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Conceição PB, San Pedro A, Praça HLF, dos Santos YT, Reis LNM, Gibson G. [Stratification of risk areas for measles transmission: a systematic reviewEstratificación de las zonas de riesgo de transmisión del sarampión: revisión sistemática]. Rev Panam Salud Publica 2024; 48:e1. [PMID: 38226153 PMCID: PMC10787521 DOI: 10.26633/rpsp.2024.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 11/17/2023] [Indexed: 01/17/2024] Open
Abstract
Objective To perform a systematic review of scientific publications addressing the use of stratification methods to define risk areas for measles transmission. Method Articles published in English, Portuguese, and Spanish in journals indexed in the SciELO, PubMed, and LILACS databases were selected. The search terms risk assessment AND measles were used without date limits. Editorials, opinion articles, individual-level observational studies, and publications that did not focus on the application of methods to stratify measles transmission risk areas were excluded. Year of publication, authorship, country where the study was performed, objective, geographic level of analysis, method used, indicators, and limitations were recorded in a data form. Results Thirteen articles published between 2011 and 2022 in nine countries from the six World Health Organization (WHO) regions were selected. Of these, 10 referred to the Measles Risk Assessment Tool developed by the WHO/Centers for Disease Control and Prevention. Only one study adapted the tool to the local context. The risk stratification indicators used in the selected studies focused on a combination of the following dimensions: population immunity, quality of surveillance systems, and epidemiologic status. The systematic output of data with adequate quality and coverage was a noteworthy aspect hindering risk stratification. Conclusion There seems to be limited dissemination of measles risk stratification strategies, especially at local levels. The need to train human resources to process and interpret risk analyses as part of the routine of surveillance services is emphasized.
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Affiliation(s)
- Paula Barbosa Conceição
- Universidade Federal do Rio de Janeiro (UFRJ)Instituto de Estudos em Saúde ColetivaRio de Janeiro (RJ)BrasilUniversidade Federal do Rio de Janeiro (UFRJ), Instituto de Estudos em Saúde Coletiva, Rio de Janeiro (RJ), Brasil.
| | - Alexandre San Pedro
- Universidade Federal do Rio de Janeiro (UFRJ)Instituto de Estudos em Saúde ColetivaRio de Janeiro (RJ)BrasilUniversidade Federal do Rio de Janeiro (UFRJ), Instituto de Estudos em Saúde Coletiva, Rio de Janeiro (RJ), Brasil.
| | - Heitor Levy Ferreira Praça
- Universidade Federal do Rio de Janeiro (UFRJ)Instituto de Estudos em Saúde ColetivaRio de Janeiro (RJ)BrasilUniversidade Federal do Rio de Janeiro (UFRJ), Instituto de Estudos em Saúde Coletiva, Rio de Janeiro (RJ), Brasil.
| | - Yasmin Toledo dos Santos
- Universidade Federal do Rio de Janeiro (UFRJ)Instituto de Estudos em Saúde ColetivaRio de Janeiro (RJ)BrasilUniversidade Federal do Rio de Janeiro (UFRJ), Instituto de Estudos em Saúde Coletiva, Rio de Janeiro (RJ), Brasil.
| | - Larissa Nunes Moreira Reis
- Universidade Federal do Rio de Janeiro (UFRJ)Instituto de Estudos em Saúde ColetivaRio de Janeiro (RJ)BrasilUniversidade Federal do Rio de Janeiro (UFRJ), Instituto de Estudos em Saúde Coletiva, Rio de Janeiro (RJ), Brasil.
| | - Gerusa Gibson
- Universidade Federal do Rio de Janeiro (UFRJ)Instituto de Estudos em Saúde ColetivaRio de Janeiro (RJ)BrasilUniversidade Federal do Rio de Janeiro (UFRJ), Instituto de Estudos em Saúde Coletiva, Rio de Janeiro (RJ), Brasil.
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Goodson JL. Recent setbacks in measles elimination: the importance of investing in innovations for immunizations. Pan Afr Med J 2020; 35:15. [PMID: 32373266 PMCID: PMC7196335 DOI: 10.11604/pamj.supp.2020.35.1.21740] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Accepted: 02/13/2020] [Indexed: 11/18/2022] Open
Abstract
The recent setbacks in efforts to achieve measles elimination goals are alarming. To reverse the current trends, it is imperative that the global health community urgently intensify efforts and make resource commitments to implement evidence-based elimination strategies fully, including supporting research and innovations. The Immunization Agenda 2030: A Global Strategy to Leave No One Behind (IA2030) is the new global guidance document that builds on lessons learned and progress made toward the GVAP goals, includes research and innovation as a core strategic priority, and identifies measles as a “tracer” for improving immunisation services and strengthening primary health care systems. To achieve vaccination coverage and equity targets that leave no one behind, and accelerate progress toward disease eradication and elimination goals, sustained and predictable investments are needed for the identified research and innovations priorities for the new decade.
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Affiliation(s)
- James L Goodson
- Accelerated Disease Control and Surveillance Branch, Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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Mohammadbeigi A, Zahraei SM, Sabouri A, Asgarian A, Afrashteh S, Ansari H. The spatial analysis of annual measles incidence and transition threat assessment in Iran in 2016. Med J Islam Repub Iran 2019; 33:130. [PMID: 32280636 PMCID: PMC7137842 DOI: 10.34171/mjiri.33.130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Indexed: 11/24/2022] Open
Abstract
Background: During the past years, due to the increase in immunization coverage and promotion of surveillance data, the incidence of measles decreased. This study aimed to determine the measles incidence risk, to conduct spatial mapping of annual measles incidence, and to assess the transition threat in different districts of Iran.
Methods: A historical cohort study with retrospective data was conducted. The measles surveillance data containing 14 294 cases suspected of having measles in Iran were analyzed during 2014-2016. WHO Measles Programmatic Risk Assessment Tool was applied to calculate and map the incidence of measles in each district, to determine the annual incidence rate, and to conduct spatial threat assessment risk. Threat assessment was measured based on factors influencing the exposure and transmission of measles virus in the population. The annual measles incidence rate and spatial mapping of incidence in each Iranian district was conducted by Measles Programmatic Risk Assessment Tool. Data were analyzed by descriptive statistics in Excel 2013 and Arc GIS 10.3.
Results: Of 14 294 suspected cases, 0.6% (CI 95%: 0.599-0.619) were identified as clinically compatible measles, 0.280 (CI 95%: 0.275-0.284) as confirmed rubella, 0.52% (CI 95%: 0.516-0.533) as epi-linked measles, 4.6% (CI 95%: 0.450-0.464) as lab-confirmed measles, and 94% (CI 95%: 93.93-94.11) were discarded. The annual incidence rate in cases per 100 000 populations increased from 0.0726, (CI 95%; 0.0714-0.0738) in 2014 to 0.1154 (CI 95%; 0.1135-0.1173) in 2016, and the 3-year incidence rate during the study period was 1.032 (CI 95%; 1.017-1.047) and the annual average was 0.3442 (CI 95%; 0.3387-0.3496).
Conclusion: The average annual incidence rate of measles in Iran was low, but after a 11-fold increase in the number of measles cases in 2015, the number of measles cases decreased to more than 7-times in 2016. However, maintaning a high immunization coverage of measles and timely vaccination can be effective in reaching the goal of measles elimination.
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Affiliation(s)
- Abolfazl Mohammadbeigi
- Neuroscience Research Center, Faculty of Health, Qom University of Medical Sciences, Qom, Iran
| | - Seyed Mohsen Zahraei
- Centre for Communicable Diseases Control, Ministry of Health and Medical Education, Tehran, Iran
| | - Azam Sabouri
- Centre for Communicable Diseases Control, Ministry of Health and Medical Education, Tehran, Iran
| | | | | | - Hossein Ansari
- Health Promotion Research Center, Department of Epidemiology and Biostatistics, Zahedan University of Medical Sciences, Zahedan, Iran
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Grant GB, Masresha BG, Moss WJ, Mulders MN, Rota PA, Omer SB, Shefer A, Kriss JL, Hanson M, Durrheim DN, Linkins R, Goodson JL. Accelerating measles and rubella elimination through research and innovation - Findings from the Measles & Rubella Initiative research prioritization process, 2016. Vaccine 2019; 37:5754-5761. [PMID: 30904317 PMCID: PMC7412823 DOI: 10.1016/j.vaccine.2019.01.081] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 12/22/2018] [Accepted: 01/23/2019] [Indexed: 12/26/2022]
Abstract
The Measles & Rubella Initiative (M&RI) identified five key strategies to achieve measles and rubella elimination, including research and innovation to support cost-effective operations and improve vaccination and diagnostic tools. In 2016, the M&RI Research and Innovation Working Group (R&IWG) completed a research prioritization process to identify key research questions and update the global research agenda. The R&IWG reviewed meeting reports and strategic planning documents and solicited programmatic inputs from vaccination experts at the program operational level through a web survey, to identify previous research priorities and new research questions. The R&IWG then convened a meeting of experts to prioritize the identified research questions in four strategic areas: (1) epidemiology and economics, (2) surveillance and laboratory, (3) immunization strategies, and (4) demand creation and communications. The experts identified 19 priority research questions in the four strategic areas to address key areas of work necessary to further progress toward elimination. Future commitments from partners will be needed to develop a platform for improved coordination with adequate and predictable resources for research implementation and innovation to address these identified priorities.
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Affiliation(s)
- Gavin B Grant
- Accelerated Disease Control and Surveillance Branch, Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, United States.
| | - Balcha G Masresha
- Immunisation and Vaccine Development Program, Regional Office for Africa, World Health Organization, Brazzaville, People's Republic of Congo
| | - William J Moss
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Mick N Mulders
- Department of Immunization, Vaccines, and Biologicals, World Health Organization, Geneva, Switzerland
| | - Paul A Rota
- Viral Vaccine Preventable Diseases Branch, Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Saad B Omer
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, United States
| | - Abigail Shefer
- Immunization Systems Branch, Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Jennifer L Kriss
- Accelerated Disease Control and Surveillance Branch, Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Matt Hanson
- Bill and Melinda Gates Foundation, Seattle, Washington, United States
| | - David N Durrheim
- School of Medicine and Public Health, University of Newcastle, Australia
| | - Robert Linkins
- Accelerated Disease Control and Surveillance Branch, Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - James L Goodson
- Accelerated Disease Control and Surveillance Branch, Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, United States
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Mohammadbeigi A, Zahraei SM, Asgarian A, Afrashteh S, Mohammadsalehi N, Khazaei S, Ansari H. Estimation of measles risk using the World Health Organization Measles Programmatic Risk Assessment Tool, Iran. Heliyon 2018; 4:e00886. [PMID: 30417154 PMCID: PMC6218648 DOI: 10.1016/j.heliyon.2018.e00886] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Revised: 09/25/2018] [Accepted: 10/16/2018] [Indexed: 10/28/2022] Open
Abstract
Introduction Based on the World Health Organization (WHO) reports the EMRO countries did not reached to eradication of measles at 2010. This study aimed to estimate the risk of measles outbreak in different districts of Iran to identify high-risk areas based on WHO measles programmatic risk assessment tool. Materials and methods The WHO measles programmatic risk assessment tool was used to estimate the overall risk of measles in 31 providences and 322 districts of Iran at 2017. The measles risk was calculated by a function of four indicator scores including population immunity, surveillance quality, program performance, and threat assessment and the overall risk of measles for each districts calculated. Then, the tool assigned each district a risk category of low, medium, high, or very high according to the overall risk score. Results Of the 322 districts in Iran, all districts were categorized as low risk and there was no very high risk, high risk and medium risk district in Iran. Twenty-six districts (7.4%) received to risk point higher than 20. Based on population immunity and program delivery performance indicators, all districts in Iarn were categorized as low risk and 92.86% of districts were in low risk category by surveillance quality indicator. Conclusion The overall risk of measles profile was categorized as low risk and Iranian practices for measles elimination is very good in comparing other studies in this area. However, more attempts should be conducted to sustaining the surveillance quality indicators in all districts.
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Affiliation(s)
- Abolfazl Mohammadbeigi
- Research Center for Environmental Pollutants, Qom University of Medical Sciences, Qom, Iran
| | - Seyed Mohsen Zahraei
- Centre for Communicable Diseases Control, Ministry of Health and Medical Education, Tehran, Iran
| | - Azadeh Asgarian
- Neurology and Neurosciences Research Center, Qom University of Medical Sciences, Qom, Iran
| | - Sima Afrashteh
- MSc of Epidemiology, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Narges Mohammadsalehi
- Research Center for Environmental Pollutants, Qom University of Medical Sciences, Qom, Iran
| | - Salman Khazaei
- Department of Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Hossein Ansari
- Health Promotion Research Center, Department of Epidemiology and Biostatistics, Zahedan University of Medical Sciences, Zahedan, Iran
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Goodson JL, Alexander JP, Linkins RW, Orenstein WA. Measles and rubella elimination: learning from polio eradication and moving forward with a diagonal approach. Expert Rev Vaccines 2017; 16:1203-1216. [PMID: 29037086 PMCID: PMC6477920 DOI: 10.1080/14760584.2017.1393337] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
INTRODUCTION In 1988, an estimated 350,000 children were paralyzed by polio and 125 countries reported polio cases, the World Health Assembly passed a resolution to achieve polio eradication by 2000, and the Global Polio Eradication Initiative (GPEI) was established as a partnership focused on eradication. Today, following eradication efforts, polio cases have decreased >99% and eradication of all three types of wild polioviruses is approaching. However, since polio resources substantially support disease surveillance and other health programs, losing polio assets could reverse progress toward achieving Global Vaccine Action Plan goals. Areas covered: As the end of polio approaches and GPEI funds and capacity decrease, we document knowledge, experience, and lessons learned from 30 years of polio eradication. Expert commentary: Transitioning polio assets to measles and rubella (MR) elimination efforts would accelerate progress toward global vaccination coverage and equity. MR elimination feasibility and benefits have long been established. Focusing efforts on MR elimination after achieving polio eradication would make a permanent impact on reducing child mortality but should be done through a 'diagonal approach' of using measles disease transmission to identify areas possibly susceptible to other vaccine-preventable diseases and to strengthen the overall immunization and health systems to achieve disease-specific goals.
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Affiliation(s)
- James L. Goodson
- Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - James P. Alexander
- Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Robert W. Linkins
- Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Walter A. Orenstein
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
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Lam E, Schluter WW, Masresha BG, Teleb N, Bravo-Alcántara P, Shefer A, Jankovic D, McFarland J, Elfakki E, Takashima Y, Perry RT, Dabbagh AJ, Banerjee K, Strebel PM, Goodson JL. Development of a District-Level Programmatic Assessment Tool for Risk of Measles Virus Transmission. RISK ANALYSIS : AN OFFICIAL PUBLICATION OF THE SOCIETY FOR RISK ANALYSIS 2017; 37:1052-1062. [PMID: 25976980 DOI: 10.1111/risa.12409] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
All six World Health Organization (WHO) regions have now set goals for measles elimination by or before 2020. To prioritize measles elimination efforts and use available resources efficiently, there is a need to identify at-risk areas that are offtrack from meeting performance targets and require strengthening of programmatic efforts. This article describes the development of a WHO measles programmatic risk assessment tool to be used for monitoring, guiding, and sustaining measles elimination efforts at the subnational level. We outline the tool development process; the tool specifications and requirements for data inputs; the framework of risk categories, indicators, and scoring; and the risk category assignment. Overall risk was assessed as a function of indicator scores that fall into four main categories: population immunity, surveillance quality, program performance, and threat assessment. On the basis of the overall score, the tool assigns each district a risk of either low, medium, high, or very high. The cut-off criteria for the risk assignment categories were based on the distribution of scores from all possible combinations of individual indicator cutoffs. The results may be used for advocacy to communicate risk to policymakers, mobilize resources for corrective actions, manage population immunity, and prioritize programmatic activities. Ongoing evaluation of indicators will be needed to evaluate programmatic performance and plan risk mitigation activities effectively. The availability of a comprehensive tool that can identify at-risk districts will enhance efforts to prioritize resources and implement strategies for achieving the Global Vaccine Action Plan goals for measles elimination.
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Affiliation(s)
- Eugene Lam
- Centers for Disease Control and Prevention (CDC), Center for Global Health, Global Immunization Division, Atlanta, GA, USA
| | - W William Schluter
- World Health Organization (WHO), Western Pacific Regional Office, Manila, Philippines
| | | | - Nadia Teleb
- WHO, Eastern Mediterranean Regional Office, Cairo, Egypt
| | | | | | | | | | | | - Yoshihiro Takashima
- World Health Organization (WHO), Western Pacific Regional Office, Manila, Philippines
| | | | | | | | | | - James L Goodson
- Centers for Disease Control and Prevention (CDC), Center for Global Health, Global Immunization Division, Atlanta, GA, USA
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Cardemil CV, Jonas A, Beukes A, Anderson R, Rota PA, Bankamp B, Gary HE, Sawadogo S, Patel SV, Zeko S, Muroua C, Gaeb E, Wannemuehler K, Gerber S, Goodson JL. Measles immunity among pregnant women aged 15-44 years in Namibia, 2008 and 2010. Int J Infect Dis 2016; 49:189-95. [PMID: 27235084 PMCID: PMC6996213 DOI: 10.1016/j.ijid.2016.05.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 05/16/2016] [Accepted: 05/18/2016] [Indexed: 11/12/2022] Open
Abstract
Background: Namibia experienced a large measles outbreak starting in 2009, with 38% of reported cases in adults, including women of reproductive age. Population immunity was assessed among pregnant women to determine whether immunization activities were needed in adults to achieve measles elimination in Namibia. Methods: A total of 1708 and 2040 specimens sampled from Namibian pregnant women aged 15–44 years who were included in the 2008 and 2010 National HIV Sentinel Survey, respectively, were tested for measles immunoglobulin G antibody. The proportion of women seropositive overall and by 5-year age strata was determined, and factors associated with seropositivity were analyzed by logistic regression, including age, facility type, gravidity, HIV status, and urban/rural setting. Seropositivity in 2008 versus 2010 was compared. Results: In both analysis years, measles seropositivity was lower in 15–19-year-olds (77%) and 20–24-year-olds (85–87%) and higher in 25–44-year-olds (90–94%) (2008, p < 0.001; 2010, p < 0.001). Overall measles seropositivity did not differ between 2008 (87%) and 2010 (87%) (p = 0.7). HIV status did not affect seropositivity. Conclusions: Late in a large measles outbreak, 13% of pregnant women in Namibia, and almost one in four 15–19-year-old pregnant women, remained susceptible to measles. In Namibia, immunization campaigns with measles-containing vaccine should be considered for adults.
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Affiliation(s)
- Cristina V Cardemil
- Centers for Disease Control and Prevention, Global Immunization Division, 1600 Clifton Road, NE, Atlanta, GA 30333, USA.
| | - Anna Jonas
- Ministry of Health and Social Services, Directorate of Special Programmes, Primary Health Directorate, and Family Health Division (Expanded Programme on Immunizations), Windhoek, Namibia
| | - Anita Beukes
- Centers for Disease Control and Prevention, Windhoek, Namibia
| | - Raydel Anderson
- Centers for Disease Control and Prevention, Division of Viral Diseases, Atlanta, GA, USA
| | - Paul A Rota
- Centers for Disease Control and Prevention, Division of Viral Diseases, Atlanta, GA, USA
| | - Bettina Bankamp
- Centers for Disease Control and Prevention, Division of Viral Diseases, Atlanta, GA, USA
| | - Howard E Gary
- Ministry of Health and Social Services, Directorate of Special Programmes, Primary Health Directorate, and Family Health Division (Expanded Programme on Immunizations), Windhoek, Namibia
| | | | - Sadhna V Patel
- Centers for Disease Control and Prevention, Windhoek, Namibia
| | - Sikota Zeko
- Ministry of Health and Social Services, Directorate of Special Programmes, Primary Health Directorate, and Family Health Division (Expanded Programme on Immunizations), Windhoek, Namibia
| | - Clementine Muroua
- Ministry of Health and Social Services, Directorate of Special Programmes, Primary Health Directorate, and Family Health Division (Expanded Programme on Immunizations), Windhoek, Namibia
| | - Esegiel Gaeb
- Namibia Institute of Pathology, Windhoek, Namibia
| | - Kathleen Wannemuehler
- Centers for Disease Control and Prevention, Global Immunization Division, 1600 Clifton Road, NE, Atlanta, GA 30333, USA
| | - Sue Gerber
- Centers for Disease Control and Prevention, Windhoek, Namibia
| | - James L Goodson
- Centers for Disease Control and Prevention, Global Immunization Division, 1600 Clifton Road, NE, Atlanta, GA 30333, USA
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