Lessons from measles outbreaks in the african region
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Lessons from Measles outbreaks in the African Region. Annual Measles Partnership meeting Feb 2007 Washington DC. Outline. Quality of surveillance Measles outbreaks in 2006 Lessons learnt. Quality of surveillance Measles outbreaks in 2006 Lessons learnt.

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Lessons from Measles outbreaks in the African Region

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Lessons from measles outbreaks in the african region

Lessons from Measles outbreaks in the African Region

Annual Measles Partnership meeting

Feb 2007

Washington DC


Outline

Outline

  • Quality of surveillance

  • Measles outbreaks in 2006

  • Lessons learnt


Lessons from measles outbreaks in the african region

  • Quality of surveillance

  • Measles outbreaks in 2006

  • Lessons learnt


Lessons from measles outbreaks in the african region

The AFR measles surveillance and lab network (Feb 2007)

  • A total population of 668.5 million

  • under case based surveillance for measles


Measles surveillance performance indicators in afr 2002 2006

Measles surveillance performance indicators in AFR. 2002 - 2006


Measles surveillance performance results afr 2006

Measles surveillance performance & results. AFR. 2006


Lessons from measles outbreaks in the african region

Measles surveillance performance & results. AFR. 2006 (2)

  • 22 countries > 2 suspected cases investigated per 100,000 population

  • 15 countries >80% districts reporting

  • 24 countries > 60% districts reporting

  • 25 countries < 1: 100,000 incidence of confirmed measles


Incidence of confirmed measles per 100 000 population by country 2006

Incidence of confirmed measles per 100,000 population by country. 2006


Lessons from measles outbreaks in the african region

  • Quality of surveillance

  • Measles outbreaks in 2006

  • Lessons learnt


Lessons from measles outbreaks in the african region

Measles outbreaks in the African Region (2004 - 2006)

  • In 2004, 80 (5%) of a total of 1590 districts covered by the case based surveillance system reported outbreaks

  • In 2005, outbreaks in 47 (3%) districts out of 1850

  • In 2006, 178 (6%) of 2923 districts in 12 countries have experienced outbreaks.

    NB: Tanzania database incomplete


Probable causes of measles outbreaks in the african region in 2006

Probable causes of measles outbreaks in the African Region in 2006

  • Accumulation of unvaccinated cohorts (~ over 3 -4 years) due to a combination of factors

    • sub-national gaps in routine EPI coverage:

      • Angola, Benin, DR Congo, Ethiopia, Mali, Tanzania, Uganda

    • delays in conducting follow up SIAs:

      • Kenya, Zambia, Ghana

  • cross border spread of outbreaks:

    • DR Congo, Rwanda


Outbreak countries afr 2006

Outbreak countries. AFR. 2006


Outbreak countries afr 20061

Outbreak countries. AFR. 2006


Outbreak countries afr 20062

Outbreak countries. AFR. 2006


Outbreak countries afr 20063

Outbreak countries. AFR. 2006


Outbreak countries afr 20064

Outbreak countries. AFR. 2006


Lessons from measles outbreaks in the african region

Trends of confirmed measles cases. Kenya. 2003 –2006.

F-up SIAs done July ‘06

F-up SIAs postponed

Catch-up SIAs: June ‘02


Lessons from measles outbreaks in the african region

Measles cases in Kenya. 2006


Confirmed measles cases by age and vaccination status kenya 2006

Confirmed measles cases by age and vaccination status. Kenya. 2006


Outbreak countries afr 20065

Outbreak countries. AFR. 2006


Lessons from measles outbreaks in the african region

Trends of confirmed measles cases. Uganda. 2002 – 2006.

F-up SIAs: Nov 2006

Catch-up SIAs: Oct 2003


Lessons from measles outbreaks in the african region

Measles cases in Uganda. 2006


Confirmed measles cases by age and vaccination status uganda 2006

Confirmed measles cases by age and vaccination status. Uganda. 2006


Probable causes of measles outbreaks in the african region in 2006 2

Probable causes of measles outbreaks in the African Region in 2006 (2)

  • Program gaps leading to a cohort of older children (ages 6 – 7.5 years) unprotected in some districts

    • Tanzania (124 districts)

      • 1999 / 2000 SIAs: all 9 – 59 months (in 91 districts)

      • 2001 SIAs: 9 months – 14 years (in 31 districts)

      • 2002 SIAs: 7 – 14 years (in 89 districts)

      • 2005 SIAs: 9 - 59 months (nation-wide follow up)


Age distribution of measles cases dar es salaam tanzania july mid oct 2006

Age distribution of measles cases. Dar es Salaam, Tanzania July – mid Oct. 2006


Disturbing gaps in the quality of data

Disturbing gaps in the quality of data


Lessons from measles outbreaks in the african region

  • Quality of surveillance

  • Measles outbreaks in 2006

  • Lessons learnt


Lessons learnt

Lessons learnt

  • Postponing measles follow-up SIAs beyond 36 months is risky even in “high” coverage countries

    • Other platforms available for integration

    • Disparities in the district level coverage

  • Surveillance and outbreak investigation should provide better quality epidemiological information

    • Training and technical support for outbreak investigation


Lessons learnt 2

Lessons learnt (2)

  • Political visibility of outbreaks;

    • an opportunity to advocate for routine EPI and good quality follow up SIAs

  • Identify districts at high risk for outbreaks for extra support to intensify immunization activities


Thank you

Thank you


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