTS A total of 4203 suspected measles cases were identified. Among them 1154 (27.5%) were laboratory confirmed, 512 (12.2%) were clinically compatible, 52 (1.2%) were epidemiologically linked cases and the rest 2485 (59.1%) were IgM negative for measles which makes total measles cases 1718 (40.9%). Median age was 5 years with 2-18 years interquartile-range. The annualized measles reporting rate was 5.9, which was 40.2 among > 1 year, 11.5 among 1-4 years, 6.0 among 5-14 years, 4.1 among 15-44 years and 0.01 among ≥ 45 years per 100,000 population. Among the total measles cases; 380 (22%) were received at least one dose of measles containing vaccine (MCV) while 415 (24%) cases were not vaccinated and the vaccination status of 923 (54%) cases were not known. CONCLUSION Our analysis revealed that the reporting rate was higher among young children than older age group. Among all the patients 22% were received at least one dose of measles vaccine whereas 13% were not vaccinated against measles antigen. Routine immunization should be strengthened to reach all children through well monitored vaccine cold chain management.
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Affiliation(s)
| | - Abyot Bekele Woyessa
- Center for Public Health Emergency Management, Ethiopian Public Health Institute, PO BOX 1242, Addis Ababa, Ethiopia
| | - Mekonen Getahun
- Center for Public Health Emergency Management, Ethiopian Public Health Institute, PO BOX 1242, Addis Ababa, Ethiopia
| | - Berhane Beyene
- Center for Public Health Emergency Management, Ethiopian Public Health Institute, PO BOX 1242, Addis Ababa, Ethiopia
| | | | | | - Alemayehu Bekele
- Center for Public Health Emergency Management, Ethiopian Public Health Institute, PO BOX 1242, Addis Ababa, Ethiopia
- Ethiopian Public Health Association, Addis Ababa, Ethiopia
| | | | - Amha Kebede
- Center for Public Health Emergency Management, Ethiopian Public Health Institute, PO BOX 1242, Addis Ababa, Ethiopia
| | - Daddi Jima
- Center for Public Health Emergency Management, Ethiopian Public Health Institute, PO BOX 1242, Addis Ababa, Ethiopia
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Belda K, Tegegne AA, Mersha AM, Bayenessagne MG, Hussein I, Bezabeh B. Measles outbreak investigation in Guji zone of Oromia Region, Ethiopia. Pan Afr Med J 2017; 27:9. [PMID: 28983397 PMCID: PMC5619924 DOI: 10.11604/pamj.supp.2017.27.2.10705] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Accepted: 02/18/2017] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Despite the increase of immunization coverage (administrative) of measles in the country, there are widespread outbreaks of measles. In this respect, we investigated one of the outbreaks that occurred in hard to reach kebeles of Guji Zone, Oromia region, to identify the contributing factors that lead to the protracted outbreak of measles. METHODS We used a cross-sectional study design to investigate a measles outbreak in Guji zone, Oromia region. Data entry and analysis was performed using EPI-Info version 7.1.0.6 and MS-Microsoft Excel. RESULTS In three months' time a total of 1059 suspected cases and two deaths were reported from 9 woredas affected by a measles outbreak in Guji zone. The cumulative attack rate of 81/100,000 population and case fatality ratio of 0.2% was recorded. Of these, 821 (77.5%) cases were < 15 years of age, and 742 (70%) were zero doses of measles vaccine. Although, all age groups were affected under five years old were more affected 495 (48%) than any other age groups. In response to the outbreak, an outbreak response immunization was organized at the 11th week of the epidemic, when the epidemic curve started to decline. 6 months to14 years old were targeted for outbreak response immunization and the overall coverage was 97 % (range: 90-103%). Case management with vitamin A supplementation, active case search, and health education was some of the activities carried out to curb the outbreak. CONCLUSION We conclude that low routine immunization coverage in conjunction with low access to routine immunization in hard to reach areas, low community awareness in utilization of immunization service, inadequate cold chain management and delivery of a potent vaccine in hard to reach woredas/kebeles were likely contributed to the outbreak that's triggered a broad spread epidemic affecting mostly children without any vaccination. We also figured that the case-based surveillance lacks sensitivity and timely confirmation of the outbreak, which as a result outbreak response immunization were delayed. We recommend establishing reaching every child (REC) strategy in Guji zone with particular emphasis too hard reach areas to enhance the current immunization service, and furthermore to conduct data quality self-assessment or cluster coverage survey to verify the reported high vaccination coverage in some kebeles. We also recommend conducting the second opportunity as a form of supplemental immunization activities in 2-3 year interval or consider the national second dose introduction in the routine immunization system to improve population immunity. We further recommend that there is a need to boost the sensitivity of case-based surveillance system to be able to early detect, confirm and react to future epidemics.
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Affiliation(s)
- Ketema Belda
- World Health Organization, Oromia Region Technical Support Team
| | | | | | | | - Ibrahim Hussein
- World Health Organization, Oromia Region Technical Support Team
| | - Belay Bezabeh
- World Health Organization Country Office, Addis Abba, Ethiopia
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Getahun M, Beyene B, Ademe A, Teshome B, Tefera M, Afework A, HaileMariam Y, Assefa E, Hailegiorgis Y, Asha A. Epidemiology of laboratory confirmed measles virus cases in the southern nations of Ethiopia, 2007-2014. BMC Infect Dis 2017; 17:87. [PMID: 28103830 PMCID: PMC5244571 DOI: 10.1186/s12879-017-2183-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 01/04/2017] [Indexed: 11/28/2022] Open
Abstract
Background In Ethiopia, measles case-based surveillance was introduced in 2004 as one strategy for measles control by laboratory confirmation of suspected cases. In this article, epidemiological distribution of laboratory-confirmed measles cases were reported from the Southern Nation Nationalities and Peoples Region (SNNPR) of Ethiopia between 2007 and 2014, as the region is one of the highly measles affected areas in Ethiopia. Method A serum sample was collected from all measles suspected cases, and patient information was captured by case reporting format (CRF). Samples were transported to the National Measles Laboratory for Measles IgM testing by ELISA technique. Data entry and analysis were done using Epi-Info 3.5.4 software. Result A total of 4810 samples were tested for measles IgM using ELISA technique and 1507 (31.3%) were found positive during 2007–2014 in SNNPR of Ethiopia. Patients with age 1–4 years were the most affected regardless of sex. The incidence of measles confirmed cases increased from 15 in 2007 to 180 in 2013 per million population. The highest percentage of laboratory-confirmed cases were found in 2014. Measles was found distributed throughout the regional state. Conclusion Measles was found a public health important disease in SNNPR of Ethiopia, mostly affecting children 1–4 years. The incidence of measles cases is increasing from time to time. Additional research to determine the genotype of circulating measles virus, knowledge, attitude and practice of professionals and the population for measles vaccination and infection in the region is important. A wide age group measles vaccination campaign is highly recommended.
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Affiliation(s)
- Mekonen Getahun
- Ethiopian Public Health Institute, Arbegnoch Street, P. O. Box 1242, Addis Ababa, Ethiopia.
| | - Berhane Beyene
- Ethiopian Public Health Institute, Arbegnoch Street, P. O. Box 1242, Addis Ababa, Ethiopia
| | | | - Birke Teshome
- Ethiopian Public Health Institute, Arbegnoch Street, P. O. Box 1242, Addis Ababa, Ethiopia
| | - Mesfin Tefera
- Ethiopian Public Health Institute, Arbegnoch Street, P. O. Box 1242, Addis Ababa, Ethiopia
| | - Aklog Afework
- Ethiopian Public Health Institute, Arbegnoch Street, P. O. Box 1242, Addis Ababa, Ethiopia
| | - Yoseph HaileMariam
- Ethiopian Public Health Institute, Arbegnoch Street, P. O. Box 1242, Addis Ababa, Ethiopia
| | - Esete Assefa
- Ethiopian Public Health Institute, Arbegnoch Street, P. O. Box 1242, Addis Ababa, Ethiopia
| | | | - Anjelo Asha
- Ethiopian Public Health Institute, Arbegnoch Street, P. O. Box 1242, Addis Ababa, Ethiopia
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Global, regional, national, and selected subnational levels of stillbirths, neonatal, infant, and under-5 mortality, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet 2016; 388:1725-1774. [PMID: 27733285 PMCID: PMC5224696 DOI: 10.1016/s0140-6736(16)31575-6] [Citation(s) in RCA: 501] [Impact Index Per Article: 62.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 08/06/2016] [Accepted: 08/09/2016] [Indexed: 01/05/2023]
Abstract
BACKGROUND Established in 2000, Millennium Development Goal 4 (MDG4) catalysed extraordinary political, financial, and social commitments to reduce under-5 mortality by two-thirds between 1990 and 2015. At the country level, the pace of progress in improving child survival has varied markedly, highlighting a crucial need to further examine potential drivers of accelerated or slowed decreases in child mortality. The Global Burden of Disease 2015 Study (GBD 2015) provides an analytical framework to comprehensively assess these trends for under-5 mortality, age-specific and cause-specific mortality among children under 5 years, and stillbirths by geography over time. METHODS Drawing from analytical approaches developed and refined in previous iterations of the GBD study, we generated updated estimates of child mortality by age group (neonatal, post-neonatal, ages 1-4 years, and under 5) for 195 countries and territories and selected subnational geographies, from 1980-2015. We also estimated numbers and rates of stillbirths for these geographies and years. Gaussian process regression with data source adjustments for sampling and non-sampling bias was applied to synthesise input data for under-5 mortality for each geography. Age-specific mortality estimates were generated through a two-stage age-sex splitting process, and stillbirth estimates were produced with a mixed-effects model, which accounted for variable stillbirth definitions and data source-specific biases. For GBD 2015, we did a series of novel analyses to systematically quantify the drivers of trends in child mortality across geographies. First, we assessed observed and expected levels and annualised rates of decrease for under-5 mortality and stillbirths as they related to the Soci-demographic Index (SDI). Second, we examined the ratio of recorded and expected levels of child mortality, on the basis of SDI, across geographies, as well as differences in recorded and expected annualised rates of change for under-5 mortality. Third, we analysed levels and cause compositions of under-5 mortality, across time and geographies, as they related to rising SDI. Finally, we decomposed the changes in under-5 mortality to changes in SDI at the global level, as well as changes in leading causes of under-5 deaths for countries and territories. We documented each step of the GBD 2015 child mortality estimation process, as well as data sources, in accordance with the Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER). FINDINGS Globally, 5·8 million (95% uncertainty interval [UI] 5·7-6·0) children younger than 5 years died in 2015, representing a 52·0% (95% UI 50·7-53·3) decrease in the number of under-5 deaths since 1990. Neonatal deaths and stillbirths fell at a slower pace since 1990, decreasing by 42·4% (41·3-43·6) to 2·6 million (2·6-2·7) neonatal deaths and 47·0% (35·1-57·0) to 2·1 million (1·8-2·5) stillbirths in 2015. Between 1990 and 2015, global under-5 mortality decreased at an annualised rate of decrease of 3·0% (2·6-3·3), falling short of the 4·4% annualised rate of decrease required to achieve MDG4. During this time, 58 countries met or exceeded the pace of progress required to meet MDG4. Between 2000, the year MDG4 was formally enacted, and 2015, 28 additional countries that did not achieve the 4·4% rate of decrease from 1990 met the MDG4 pace of decrease. However, absolute levels of under-5 mortality remained high in many countries, with 11 countries still recording rates exceeding 100 per 1000 livebirths in 2015. Marked decreases in under-5 deaths due to a number of communicable diseases, including lower respiratory infections, diarrhoeal diseases, measles, and malaria, accounted for much of the progress in lowering overall under-5 mortality in low-income countries. Compared with gains achieved for infectious diseases and nutritional deficiencies, the persisting toll of neonatal conditions and congenital anomalies on child survival became evident, especially in low-income and low-middle-income countries. We found sizeable heterogeneities in comparing observed and expected rates of under-5 mortality, as well as differences in observed and expected rates of change for under-5 mortality. At the global level, we recorded a divergence in observed and expected levels of under-5 mortality starting in 2000, with the observed trend falling much faster than what was expected based on SDI through 2015. Between 2000 and 2015, the world recorded 10·3 million fewer under-5 deaths than expected on the basis of improving SDI alone. INTERPRETATION Gains in child survival have been large, widespread, and in many places in the world, faster than what was anticipated based on improving levels of development. Yet some countries, particularly in sub-Saharan Africa, still had high rates of under-5 mortality in 2015. Unless these countries are able to accelerate reductions in child deaths at an extraordinary pace, their achievement of proposed SDG targets is unlikely. Improving the evidence base on drivers that might hasten the pace of progress for child survival, ranging from cost-effective intervention packages to innovative financing mechanisms, is vital to charting the pathways for ultimately ending preventable child deaths by 2030. FUNDING Bill & Melinda Gates Foundation.
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Thompson KM, Odahowski CL, Goodson JL, Reef SE, Perry RT. Synthesis of Evidence to Characterize National Measles and Rubella Exposure and Immunization Histories. RISK ANALYSIS : AN OFFICIAL PUBLICATION OF THE SOCIETY FOR RISK ANALYSIS 2016; 36:1427-1458. [PMID: 26249328 DOI: 10.1111/risa.12454] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 05/26/2015] [Accepted: 05/26/2015] [Indexed: 06/04/2023]
Abstract
Population immunity depends on the dynamic levels of immunization coverage that countries achieve over time and any transmission of viruses that occur within the population that induce immunity. In the context of developing a dynamic transmission model for measles and rubella to support analyses of future immunization policy options, we assessed the model inputs required to reproduce past behavior and to provide some confidence about model performance at the national level. We reviewed the data available from the World Health Organization (WHO) and existing measles and rubella literature for evidence of historical reported routine and supplemental immunization activities and reported cases and outbreaks. We constructed model input profiles for 180 WHO member states and three other areas to support disease transmission model development and calibration. The profiles demonstrate the significant variability in immunization strategies used historically by regions and member states and the epidemiological implications of these historical choices. The profiles provide a historical perspective on measles and rubella immunization globally at the national level, and they may help immunization program managers identify existing immunity and/or knowledge gaps.
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Affiliation(s)
- Kimberly M Thompson
- Kid Risk, Inc, Orlando, FL, USA
- University of Central Florida, College of Medicine, Orlando, FL, USA
| | | | - James L Goodson
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Susan E Reef
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Getahun M, Beyene B, Ademe A, Teshome B, Tefera M, Asha A, Afework A, HaileMariyam Y, Assefa E, Gallagher K. Epidemiology of laboratory confirmed measles virus cases in Amhara Regional State of Ethiopia, 2004-2014. BMC Infect Dis 2016; 16:133. [PMID: 27001744 PMCID: PMC4802717 DOI: 10.1186/s12879-016-1457-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 03/09/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Measles is a highly contagious viral infection causing large outbreaks all over the world. Despite the availability of safe and cost effective vaccine, measles remained endemic with persistent periodic outbreaks in the Horn of Africa. The aim of this study is to characterize laboratory confirmed measles cases in Amhara Regional State, which was one of the highly affected regions in Ethiopia. METHOD A suspected measles case was defined as any person presenting with fever, maculopapular rash and one or more of the three symptoms cough, coryza or conjunctivitis or a patient in whom a clinician suspects measles. A blood sample was collected for any measles suspected patient with a case based investigation form and specimen transported to the National Measles Laboratory in good condition where it was to be tested for Measles IgM antibody by ELISA technique. Data was entered and analyzed using Epi-Info 3.5.4 software. RESULT A total of 6579 samples were tested for measles IgM among 7296 samples collected in Amhara Regional State over 11 years (2004-2014). Of the tested samples, 2412 (36.7%) were found positive, while 3965 and 202 samples were found to be negative and equivocal (compatible) respectively. Patients with age ≥ 10 years were the most affected. The highest number of laboratory confirmed measles cases were detected in 2014 and cases were occurred in all of the 11 zones of the state. A seasonal peak was noted in the hot-dry season of the year. CONCLUSION Measles remains to be a public health problem in Amhara Regional State of Ethiopia, mostly affecting people ≥ 10 years of age. Measles virus was detected in all zones of the state, reaching its peak in the hot-dry season. To reduce the incidence of measles, it is highly recommended to improve routine immunization, and conduct a wide age group campaign. Additional research to evaluate the knowledge, attitudes and practices of the general population and health care professionals about measles infection and vaccination is important. Genotyping of circulating measles virus strain is recommended.
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Affiliation(s)
- Mekonen Getahun
- Ethiopian Public Health Institute, Arbegnoch Street, P. O. Box 1242, Addis Ababa, Ethiopia.
| | - Berhane Beyene
- Ethiopian Public Health Institute, Arbegnoch Street, P. O. Box 1242, Addis Ababa, Ethiopia
| | | | - Birke Teshome
- Ethiopian Public Health Institute, Arbegnoch Street, P. O. Box 1242, Addis Ababa, Ethiopia
| | - Mesfin Tefera
- Ethiopian Public Health Institute, Arbegnoch Street, P. O. Box 1242, Addis Ababa, Ethiopia
| | - Anjelo Asha
- Ethiopian Public Health Institute, Arbegnoch Street, P. O. Box 1242, Addis Ababa, Ethiopia
| | - Aklog Afework
- Ethiopian Public Health Institute, Arbegnoch Street, P. O. Box 1242, Addis Ababa, Ethiopia
| | - Yoseph HaileMariyam
- Ethiopian Public Health Institute, Arbegnoch Street, P. O. Box 1242, Addis Ababa, Ethiopia
| | - Esete Assefa
- Ethiopian Public Health Institute, Arbegnoch Street, P. O. Box 1242, Addis Ababa, Ethiopia
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Driessen J, Olson ZD, Jamison DT, Verguet S. Comparing the health and social protection effects of measles vaccination strategies in Ethiopia: An extended cost-effectiveness analysis. Soc Sci Med 2015; 139:115-22. [DOI: 10.1016/j.socscimed.2015.06.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Scobie HM, Ilunga BK, Mulumba A, Shidi C, Coulibaly T, Obama R, Tamfum JJM, Simbu EP, Smit SB, Masresha B, Perry RT, Alleman MM, Kretsinger K, Goodson J. Antecedent causes of a measles resurgence in the Democratic Republic of the Congo. Pan Afr Med J 2015; 21:30. [PMID: 26401224 PMCID: PMC4561157 DOI: 10.11604/pamj.2015.21.30.6335] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 04/20/2015] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION 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. CONCLUSION 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.
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Affiliation(s)
- Heather Melissa Scobie
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA ; Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta
| | | | - Audry Mulumba
- Ministry of Public Health, Kinshasa, Democratic Republic of the Congo
| | - Calixte Shidi
- Ministry of Public Health, Kinshasa, Democratic Republic of the Congo
| | | | | | | | | | | | - Balcha Masresha
- World Health Organization African Regional Office, Brazzaville, Republic of the Congo
| | | | | | | | - James Goodson
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Wallace AS, Masresha BG, Grant G, Goodson JL, Birhane H, Abraham M, Endailalu TB, Letamo Y, Petu A, Vijayaraghavan M. Evaluation of economic costs of a measles outbreak and outbreak response activities in Keffa Zone, Ethiopia. Vaccine 2014; 32:4505-4514. [PMID: 24951866 DOI: 10.1016/j.vaccine.2014.06.035] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Revised: 05/22/2014] [Accepted: 06/06/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To estimate the economic impact of a measles outbreak and response activities that occurred in Keffa Zone, Ethiopia with 5257 reported cases during October 1, 2011-April 8, 2012, using the health sector and household perspectives. METHODS We collected cost input data through interviews and record reviews with government and partner agency staff and through a survey of 100 measles cases-patients and their caretakers. We used cost input data to estimate the financial and opportunity costs of the following outbreak and response activities: investigation, treatment, case management, active surveillance, immunization campaigns, and immunization system strengthening. FINDINGS The economic cost of the outbreak and response was 758,869 United States dollars (US$), including the opportunity cost of US$327,545 (US$62.31/case) and financial cost of US$431,324 (US$82.05/case). Health sector costs, including the immunization campaign (US$72.29/case), accounted for 80% of the economic cost. Household economic cost was US$29.18/case, equal to 6% of the household median annual income. 92% of financial costs were covered by partner agencies. CONCLUSION The economic cost of the measles outbreak was substantial when compared to household income and health sector expenditures. Improvement in two-dose measles vaccination coverage above 95% would both reduce measles incidence and save considerable outbreak-associated costs to both the health sector and households.
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Affiliation(s)
- Aaron S Wallace
- Global Immunization Division, Centers for Disease Control and Prevention, 1600 Clifton Road, MS-E05, Atlanta, GA 30329, USA.
| | - Balcha G Masresha
- Immunization and Vaccines Development Programme, Regional Office for Africa, World Health Organization, Republic of Congo
| | - Gavin Grant
- Immunization and Vaccines Development Programme, World Health Organization, Addis Ababa, Ethiopia
| | - James L Goodson
- Global Immunization Division, Centers for Disease Control and Prevention, 1600 Clifton Road, MS-E05, Atlanta, GA 30329, USA
| | - Hailye Birhane
- General Policy, Planning and Finance Directorate, Federal Ministry of Health, Addis Ababa, Ethiopia
| | - Meseret Abraham
- Immunization and Vaccines Development Programme, World Health Organization, Addis Ababa, Ethiopia
| | - Tewodros B Endailalu
- General Policy, Planning and Finance Directorate, Federal Ministry of Health, Addis Ababa, Ethiopia
| | - Yohannes Letamo
- Operations Research Directorate, Regional Ministry of Health, Southern Nations, Nationalities and Peoples' Region, Awasa, Ethiopia
| | - Amos Petu
- Immunization and Vaccines Development Programme, Regional Office for Africa, World Health Organization, Republic of Congo
| | - Maya Vijayaraghavan
- Global Immunization Division, Centers for Disease Control and Prevention, 1600 Clifton Road, MS-E05, Atlanta, GA 30329, USA
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Muloliwa AM, Camacho LAB, Verani JFS, Simões TC, Dgedge MDC. Impact of vaccination on the incidence of measles in Mozambique in the period 2000 to 2011. CAD SAUDE PUBLICA 2013; 29:257-69. [PMID: 23459812 DOI: 10.1590/s0102-311x2013000200013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Accepted: 10/01/2012] [Indexed: 11/22/2022] Open
Abstract
The aim of this study was to contribute to the better planning of measles elimination actions in Mozambique, by considering the impact of vaccination actions over the period 2000 to 2011. Descriptive and ecological studies and case records made available by the Ministry of Health were used to analyze measles vaccination coverage. Statistical analysis was performed using time series and spatial analysis. Vaccine coverage rates ranged from 82% to 99%. Coverage rates in Maputo city were under 70% and in Niassa province they were over 100%. Coverage showed a clustered pattern in the districts. The measles incidence rate was 1.58 per 100,000 inhabitants (0.00-40.08 per 100,000 inhabitants); districts bordering neighboring countries presented high incidence rates. Although measles morbidity and mortality has decreased in Mozambique, vaccine coverage has been insufficient to interrupt measles transmission. Enhanced surveillance, including investigation of cases and outbreaks, and improvements in measles vaccination are recommended in order to achieve a homogenous coverage rate of ≥ 95% for both routine and mass vaccination campaigns.
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Fatiregun AA, Odega CC. Representativeness of suspected measles cases reported in a southern district of Nigeria. ASIAN PAC J TROP MED 2013; 6:131-4. [PMID: 23339915 DOI: 10.1016/s1995-7645(13)60008-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Revised: 10/15/2012] [Accepted: 12/15/2012] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To compare the characteristics of suspected measles cases at the health facilities and to determine the representativeness of the data. METHODS We visited 25 hospitals in the Aniocha Local Government Area (LGA) of Delta State, Nigeria, from which information on reportable diseases was collected. In particular, the suspected measles cases in their registries between January 1, 2007, and June 30, 2008, were reviewed. We compared the characteristics, including age, sex, location, and month of reporting, of the suspected cases with the LGA surveillance records. RESULTS In the LGA records, 10% cases involved individuals older than 14 years, compared with 20% in the same age group in the health facility records. Based on geographic location, 53% of the measles cases among the hospital records came from a single location, in contrast to only 30% of the cases among the LGA records. An analysis considering time revealed that 30% of the cases in the LGA records occurred in August 2007, whereas 20% of hospital cases were reported in February and May 2008 combined. CONCLUSIONS The two record types differed considerably in all of the characteristics used in this comparison.
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Affiliation(s)
- Akinola A Fatiregun
- College of Medicine, Faculty of Public Health, Department of Epidemiology and Medical Statistics, University of Ibadan, Nigeria.
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Verguet S, Jassat W, Hedberg C, Tollman S, Jamison DT, Hofman KJ. Measles control in Sub-Saharan Africa: South Africa as a case study. Vaccine 2012; 30:1594-600. [DOI: 10.1016/j.vaccine.2011.12.123] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2011] [Revised: 12/19/2011] [Accepted: 12/23/2011] [Indexed: 10/14/2022]
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Levine MM. “IDEAL” vaccines for resource poor settings. Vaccine 2011; 29 Suppl 4:D116-25. [DOI: 10.1016/j.vaccine.2011.11.090] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2011] [Revised: 11/18/2011] [Accepted: 11/23/2011] [Indexed: 12/22/2022]
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