Measles outbreak in South Africa: epidemiology of laboratory-confirmed measles cases and assessment of intervention, 2009-2011
Since 1995, measles vaccination at nine and 18 months has been routine in South Africa; however, coverage seldom reached >95%. We describe the epidemiology of laboratory-confirmed measles case-patients and assess the impact of the nationwide mass vaccination campaign during the 2009 to 2011 measl...
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| Published in: | PloS one Vol. 8; no. 2; p. e55682 |
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| Abstract | Since 1995, measles vaccination at nine and 18 months has been routine in South Africa; however, coverage seldom reached >95%. We describe the epidemiology of laboratory-confirmed measles case-patients and assess the impact of the nationwide mass vaccination campaign during the 2009 to 2011 measles outbreak in South Africa.
Serum specimens collected from patients with suspected-measles were tested for measles-specific IgM antibodies using an enzyme-linked immunosorbent assay and genotypes of a subset were determined. To estimate the impact of the nationwide mass vaccination campaign, we compared incidence in the seven months pre- (1 September 2009-11 April 2010) and seven months post-vaccination campaign (24 May 2010-31 December 2010) periods in seven provinces of South Africa.
A total of 18,431 laboratory-confirmed measles case-patients were reported from all nine provinces of South Africa (cumulative incidence 37 per 100,000 population). The highest cumulative incidence per 100,000 population was in children aged <1 year (603), distributed as follows: <6 months (302/100,000), 6 to 8 months (1083/100,000) and 9 to 11 months (724/100,000). Forty eight percent of case-patients were ≥ 5 years (cumulative incidence 54/100,000). Cumulative incidence decreased with increasing age to 2/100,000 in persons ≥ 40 years. A single strain of measles virus (genotype B3) circulated throughout the outbreak. Prior to the vaccination campaign, cumulative incidence in the targeted vs. non-targeted age group was 5.9-fold higher, decreasing to 1.7 fold following the campaign (P<0.001) and an estimated 1,380 laboratory-confirmed measles case-patients were prevented.
We observed a reduction in measles incidence following the nationwide mass vaccination campaign even though it was conducted approximately one year after the outbreak started. A booster dose at school entry may be of value given the high incidence in persons >5 years. |
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| AbstractList | Since 1995, measles vaccination at nine and 18 months has been routine in South Africa; however, coverage seldom reached >95%. We describe the epidemiology of laboratory-confirmed measles case-patients and assess the impact of the nationwide mass vaccination campaign during the 2009 to 2011 measles outbreak in South Africa. Serum specimens collected from patients with suspected-measles were tested for measles-specific IgM antibodies using an enzyme-linked immunosorbent assay and genotypes of a subset were determined. To estimate the impact of the nationwide mass vaccination campaign, we compared incidence in the seven months pre- (1 September 2009-11 April 2010) and seven months post-vaccination campaign (24 May 2010-31 December 2010) periods in seven provinces of South Africa. A total of 18,431 laboratory-confirmed measles case-patients were reported from all nine provinces of South Africa (cumulative incidence 37 per 100,000 population). The highest cumulative incidence per 100,000 population was in children aged <1 year (603), distributed as follows: <6 months (302/100,000), 6 to 8 months (1083/100,000) and 9 to 11 months (724/100,000). Forty eight percent of case-patients were [greater than or equal to]5 years (cumulative incidence 54/100,000). Cumulative incidence decreased with increasing age to 2/100,000 in persons [greater than or equal to]40 years. A single strain of measles virus (genotype B3) circulated throughout the outbreak. Prior to the vaccination campaign, cumulative incidence in the targeted vs. non-targeted age group was 5.9-fold higher, decreasing to 1.7 fold following the campaign (P<0.001) and an estimated 1,380 laboratory-confirmed measles case-patients were prevented. We observed a reduction in measles incidence following the nationwide mass vaccination campaign even though it was conducted approximately one year after the outbreak started. A booster dose at school entry may be of value given the high incidence in persons >5 years. Background Since 1995, measles vaccination at nine and 18 months has been routine in South Africa; however, coverage seldom reached >95%. We describe the epidemiology of laboratory-confirmed measles case-patients and assess the impact of the nationwide mass vaccination campaign during the 2009 to 2011 measles outbreak in South Africa. Methods Serum specimens collected from patients with suspected-measles were tested for measles-specific IgM antibodies using an enzyme-linked immunosorbent assay and genotypes of a subset were determined. To estimate the impact of the nationwide mass vaccination campaign, we compared incidence in the seven months pre- (1 September 2009–11 April 2010) and seven months post-vaccination campaign (24 May 2010–31 December 2010) periods in seven provinces of South Africa. Results A total of 18,431 laboratory-confirmed measles case-patients were reported from all nine provinces of South Africa (cumulative incidence 37 per 100,000 population). The highest cumulative incidence per 100,000 population was in children aged <1 year (603), distributed as follows: <6 months (302/100,000), 6 to 8 months (1083/100,000) and 9 to 11 months (724/100,000). Forty eight percent of case-patients were ≥5 years (cumulative incidence 54/100,000). Cumulative incidence decreased with increasing age to 2/100,000 in persons ≥40 years. A single strain of measles virus (genotype B3) circulated throughout the outbreak. Prior to the vaccination campaign, cumulative incidence in the targeted vs. non-targeted age group was 5.9-fold higher, decreasing to 1.7 fold following the campaign (P<0.001) and an estimated 1,380 laboratory-confirmed measles case-patients were prevented. Conclusion We observed a reduction in measles incidence following the nationwide mass vaccination campaign even though it was conducted approximately one year after the outbreak started. A booster dose at school entry may be of value given the high incidence in persons >5 years. Background Since 1995, measles vaccination at nine and 18 months has been routine in South Africa; however, coverage seldom reached >95%. We describe the epidemiology of laboratory-confirmed measles case-patients and assess the impact of the nationwide mass vaccination campaign during the 2009 to 2011 measles outbreak in South Africa. Methods Serum specimens collected from patients with suspected-measles were tested for measles-specific IgM antibodies using an enzyme-linked immunosorbent assay and genotypes of a subset were determined. To estimate the impact of the nationwide mass vaccination campaign, we compared incidence in the seven months pre- (1 September 2009-11 April 2010) and seven months post-vaccination campaign (24 May 2010-31 December 2010) periods in seven provinces of South Africa. Results A total of 18,431 laboratory-confirmed measles case-patients were reported from all nine provinces of South Africa (cumulative incidence 37 per 100,000 population). The highest cumulative incidence per 100,000 population was in children aged <1 year (603), distributed as follows: <6 months (302/100,000), 6 to 8 months (1083/100,000) and 9 to 11 months (724/100,000). Forty eight percent of case-patients were [greater than or equal to]5 years (cumulative incidence 54/100,000). Cumulative incidence decreased with increasing age to 2/100,000 in persons [greater than or equal to]40 years. A single strain of measles virus (genotype B3) circulated throughout the outbreak. Prior to the vaccination campaign, cumulative incidence in the targeted vs. non-targeted age group was 5.9-fold higher, decreasing to 1.7 fold following the campaign (P<0.001) and an estimated 1,380 laboratory-confirmed measles case-patients were prevented. Conclusion We observed a reduction in measles incidence following the nationwide mass vaccination campaign even though it was conducted approximately one year after the outbreak started. A booster dose at school entry may be of value given the high incidence in persons >5 years. BACKGROUNDSince 1995, measles vaccination at nine and 18 months has been routine in South Africa; however, coverage seldom reached >95%. We describe the epidemiology of laboratory-confirmed measles case-patients and assess the impact of the nationwide mass vaccination campaign during the 2009 to 2011 measles outbreak in South Africa.METHODSSerum specimens collected from patients with suspected-measles were tested for measles-specific IgM antibodies using an enzyme-linked immunosorbent assay and genotypes of a subset were determined. To estimate the impact of the nationwide mass vaccination campaign, we compared incidence in the seven months pre- (1 September 2009-11 April 2010) and seven months post-vaccination campaign (24 May 2010-31 December 2010) periods in seven provinces of South Africa.RESULTSA total of 18,431 laboratory-confirmed measles case-patients were reported from all nine provinces of South Africa (cumulative incidence 37 per 100,000 population). The highest cumulative incidence per 100,000 population was in children aged <1 year (603), distributed as follows: <6 months (302/100,000), 6 to 8 months (1083/100,000) and 9 to 11 months (724/100,000). Forty eight percent of case-patients were ≥ 5 years (cumulative incidence 54/100,000). Cumulative incidence decreased with increasing age to 2/100,000 in persons ≥ 40 years. A single strain of measles virus (genotype B3) circulated throughout the outbreak. Prior to the vaccination campaign, cumulative incidence in the targeted vs. non-targeted age group was 5.9-fold higher, decreasing to 1.7 fold following the campaign (P<0.001) and an estimated 1,380 laboratory-confirmed measles case-patients were prevented.CONCLUSIONWe observed a reduction in measles incidence following the nationwide mass vaccination campaign even though it was conducted approximately one year after the outbreak started. A booster dose at school entry may be of value given the high incidence in persons >5 years. Background Since 1995, measles vaccination at nine and 18 months has been routine in South Africa; however, coverage seldom reached >95%. We describe the epidemiology of laboratory-confirmed measles case-patients and assess the impact of the nationwide mass vaccination campaign during the 2009 to 2011 measles outbreak in South Africa. Methods Serum specimens collected from patients with suspected-measles were tested for measles-specific IgM antibodies using an enzyme-linked immunosorbent assay and genotypes of a subset were determined. To estimate the impact of the nationwide mass vaccination campaign, we compared incidence in the seven months pre- (1 September 2009–11 April 2010) and seven months post-vaccination campaign (24 May 2010–31 December 2010) periods in seven provinces of South Africa. Results A total of 18,431 laboratory-confirmed measles case-patients were reported from all nine provinces of South Africa (cumulative incidence 37 per 100,000 population). The highest cumulative incidence per 100,000 population was in children aged <1 year (603), distributed as follows: <6 months (302/100,000), 6 to 8 months (1083/100,000) and 9 to 11 months (724/100,000). Forty eight percent of case-patients were ≥5 years (cumulative incidence 54/100,000). Cumulative incidence decreased with increasing age to 2/100,000 in persons ≥40 years. A single strain of measles virus (genotype B3) circulated throughout the outbreak. Prior to the vaccination campaign, cumulative incidence in the targeted vs. non-targeted age group was 5.9-fold higher, decreasing to 1.7 fold following the campaign (P<0.001) and an estimated 1,380 laboratory-confirmed measles case-patients were prevented. Conclusion We observed a reduction in measles incidence following the nationwide mass vaccination campaign even though it was conducted approximately one year after the outbreak started. A booster dose at school entry may be of value given the high incidence in persons >5 years. Since 1995, measles vaccination at nine and 18 months has been routine in South Africa; however, coverage seldom reached >95%. We describe the epidemiology of laboratory-confirmed measles case-patients and assess the impact of the nationwide mass vaccination campaign during the 2009 to 2011 measles outbreak in South Africa. Serum specimens collected from patients with suspected-measles were tested for measles-specific IgM antibodies using an enzyme-linked immunosorbent assay and genotypes of a subset were determined. To estimate the impact of the nationwide mass vaccination campaign, we compared incidence in the seven months pre- (1 September 2009-11 April 2010) and seven months post-vaccination campaign (24 May 2010-31 December 2010) periods in seven provinces of South Africa. A total of 18,431 laboratory-confirmed measles case-patients were reported from all nine provinces of South Africa (cumulative incidence 37 per 100,000 population). The highest cumulative incidence per 100,000 population was in children aged <1 year (603), distributed as follows: <6 months (302/100,000), 6 to 8 months (1083/100,000) and 9 to 11 months (724/100,000). Forty eight percent of case-patients were ≥ 5 years (cumulative incidence 54/100,000). Cumulative incidence decreased with increasing age to 2/100,000 in persons ≥ 40 years. A single strain of measles virus (genotype B3) circulated throughout the outbreak. Prior to the vaccination campaign, cumulative incidence in the targeted vs. non-targeted age group was 5.9-fold higher, decreasing to 1.7 fold following the campaign (P<0.001) and an estimated 1,380 laboratory-confirmed measles case-patients were prevented. We observed a reduction in measles incidence following the nationwide mass vaccination campaign even though it was conducted approximately one year after the outbreak started. A booster dose at school entry may be of value given the high incidence in persons >5 years. |
| Audience | Academic |
| Author | Tempia, Stefano van den Heever, Johann Cengimbo, Ayanda Blumberg, Lucille H Puren, Adrian Cohen, Cheryl Smit, Sheilagh B Mashele, Mirriam Thomas, Juno McAnerney, Johanna M Schoub, Barry D Ntshoe, Genevie M Moyes, Jocelyn Singh, Beverley Harris, Bernice N Archer, Brett N |
| AuthorAffiliation | 1 Centre for Vaccines and Immunology, National Institute for Communicable Diseases (NICD) of the National Health Laboratory Service (NHLS), Johannesburg, South Africa 3 Division of Public Health Surveillance and Response, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa 7 Expanded Programme on Immunisation in South Africa (EPI SA), Department of Health, Pretoria, South Africa University of Missouri-Columbia, United States of America 2 Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa 4 School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa 6 Centre for HIV and STI, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa 5 Influenza Division, United States Centers for Disease Control and Prevention (CDC), Attaché to the NICD |
| AuthorAffiliation_xml | – name: 7 Expanded Programme on Immunisation in South Africa (EPI SA), Department of Health, Pretoria, South Africa – name: 5 Influenza Division, United States Centers for Disease Control and Prevention (CDC), Attaché to the NICD-NHLS, Johannesburg, South Africa – name: University of Missouri-Columbia, United States of America – name: 1 Centre for Vaccines and Immunology, National Institute for Communicable Diseases (NICD) of the National Health Laboratory Service (NHLS), Johannesburg, South Africa – name: 6 Centre for HIV and STI, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa – name: 2 Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa – name: 4 School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa – name: 3 Division of Public Health Surveillance and Response, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa |
| Author_xml | – sequence: 1 givenname: Genevie M surname: Ntshoe fullname: Ntshoe, Genevie M email: genevien@nicd.ac.za organization: Centre for Vaccines and Immunology, National Institute for Communicable Diseases (NICD) of the National Health Laboratory Service (NHLS), Johannesburg, South Africa. genevien@nicd.ac.za – sequence: 2 givenname: Johanna M surname: McAnerney fullname: McAnerney, Johanna M – sequence: 3 givenname: Brett N surname: Archer fullname: Archer, Brett N – sequence: 4 givenname: Sheilagh B surname: Smit fullname: Smit, Sheilagh B – sequence: 5 givenname: Bernice N surname: Harris fullname: Harris, Bernice N – sequence: 6 givenname: Stefano surname: Tempia fullname: Tempia, Stefano – sequence: 7 givenname: Mirriam surname: Mashele fullname: Mashele, Mirriam – sequence: 8 givenname: Beverley surname: Singh fullname: Singh, Beverley – sequence: 9 givenname: Juno surname: Thomas fullname: Thomas, Juno – sequence: 10 givenname: Ayanda surname: Cengimbo fullname: Cengimbo, Ayanda – sequence: 11 givenname: Lucille H surname: Blumberg fullname: Blumberg, Lucille H – sequence: 12 givenname: Adrian surname: Puren fullname: Puren, Adrian – sequence: 13 givenname: Jocelyn surname: Moyes fullname: Moyes, Jocelyn – sequence: 14 givenname: Johann surname: van den Heever fullname: van den Heever, Johann – sequence: 15 givenname: Barry D surname: Schoub fullname: Schoub, Barry D – sequence: 16 givenname: Cheryl surname: Cohen fullname: Cohen, Cheryl |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/23437059$$D View this record in MEDLINE/PubMed |
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| Cites_doi | 10.1093/ije/26.3.662 10.1136/bmj.c1626 10.1016/j.vaccine.2006.01.049 10.1093/infdis/173.5.1077 10.1086/522989 10.1001/archpedi.1992.02160170030011 10.1086/429963 10.1016/S0140-6736(83)92091-3 10.1016/j.vaccine.2009.07.057 10.1093/infdis/165.2.262 10.1097/00006454-199207000-00004 |
| ContentType | Journal Article |
| Copyright | COPYRIGHT 2013 Public Library of Science 2013 Ntshoe et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License: https://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License. 2013 Ntshoe et al 2013 Ntshoe et al |
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| DOI | 10.1371/journal.pone.0055682 |
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| DocumentTitleAlternate | Measles Outbreak in South Africa, 2009–2011 |
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| Notes | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 Competing Interests: The authors have declared that no competing interests exist. Data management: GMN JMM BNA. Revised article for important intellectual content: BNA SBS BNH ST AP JvdH BDS CC. Outbreak Response: JT AC LHB. Acquisition of vaccination coverage data: JvdH. Conceived and designed the experiments: JM CC. Performed the experiments: SBS MM BS. Analyzed the data: GMN ST. Wrote the paper: GMN. |
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| References_xml | – ident: ref1 – ident: ref3 – volume: 26 start-page: 662 year: 1997 ident: ref29 article-title: The impact of immunization control activities on measles outbreaks in middle and low income countries publication-title: Int J Epidemiol doi: 10.1093/ije/26.3.662 contributor: fullname: RB Aylward – ident: ref5 – ident: ref7 – volume: 340 start-page: c1626 year: 2010 ident: ref19 article-title: Early waning of maternal measles antibodies in era of measles elimination: longitudinal study publication-title: BMJ doi: 10.1136/bmj.c1626 contributor: fullname: E Leuridan – volume: 86(14) start-page: 129 year: 2011 ident: ref31 article-title: Measles outbreaks and progress towards meeting measles pre-elimination goals: WHO African Region, 2009–2010 publication-title: Wkly Epidemiol Rec – volume: 24 start-page: 3984 year: 2006 ident: ref9 article-title: Late vaccination reinforcement during a measles epidemic in Niamey, Niger (2003–2004) publication-title: Vaccine doi: 10.1016/j.vaccine.2006.01.049 contributor: fullname: C Dubray – ident: ref27 – volume: 81 start-page: 469 year: 2006 ident: ref30 article-title: Global distribution of measles and rubella genotypes – update publication-title: Wkly Epidemiol Rec – ident: ref17 – ident: ref15 – ident: ref4 – ident: ref2 – volume: 173(5) start-page: 1077 year: 1996 ident: ref22 article-title: Placental transfer and maternally acquired neonatal IgG immunity in human immunodeficiency virus infection publication-title: J Infect Dis doi: 10.1093/infdis/173.5.1077 contributor: fullname: MI de Moraes-Pinto – ident: ref28 – volume: 84(39) start-page: 397 year: 2009 ident: ref13 article-title: Progress towards measles control in WHO's African Region, 2001–2008 publication-title: Wkly Epidemiol Rec – volume: 45 start-page: 1417 year: 2007 ident: ref24 article-title: The influence of HIV-1 exposure and infection on levels of passively acquired antibodies to measles virus in Zambian infants publication-title: Clin Infect Dis doi: 10.1086/522989 contributor: fullname: S Scott – ident: ref26 – volume: 146(5) start-page: 550 year: 1992 ident: ref25 article-title: Safety and immunogenicity of high dose Edmonston-Zagreb measles vaccine in children with HIV-1 infection: a cohort study in Kigali Rwanda publication-title: Am J Dis Child doi: 10.1001/archpedi.1992.02160170030011 contributor: fullname: P Lepage – volume: 191 start-page: 1854 year: 2005 ident: ref21 article-title: Neonatal measles immunity in rural Kenya: the influence of HIV and placental malaria infections on placental transfer of antibodies and levels of antibody in maternal and cord serum samples publication-title: J Infect Dis doi: 10.1086/429963 contributor: fullname: S Scott – volume: 99(5) start-page: 314 year: 2009 ident: ref11 article-title: Measles outbreak in South Africa, 2003–2005 publication-title: SAMJ contributor: fullname: ML McMorrow – ident: ref8 – ident: ref18 – ident: ref6 doi: 10.1016/S0140-6736(83)92091-3 – volume: 27 start-page: 5870 year: 2009 ident: ref10 article-title: Impact of measles outbreak response vaccination campaign in Dar es Salaam, Tanzania publication-title: Vaccine doi: 10.1016/j.vaccine.2009.07.057 contributor: fullname: JL Goodson – ident: ref16 – ident: ref12 – volume: 165(2) start-page: 262 year: 1992 ident: ref23 article-title: Increased risk of early measles in infants of human immunodeficiency virus type 1-seropositive mothers publication-title: J Infect Dis doi: 10.1093/infdis/165.2.262 contributor: fullname: JE Embree – ident: ref14 – volume: 11(7) start-page: 525 year: 1992 ident: ref20 article-title: Reduced measles immunity in infants in a well vaccinated population publication-title: Pediatr Infect Dis J doi: 10.1097/00006454-199207000-00004 contributor: fullname: HF Pabst |
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| Snippet | Since 1995, measles vaccination at nine and 18 months has been routine in South Africa; however, coverage seldom reached >95%. We describe the epidemiology of... Background Since 1995, measles vaccination at nine and 18 months has been routine in South Africa; however, coverage seldom reached >95%. We describe the... BACKGROUNDSince 1995, measles vaccination at nine and 18 months has been routine in South Africa; however, coverage seldom reached >95%. We describe the... BackgroundSince 1995, measles vaccination at nine and 18 months has been routine in South Africa; however, coverage seldom reached >95%. We describe the... Background Since 1995, measles vaccination at nine and 18 months has been routine in South Africa; however, coverage seldom reached >95%. We describe the... |
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| SubjectTerms | Adolescent Adult Age Age Distribution Analysis Antibodies Biology Child Child, Preschool Children Clinical Laboratory Techniques Disease Disease Outbreaks - prevention & control Enzyme-linked immunosorbent assay Enzymes Epidemics Epidemiology Female Genotype Genotypes HIV Human immunodeficiency virus Humans Immunoglobulin M Immunoglobulin M - immunology Immunoglobulins Immunology Incidence Infant Infections Laboratories Male Measles Measles - epidemiology Measles - genetics Measles - immunology Measles - prevention & control Measles Vaccine - administration & dosage Measles Vaccine - immunology Measles-mumps-rubella vaccines Medical research Medicine Meningitis Outbreaks Patients Public health Reproducibility of Results Respiratory diseases South Africa - epidemiology Target marketing Vaccination Vaccines Viruses |
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| Title | Measles outbreak in South Africa: epidemiology of laboratory-confirmed measles cases and assessment of intervention, 2009-2011 |
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