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MEASLES - CHRONOLOGY OF IMPORTATIONS
************************************
A ProMED-mail post
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ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Tue 14 Apr 2009
From: Steve Berger
<mberger@post.tau.ac.il>


A case imported from India into the United States [see: Measles -
USA: (PA) ex India, alert 20090412.1397] is the latest in a growing
list of cross-border measles episodes. The following is a chronology
of notable outbreaks reported during the past decade. (Source:
Gideon:
<http://www.gideononline.com/blog/2009/0 ... ted-cases/>).

1998 - An outbreak (69 cases, 2 hospitalized, 0 fatal) in Tuvalu was
ascribed to introduced cases among workers from Nauru.

1998 - An outbreak (33 cases) was linked to an infected visitor
arriving to Alaska, United States from Japan.

1999 - An outbreak (75 confirmed cases) in Australia was traced to an
index case from Indonesia.

2000 - Outbreaks (78 cases, total) in Canada were linked to travel in
Mexico (6 cases), Bolivia (19 cases) and Belgium (25 cases).

2000 - An outbreak (992 cases, or 57 percent of all cases for the
Americas region) in Haiti was thought to have originated with
imported cases from the Dominican Republic.

2000 to 2001 - An outbreak (1062 cases, 0 fatal) was reported in
Tanzania among refugees from Burundi.

2001 - An outbreak (37 cases) in Venezuela was ascribed to a case
imported from Europe.

2001 - An outbreak (14 cases) in the United States was reported among
internationally-adopted children.

2002 - An outbreak (1334 suspect cases; 128 confirmed) in Colombia
was traced to index patients who had acquired the disease in
Venezuela.

2002 - An outbreak (13 cases) in the United States resulted from a
case imported from the Philippines.

2002 - An outbreak (6380 suspect cases; 2397 confirmed) in Venezuela
was traced to measles imported from Europe.

2003 - An outbreak (107 cases) in an unvaccinated religious community
in Israel followed introduction of an index patient from Switzerland.

2003 - An outbreak (22 cases) was reported in Mexico following
importation of measles from either Japan or Korea.

2004 - An outbreak (59 cases) was reported in Mexico following
importation of an index case from Asia.

2004 - A total of 10 confirmed cases were identified among Chinese
children (from Hunan) arriving to the United States, and 3 Chinese
children arriving to Norway.

2004 - An outbreak (5 cases) was reported among American children
living in a military community in Germany.

2005 - An outbreak (34 cases) in the United States was related to an
index case who contracted measles in Romania.

2005 - An outbreak (6 cases) in Portugal was related to an index
patient from Romania.

2005 - A total of 2 Spanish travelers developed measles following
return from Thailand and Mozambique.

2005 to 2006 - An outbreak (27 cases) in Mexico was related to index
cases who had worked at an international airport.

2006 - An outbreak (7 cases) in Australia was related to an imported
index case.

2006 - An outbreak (15 cases) in an office building in the United
States was associated with an index case which had arrived from India.

2006 - An outbreak (3 cases) was reported among members of an
adoption group returning to the United States from China.

2006 - An outbreak (44 cases) in Venezuela was ascribed to an index
case arriving from Spain.

2006 - A total of 3 cases of measles in Poland were associated with
an outbreak in Ukraine.

2006 to 2007 - An outbreak (213 cases) in Spain followed importation
of a case from Eastern Europe.

2007 - A case of measles reported in the United States originated in India.

2007 - An outbreak (92 cases) was reported among Irish tourists in
England. Additional outbreaks related to travel in England were
reported among Irish tourists in Norway (15 cases), Belgians (23
cases), Italians (46 cases) and Israelis (3 cases) exposed to
tourists returning from England.

2007 - Quarantine measures were evoked when a child with measles was
discovered in a Japanese tourist about to board an airplane flight
from Canada to Japan.

2007 - An outbreak (6 cases) in the United States was related to an
index case from Japan.

2007 - An outbreak (11 cases) in the Russian Federation was related
to a group of 3 infected patients returning from China.

2007 - An outbreak (90 cases) in Germany was related to 2 index
patients who had returned from Switzerland.

2007 - An outbreak (4 cases) in New Zealand was related to an index
patient who had returned from India.

2008 - An outbreak (12 cases) in the United States was related to an
index patient who had been infected in Switzerland. 16 secondary
cases were reported in Arizona; and 6 additional cases resulted when
an infected infant traveled from the outbreak region (California) to
Hawaii. As of July 2008, 116 cases were imported or related to
imported cases (from Belgium, India, Israel, China, Germany,
Pakistan, the Philippines, and Russia).

2008 - An outbreak (5 cases) in Denmark was related to an index
patient who had returned from India and Nepal.

2008 - An outbreak (259 cases) including 202 in Austria, 53 in
Germany and 4 in Norway was related to attendance at an
anthroposophic school in Austria.

2008 - An outbreak (5 cases) in Sweden was related to an index
patient who had been infected in France.

2008 - An outbreak (109 cases) involving 2 religious schools in
France was related to an index patient who had been infected in
Austria.

2008 to 2009 - An outbreak (6 cases) in a Danish hospital was related
to an index patient who had returned from East Africa.

2009 - Outbreaks (11 cases in 2 outbreaks) in Taiwan were related to
index cases who had visited mainland China.

--
Steve Berger
Geographic Medicine
Tel Aviv Medical Center
<mberger@post.tau.ac.il>

[ProMED-mail thanks Professor Berger for providing this compilation
of measles importations. The primary sources are available on request
from Professor Berger. Further information on many can be obtained
from the ProMED-mail archive at <http://www.promed.org> by keying in
'Measles' followed by 'ex'. This will generate a total of 51
references going back to 1991. - Mod.CP]
..........................cp/ejp/lm

IRIN hat geschrieben:BURKINA FASO: Meningitis, measles deaths climb in Burkina Faso

DAKAR, 30 April 2009 (IRIN) - As of 26 April, 449 people have died of meningitis and 226 from measles in Burkina Faso, according to the Ministry of Health. The meningitis death toll has climbed to 12.7 percent of those affected, Ousmane Badolo, the director of the ministry's epidemiological surveillance, told IRIN.

A disease is considered under effective control if the death rate is 10 percent or less, according to World Health Organization (WHO).

More than 31,000 measles infections have been reported, giving the outbreak a 0.7-percent mortality rate. During the same period last year, there were less than 100 reported cases.

Thirty seven out of 56 districts have reported measles cases. The government is requesting donor support for a still unscheduled measles vaccination campaign in 19 districts that would target more than three million people.

http://www.irinnews.org

Burkina Faso - Masern
06.07.2009

Seit Anfang des Jahres wird Burkina Faso von einem Masern-Ausbruch heimgesucht. Bis Ende Juni wurden mehr als 51.000 Erkrankungen und 300 Todesfälle gemeldet. Mehr als zehnmal so viele wie in den vergangenen Jahren. Nach dem deutschen Impfkalender sind 2 MMR-Impfungen für alle Kinder vorgesehen. Ein fehlender Impfschutz kann auch später jederzeit, z.B. anlässlich einer Reise, nachgeholt werden. / Quelle: crm

MEASLES - TANZANIA, ex DEMOCRATIC REPUBLIC OF THE CONGO
*******************************************************
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ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Fri 31 Jul 2009
Source: Daily News online [edited]
<http://www.dailynews.co.tz/home/?n=3216>


Nkasi District fights to contain measles 'imported' from Congo DR
-----------------------------------------------------------------
There has been an influx of people from the Democratic Republic of
Congo (Congo DR) into 6 villages in Nkasi District, Rukwa Region
following an outbreak of measles in their country, the 'Daily News'
has learnt. The Rukwa Health Officer, Mr Jacob Twange, has said
already 7 measles patients, 5 adults and 2 children below 5, have
died at Kalungu village dispensary.

Kalungu is a small fishing camp located along the shores of Lake
Tanganyika in Kirando Division, Nkasi District. All the deceased were
identified as citizens from Congo DR. Mr Twangwe is also in charge of
the measles vaccination campaign in the region. He said the patients
had 1st been taken to traditional healers by their relatives and were
brought to the dispensary when it was too late to save their lives,
adding that there were still 2 measles patients from the Congo DR
admitted to the dispensary and their conditions were reported to be improving.

He said it was difficult to determine the number of people running
away from the Congo DR into the country seeking treatment and
vaccination against measles which is said to be ravaging that
country [the Congo DR] because their hosts were reluctant to expose them.

Mr Twange said the most affected villages by the influx were Kirando,
Manda Kerenge, Kalungu and Namasi, all situated along the shore of
Lake Tanganyika in the district. According to Mr Twange, a team of 4
medical experts were dispatched to the villages to carry out further
investigations. He added that after house to house search, it was
discovered that about 183 children aged below 5 years were attacked
by the disease among them are 22 children below 9 months old, saying
that all were citizens from the Congo DR. Mr Twange said parents of
the children claimed that they were compelled to run away from their
country to Tanzania because there was no treatment in their country.

Following the outbreak of measles in the 5 villages in Nkasi
District, the regional authorities have launched a special house to
house a vaccination campaign against measles along the shores of Lake
Tanganyika in the district in order to stop it from spreading to the
neighbouring districts in the region.

[Byline: Peti Siyame]

--
Communicated by:
HealthMap Alerts via ProMED-mail
<promed@promedmail.org>

[A detailed map of Nkasi and neighboring regions can be accessed at:
<http://www.maplandia.com/tanzania/rukwa/nkasi/>. - Mod.CP]

[The interactive HealthMap/ProMED map of Nkasi can be found at
<http://healthmap.org/r/00DQ>. - Mod.MPP]

MEASLES - ANGOLA (CUNENE)
*************************
A ProMED-mail post
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ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Thu 27 Aug 2009
Source: Agence AngolaPress (Abgop) [edited]
<http://www.portalangop.co.ao/motix/en_u ... 5c83a.html>


At least 99 cases of measles were diagnosed in the districts of Kwanhama,
Cahama, and Coroca in the southern province of Cunene between the 2nd
fortnight of July 2009 and 23 Aug 2009. The information was supplied to
Angop on Monday [24 Aug 2009] by the supervisor of the epidemiological
surveillance programme, Adelina Francisca.

According to her, 2 children died of measles in Cahama district, and the
disease is spreading to Kwanhama, having affected children aged from 9
months to 15 years. In order to reverse the situation, Adelina Francisca
said, the health sector is holding awareness campaigns to inform the
communities about the symptoms and care to better prevent the disease.
According to Francisca, the symptoms of measles are high temperature, skin
eruptions, pimples, conjunctivitis, eye ache, cough, and flu. She appealed
to child guardians to take their kids to health centres for vaccination
against the disease.

No cases of measles were recorded in Cunene province in 2008.

--
communicated by:
ProMED-mail rapporteur Brent Barrett

[This outbreak seems large enough to indicate a serious breakdown in
vaccination coverage in southern Angola.

The southern province of Cunene can be located by accessing the
HealthMap/ProMED-mail interactive map of Angola via
<http://healthmap.org/r/00JD>. - Mod.CP]

MEASLES - NAMIBIA: (OHANGWENA)
******************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Fri 28 Aug 2009
Source: New Era, Namibia [edited]
<http://www.newera.com.na/article.php?articleid=6440>


Ohangwena battles measles outbreak
----------------------------------
Recent confirmation of measles cases in the Ohangwena Region is likely to
add to the woes of the health ministry, which is already battling to
contain swelling numbers of H1N1 cases. National Health Emergency
Preparedness Committee chairperson, Dr Jack Vries, yesterday [27 Aug 2009]
told New Era there are 29 suspected cases of measles in the Engela
district. 2 cases were confirmed positive, while 15 patients are admitted
to that district's hospital. An adult male is also suspected to have the
disease in the Khomas Region and has been admitted at the Katutura State
Hospital.

Epidemiologists are investigating the cases and analysing data before
health experts take further action, Vries said. Should the situation
develop into an outbreak, Namibia might have to re-vaccinate certain
population groups in targeted areas, added Vries. The country's health
authorities especially those in the north of the country are on full alert
after a measles outbreak in Angola is said to have spread to Namibia.

Unlike other diseases that require human contact for transmission, measles
virus can spread very easily through micro-droplets contained in the air
people breathe out or cough. Every year, the country's health ministry goes
on a mass vaccination campaign that sees children under the age of 5
immunised against measles, a disease that can easily lead to pneumonia,
which can be fatal when severe.

Health authorities say there is no reason for alarm as they are monitoring
the situation closely. The symptoms of measles are high temperature, skin
eruptions, pimples, conjunctivitis, earache, cough, and flu. The virus is
now circulating internally and one does not have to travel abroad to be at
risk. The situation, according to health officials, calls for re-doubled
efforts on prevention. It has not been established whether or not travel
restrictions imposed by other countries have served any purpose in
protecting the public or containing the outbreak. It remains unknown how
the situation will evolve in Namibia.

[byline: Petronella Sibeene]

--
communicated by:
HealthMap/ProMED-mail
<promed@promedmail.org>

[An interactive map of Namibia can be accessed at
<http://encarta.msn.com/map_701514947/namibia.html>. Further information on
Ohangwena can be found at
<http://travelingluck.com/Africa/Namibia ... #local_map>.
- Mod.CP]

MEASLES - AFRICA: NAMIBIA, ANGOLA, SOUTH AFRICA
***********************************************
A ProMED-mail post
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ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

In this update:

[1] Namibia, Angola
[2] South Africa

******
[1] Namibia, Angola
Date: Wed 2 Sep 2009
Source: New Era, Namibia [edited]
<http://www.newera.com.na/article.php?articleid=6540>


Cases of measles, a disease that has affected hundreds of people in
neighbouring Angola, have now reached 15 in Namibia. Acting
Chairperson of the National Health Emergency Committee (NHEC), Dr
Rheinhardt Collin Gariseb, told New Era 3 more cases were confirmed
positive yesterday morning [Tue 1 Sep 2009], bringing the total number
of positive cases to 15 by yesterday from 12 on Friday [28 Aug 2009].

Despite the increasing numbers of people testing positive for measles,
Dr Gariseb gave assurances that all necessary measures were in place
to minimise the spread of the disease, especially among children under
the age of 5. He could not provide the number of those admitted to
Engela hospital.

The disease is reported to have spread from Angola, where by last week
there were 99 cases of measles diagnosed in the districts of Kwanhama,
Cahama and Coroca in southern Cunene province of Angola. The health
sector is said to be holding awareness campaigns to inform communities
about symptoms and care to better prevent the disease.

Ohangwena Regional Health Director Kaino Pohamba told New Era on
Monday [31 Aug 2009] that Namibia and Angola were involved in
cross-border talks on how to prevent and respond effectively to measles.

Symptoms of measles are high temperature, skin eruptions, pimples,
conjunctivitis, sore eyes, cough and flu [fever]. The Ministry of
Health and Social Services yesterday [1 Sep 2009] appealed to
guardians to take their children to health centres for vaccination
against the disease.

[Byline: Petronella Sibeene]

******
[2] South Africa
Date: Tue 1 Sep 2009
Source: allAfrica.com [edited]
<http://allafrica.com/stories/200909020719.html>


The health department has urged the public and medical practitioners
to be aware of measles symptoms and for parents to get their children
vaccinated after a reported outbreak in Gauteng. Fidel Hadebe,
spokesperson for the health department, said there was a possibility
that the disease could spread to other provinces, as over 131 cases
had been reported by 30 Aug 2009. About 109 cases were from Gauteng,
with 97 of these from the Tshwane (Pretoria) health district. Random
cases have been reported in other parts of the country, including
Mpumalanga with 8 cases. The Western Cape recorded 5, while 3 were
reported in the Eastern Cape. The North West Province and Northern
Cape both recorded one case each. Some suspected cases were yet to be
confirmed in Limpopo.

Measles is an infectious disease that is spread through contact with
the nose and throat discharges of an infected person and is mostly
spread when an infected person sneezes or coughs. An infected person
can infect others for several days before and after developing
symptoms. It is known to spread faster in areas where infants and
children gather, such as schools, day care centres and health care
facilities.

According to the World Health Organisation, measles remains a leading
cause of death among young children, although a safe and
cost-effective vaccine is available to prevent the disease. In 2007,
about 197 000 measles deaths were recorded globally, nearly 540 deaths
every day or 22 deaths hourly.

Hadebe [Health Department spokesperson] called upon the public to work
hand-in-hand with the health department in eradicating the virus. He
said it was unfortunate that some parents still chose not to vaccinate
their children even though the health department had a structured
system to facilitate effective vaccination. "Parents and caregivers of
children are urged to ensure that children have received all their
vaccines for the age of the child by checking their Road to
Health/immunisation cards. If unsure, have these checked at the local
clinic. Two doses of measles vaccine should be administered, at 9 and
18 months of age. Measles immunisations are available free of charge
from all public and municipal health clinics," he said. Medical
practitioners were urged to put surveillance measures in place to
prevent further outbreaks by promptly reporting suspected cases of
measles or German measles [rubella] to their nearest local authority
health department.

In an effort to contain the outbreak, the Tshwane district launched a
mass measles immunisation campaign from 24 Aug to 5 Sep 2009 targeting
all schools. Parents should bring their children even if they had
received their measles vaccines. "School children will be immunised at
school, and therefore parents are asked to complete and return consent
forms obtained from the schools. Parents whose children are not in
school should please take their children to the local clinic or health
facility for immunisation," said Hadebe.

For more information visit: the National Institute for Communicable
Disease website: <http://www.nicd.ac.za>, or the Department of Health
website: <http://www.health.gov.za>, or contact your nearest clinic.

[Byline: Lungi Langa]

--
Communicated by:
ProMED-mail Rapporteur Brent Barrett

[These are serious outbreaks in southern Africa which appear to be
spreading, as elsewhere, as a consequence of localised resistance to
vaccination and incomplete coverage of the population.

A map showing the location of Ohangwena in Namibia can be accessed via
the HealthMap/ProMED-mail interactive map at
<http://healthmap.org/r/00Ls>; a map showing the location of the
adjacent Cunene province of Angola can be located at:
<http://healthmap.org/r/00JD>. The HealthMap/ProMED-mail interactive
map of South Africa can be accessed at: <http://healthmap.org/r/00Lu>.
- Mod.CP]

Südafrika - Masern
07.09.2009

Aus der Provinz Gauteng, insbesondere aus der Hauptstadt Tshwane (früher Pretoria) wir eine Zunahme der Masern-Erkrankungen gemeldet. Landesweit wurden 131 Fälle gemeldet, davon 97 aus Tshwane. Nach dem deutschen Impfkalender sind 2 MMR-Impfungen für alle Kinder vorgesehen. Ein fehlender Impfschutz kann auch später jederzeit, z.B. anlässlich einer Reise, nachgeholt werden. / Quelle: crm

MEASLES - AFRICA (02): CONTROL ACTIVITIES, 2001-2008
****************************************************
A ProMED-mail post
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ProMED-mail is a program of the
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Date: Fri 25 Sep 2009
Source: CDC. MMWR Morb Mortal Wkly Rep 2009 58(37); 1036-41 [edited]
<http://www.cdc.gov/mmwr/preview/mmwrhtm ... mm5837a3_e>


Progress toward measles control - African region, 2001-2008
-----------------------------------------------------------
In 2001, the countries of the World Health Organization (WHO) African
Region (AFR) became part of a global initiative with a goal of
reducing the number of measles deaths by 50 percent by 2005, compared
with 1999. [The 46 African Region (AFR) countries are: Algeria,
Angola, Benin, Botswana, Burkina Faso, Burundi, Cameroon, Cape Verde,
Central African Republic, Chad, Comoros, Congo, Cote d'Ivoire,
Democratic Republic of Congo, Equatorial Guinea, Eritrea, Ethiopia,
Gabon, Gambia, Ghana, Guinea, Guinea-Bissau, Kenya, Lesotho, Liberia,
Madagascar, Malawi, Mali, Mauritania, Mauritius, Mozambique, Namibia,
Niger, Nigeria, Rwanda, Sao Tome and Principe, Senegal, Seychelles,
Sierra Leone, South Africa, Swaziland, Togo, Uganda, United Republic
of Tanzania, Zambia, and Zimbabwe. - Mod.CP]

Recommended strategies for measles mortality reduction included 1)
increasing routine coverage for the 1st dose of measles-containing
vaccine (MCV1) for all children, 2) providing a 2nd opportunity for
measles vaccination through supplemental immunization activities
(SIAs), 3) improving measles case management, and 4) establishing
case-based surveillance with laboratory confirmation of all suspected
measles cases (1). Before introduction of MCV throughout AFR,
approximately 1 million measles cases had been reported each year in
the early 1980s (2). After strengthening measles-control activities,
annual reported cases declined to an estimated 300 000-580 000 during
the 1990s. This report summarizes the progress made during 2001-2008
toward improving measles control in AFR. During 2001-2008 estimated
MCV1 coverage increased from 57 percent to 73 percent, SIAs
vaccinated approximately 398 million children, and reported measles
cases decreased by 93 percent, from 492, 116 in 2001 to 32, 278 in
2008. By 2005, global measles deaths had decreased by 60 percent, and
the AFR goal had been achieved (3); AFR adopted a new goal to reduce
deaths by 90 percent, compared with 2000, and that goal was achieved
in 2006 (3,4). However, inaccuracies in reported vaccination coverage
exist, surveillance is suboptimal, and measles outbreaks continue to
occur in AFR countries. Further progress in measles control will
require full implementation of recommended strategies, including
validation of vaccination coverage.

Since the 1980s, AFR countries have reported measles vaccination
coverage and the number of measles cases each year to the WHO African
Regional Office (AFRO), using the WHO and United Nations Children's
Fund (UNICEF) Joint Reporting Form. These data are collected through
administrative reports from routine vaccination programs and SIAs and
routine surveillance systems that provide aggregated case counts
based on clinical diagnosis. Estimates of routine coverage with MCV1
are based on review of coverage data from administrative records,
surveys, national reports, and consultation with local and regional
experts. Coverage achieved during nationwide SIAs against measles are
reported on the basis of the reported number of doses administered,
divided by the target population.

In 1999, as part of the measles mortality reduction strategy,
case-based surveillance with laboratory testing for all suspected
measles cases was introduced with support from WHO AFRO. A suspected
measles case is defined as 1) any person with generalized
maculo-papular rash and fever plus cough or coryza or conjunctivitis
or 2) any person in whom a clinician suspects measles. Each suspected
measles case should be reported using an individual
case-investigation form, and a blood specimen should be collected and
sent to the laboratory for measles-specific immunoglobulin M testing.
Laboratory confirmation of individual cases is discontinued after an
outbreak has been confirmed as measles. An outbreak is confirmed when
3 or more measles laboratory-confirmed cases are detected in a health
facility or district in 1 month; subsequent cases are confirmed by
epidemiologic link. An epidemiologic link is defined as a suspected
measles case that did not have a specimen collected for laboratory
testing and is linked in person, place, and time to a
laboratory-confirmed case (that is, in a patient living in the same
district or an adjacent district with a patient with
laboratory-confirmed measles where a likelihood of transmission and
onset of rash in the 2 patients within 30 days of each other exists)
(5). Case-based surveillance data from AFR countries are shared
regularly with WHO AFRO. Data quality is monitored using annualized
performance indicators that include the 1) percentage of districts
reporting one or more suspected case with a blood specimen (target:
greater than 80 percent) and 2) non-measles febrile rash illness rate
(target: more than 2 cases per 100 000).

Routine vaccination activities
------------------------------
In AFR, MCV1 is administered through routine services to children at
age 9 months. According to WHO and UNICEF estimates, AFR MCV1
coverage increased from 57 percent in 2001 to 73 percent in 2008. In
2008, among the 46 AFR countries, 3 (7 percent) had MCV1 coverage of
less than 60 percent, 13 (28 percent) had coverage of 60-69 percent,
11 (24 percent) had coverage of 70-79 percent, 10 (22 percent) had
coverage of 80-89 percent, and 9 (20 percent) had coverage of at
least 90 percent (data tabulated in the original text). As of 2008, 5
(10 percent) countries provided a 2nd dose of MCV (MCV2) through
routine services: South Africa and Swaziland reported MCV2 coverage
of 70 percent, Lesotho reported MCV2 coverage of 80 percent, and
Algeria and Seychelles reported MCV2 coverage of more than 95 percent
in 2008.

SIA results
-----------
SIAs provide a 2nd opportunity for measles immunization to all
children, including those not vaccinated with MCV1 and those
previously vaccinated; approximately 15 percent of children
vaccinated with a single dose at age 9 months will not develop
immunity to measles. The SIA strategy generally consists of a
one-time catch-up SIA, targeted to a wide age range, which aims to
reduce susceptibility to measles in the population. This is followed
by periodic follow-up SIAs targeting children born since the last
SIA, thus reducing the accumulation of susceptible children in new
birth cohorts.

Before 2000, 7 (15 percent) AFR countries (Botswana, Lesotho, Malawi,
Namibia, South Africa, Swaziland, and Zimbabwe) had completed a
catch-up SIA, and Namibia and South Africa had completed a follow-up
SIA (6). By the end of 2008, 43 AFR countries (all except Algeria,
Mauritius, and Seychelles) had completed a catch-up SIA, and all but
Comoros and Guinea-Bissau had completed at least one follow-up SIA
(data tabulated in the original text). During 2001-2008,
approximately 398 million children were vaccinated during measles
SIAs in AFR: 237 million (60 percent) during catch-up SIAs in 34
countries, and 161 million (40 percent) during follow-up SIAs in 39
countries. 9 countries (Benin, Cameroon, Chad, the Democratic
Republic of Congo, Ethiopia, Ghana, Niger, Nigeria, and Tanzania)
conducted nationwide SIAs in phases covering different geographic
areas implemented over a period of at least 2 years.

Measles surveillance
--------------------
By December 2008, all AFR countries except Algeria, Comoros, Guinea
Bissau, Mauritius, Sao Tome & Principe, and Seychelles had
established measles case-based surveillance in accordance with the
WHO AFRO measles surveillance guidelines (5). In 2008, of the 40
countries with case-based surveillance, 21 (53 percent) met the
target of more than 80 percent of districts reporting one or more
suspected cases; 24 (60 percent) had a non-measles febrile rash
illness rate of more than 2 cases per 100 000 population; and 16 (40
percent) met both targets.

Monitoring measles incidence
----------------------------
Following implementation of the measles mortality reduction
strategies during 2001-2008, including introduction of case-based
measles surveillance, the number of reported measles cases decreased
93 percent, from 492 116 in 2001 to 32 278 in 2008 (illustrated
graphically in the original text). Average annual measles incidence
in AFR decreased 66 percent, from 50.2 per 100 000 population during
2001-2004 to 17.2 during 2005-2008 (data tabulated in the original
text). Despite this decrease, during 2005-2008, 14 countries reported
outbreaks. Outbreak field investigations conducted during 2003-2007
in South Africa (1676 cases, 2003-2005) (7), Kenya (2544 cases,
2005-2007) (8), and Tanzania (1533 cases, 2006-2007) (9) found that
failure to vaccinate was the primary cause. In 2008, outbreaks also
contributed to annual case counts in Burkina Faso (395), Cameroon
(495), the Democratic Republic of Congo (12,461), Ethiopia (3,511),
Niger (1,317), and Nigeria (9,960) (2).

[Reported by: Countries in the World Health Organization African
Region; Immunization and Vaccine Development, World Health
Organization Regional Office for Africa. Dept of Immunization,
Vaccines, and Biologicals, World Health Organization, Geneva,
Switzerland. Global Immunization Div, National Center for
Immunization and Respiratory Diseases, CDC.]

MMWR editorial note
-------------------
In 2008, after implementation of the measles mortality reduction
strategy, routine measles vaccination coverage in AFR reached 73
percent, SIAs were conducted in nearly all AFR countries, and
reported measles cases decreased to a historic low of 32 278.
According to previously published WHO estimates, by 2006 AFR had
achieved approximately 90 percent reduction in measles deaths,
compared with 2000 (3). However, despite this progress, vaccination
coverage reports remain imprecise, disease surveillance remains
suboptimal, and outbreaks continue to occur, even in countries that
reported implementation of all recommended components of the measles
strategy. Available mathematical models likely overestimate the
disease burden and underreporting of measles cases is common, even
with high-performing surveillance systems; therefore, caution is
recommended when drawing comparisons between reported incidence of
measles and estimates of measles deaths generated from models.

SIAs are recommended to provide a 2nd opportunity for immunization
and increase the likelihood of vaccinating hard-to-reach children.
SIA coverage usually is estimated by an administrative method relying
on the reported number of vaccine doses administered and available
target population denominator data, both of which often are
imprecise. For example, during 2001-2008, several countries reported
vaccinating more than 100 percent of children targets in SIAs.
Improved methods for determining the actual target population size
for SIAs are needed; reported coverage also should be routinely
validated by independent surveys. In addition, detailed field
investigations of outbreaks should be undertaken to identify post-SIA
risk factors for measles, and help refine vaccination strategies.

The findings in this report are subject to at least 2 limitations.
First, a change in measles surveillance methods might result in
underestimates or overestimates of the disease burden over time. For
example, in 1999, AFR countries routinely reported an aggregated
number of clinically diagnosed measles cases; however, after
implementation of measles case-based surveillance, by 2005, most
countries had changed to reporting laboratory-confirmed measles cases
(6). Second, although the case definition for suspected measles
remained the same, the change in measles reporting practices might
have led to either underreporting, because of the additional
resources needed to complete individual case investigations and
collect blood samples, or overreporting because of overall efforts to
strengthen measles surveillance.

In light of progress made toward reducing measles deaths, a more
advanced goal was proposed recently for the region with several
recommendations to improve vaccination coverage and surveillance
performance. The AFR measles technical advisory group met in May 2008
and recommended that AFR countries aim to meet the following targets
by 2012: 1) reducing estimated measles deaths by 98 percent, compared
with 2000 estimates; 2) reducing measles incidence to less than 5
cases per 1 million population per year; 3) achieving at least 90
percent routine MCV1 coverage nationwide and more than 80 percent in
all districts; 4) achieving more than 95 percent SIA coverage in all
districts; and 5) attaining 2 primary measles surveillance
performance indicator targets (a non-measles febrile rash illness
rate of more 2 cases per 100 000 population per year and one or more
suspected measles case investigated with blood specimen in more than
80 percent of districts per year); and 6) routine reporting from all
districts (10). The group also recommended that AFR countries
consider introduction of MCV2 in the routine vaccination schedule if
MCV1 coverage of more than 80 percent has been achieved and
maintained for at least 3 consecutive years and at least 1 of the 2
primary measles surveillance indicator targets has been achieved and
maintained for at least 2 years. For countries adopting a 2-dose
routine measles vaccination schedule, continued follow-up SIAs were
recommended for all new birth cohorts every 3-5 years until national
MCV2 coverage of at least 90 percent is sustained for at least 2
years (10).

References
----------
1. World Health Organization and United Nations Children's Fund:
Measles mortality reduction and regional elimination - strategic
plan, 2001-2005. Available at
<http://www.who.int/vaccines-documents/d ... www573.pdf>.
2. World Health Organization: Measles reported cases. (Updated 10 Aug
2009). Available at
<http://www.who.int/immunization_monitor ... ncemea.htm>
(Accessed 18 Aug 2009).
3. CDC: Progress in global measles control and mortality reduction,
2000-2006. MMWR 2007; 56: 1237-41. Available at
.
4. World Health Organization, Regional Office for Africa: Regional
strategic plan for the expanded programme on immunization, 2006-2009.
Available at
<http://www.afro.who.int/cah/documents/e ... p_2006.pdf>.
5. World Health Organization Regional Office for Africa: Measles
surveillance guidelines. Available at
<http://www.afro.who.int/measles/guidelines>.
6. CDC: Effects of measles-control activities - African Region,
1999-2005. MMWR 2006; 55: 1017-21. Available at
<http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5537a3.htm>.
7. McMorrow M, Gebremedhin G, van den Heever J, et al: Measles
outbreak in South Africa, 2003-2005. S Afr Med J 2009; 99(5): 314-9.
[Available at
<https://repository.up.ac.za/upspace/bit ... 009%29.pdf>].
8. CDC. Progress in measles control - Kenya 2002-2007. MMWR 2007; 56:
969-72. Available at
<http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5637a5.htm>.
9. Goodson JL, Wiesen E, Perry RT, et al: Impact of measles outbreak
response vaccination campaign in Dar es Salaam, Tanzania. Vaccine
2009; 27(42): 5870-4. [Abstract available at
<http://www.ncbi.nlm.nih.gov/pubmed/19656496>].
10. World Health Organization Regional Office for Africa. Report of
the second meeting of the African regional measles technical advisory
group (TAG). Available at
<http://www.afro.who.int/measles/2ndtagm ... report.pdf>.

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

[In the light of the remarkable progress achieved toward reducing the
incidence of measles and the number of measles deaths in the African
Region, more advanced goals are now being proposed, which include
reducing estimated measles deaths by 98 percent, compared with 2000
estimates, and reducing measles incidence to less than 5 cases per 1
million population per year by 2012. A formidable medical and
logistic challenge. - Mod.CP]

MEASLES - AFRICA (03): SOUTH AFRICA (JOHANNESBURG)
**************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Tue 29 Sep 2009
Source: News24, South African Press Association (SAPA) report [edited]
<http://www.news24.com/Content/SouthAfri ... _in_Joburg>


Measles outbreak in Johannesburg
--------------------------------
There is an outbreak of measles in Johannesburg, with 48 cases reported
this month [September 2009], the City of Johannesburg said on Tuesday [29
Sep 2009]. "Since the beginning of September, 48 measles cases have been
reported in Johannesburg. All the regions in the city are affected by the
outbreak," said spokesperson Nkosinathi Nkabinde. From January to August
[2009] there were 11 cases of confirmed measles reported.

"Some of the persons affected had one or 2 doses of measles vaccine,
meaning all persons are at risk of contracting measles." Anyone with a
fever, rash, running nose, red infected eyes, or cough should be
investigated for measles. "Measles is a serious disease that can cause,
deafness, brain damage, pneumonia, and even death," said Nkabinde. "Measles
can affect anyone, including adults. All cases of suspected measles must be
reported to the health department as failure to control the spread of
measles will result in unnecessary suffering and even death."

The health department will immunise all [contacts of] identified cases at
home, school, and at the workplace. The vaccine must be administered as
soon as possible after exposure to be effective, Nkabinde said.

"Although the 1st measles vaccination given at 9 months protects infants,
immunity acquired is not optimal due to the presence of maternal
antibodies. The 2nd dose administered at 18 months of age, provides another
chance to protect the children against measles, especially for those
children who did not respond to the 1st dose of the vaccine. About one of
every 10 children does not respond to the 1st dose of vaccine." Nkabinde
said the 2nd dose also served as a booster to increase antibody levels in
those with low antibody levels. After the 2nd dose, 99 per cent of children
are protected against measles. "Parents who have younger children who are
not attending school should please ensure that these children are fully
immunised. If you are not certain that your child is fully immunised,
please visit your local clinic."

Members of the public, especially medical personnel, traditional healers,
and training institutions, were urged to report all cases of suspected measles.

--
communicated by:
HealthMap Alerts via ProMED-mail
<promed@promedmail.org>

[This large number of case is indicative of a serious failure in vaccine
overage.

The HealthMap/ProMED-mail interactive map, showing the location of
Johannesburg, can be accessed at <http://healthmap.org/r/00SG>. - Mod.CP]

MEASLES - SOUTH AFRICA (04): (GAUTENG)
**************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Thu 1 Oct 2009
Source: The National Institute for Communicable Diseases, National Health
Laboratory System, South Africa [edited]
<http://www.nicd.ac.za/pubs/communique/c ... #heading02>


Measles outbreak
----------------
The number of positive measles IgM specimens increased markedly during
September [2009] with 246 positive cases compared with 99 in August [2009],
bringing the total for the year to 414. Most of these patients (372 or 90
per cent) were from Gauteng [province]. Of the Gauteng patients, 296 (80
per cent) were from the the Tshwane district [the district municipality
around Pretoria]. However during the past month there have been 35 and 31
cases in Ekurhuleni and Johannesburg respectively. Ages were known for 405
(98 per cent) patients and ranged from 2 months to 54 years with a median
of 12 years.

(Source: Epidemiology Division, Respiratory Virus and Viral; Diagnostics
Units, Molecular Measles Unit, NICD; Communicable and the Disease
Directorate, Tshwane District and Gauteng Province.)

Sporadic outbreaks of measles at not uncommon in the Johannesburg-Pretoria
region, an area undergoing quite rapid urban growth. The South Africa
immunization schedule indicates that measles vaccine should be given at 9
months with a booster at 18 months. The State of the World's Children 2009
(UNICEF) gives the measles immunization coverage rate in 2007 at one year
as 83 per cent based in information supplied by the National Department of
Health.

--
communicated by:
Neil Cameron
Division of Community Health
Department of Interdisciplinary Health Sciences
Faculty of Health Sciences
Stellenbosch University
Francie van Zjil Ave / PO Box 19063
Tygerberg
7505 South Africa
<nac@sun.ac.za>

[A map of Gauteng province, which embraces Pretoria [now named Tshwane] and
Johannesburg, can be accessed at
<http://www.sa-venues.com/maps/gauteng_regional.htm>. The
HealthMap/ProMED-mail interactive map of South Africa is available at
<http://healthmap.org/r/00TQ>. - Mod.CP]

Südafrika - Masern
05.10.2009

In Südafrika wurde im September ein deutlicher Anstieg der Masern-Erkrankungen registriert. Während es im August 99 Erkrankungen waren, wurden im September 246 Fälle registriert, womit die Zahl der Erkrankungen seit Jahresbeginn auf 414 anstieg. Aus der Provinz Gauteng, insbesondere aus der Hauptstadt Tshwane (296 Erkrankungen) (früher Pretoria) werden die meisten Masern-Erkrankungen gemeldet. Auch Johannesburg meldete im September mit 48 Erkrankungen steigende Fallzahlen. Nach dem deutschen Impfkalender sind 2 MMR-Impfungen für alle Kinder vorgesehen. Ein fehlender Impfschutz kann auch später jederzeit, z.B. anlässlich einer Reise, nachgeholt werden. / Quelle: crm

MEASELS - SOUTH AFRICA (05): (GAUTENG)
**************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Tue 13 Oct 2009
Source: National Institute for Communicable Diseases (NCID) [edited]
<http://www.nicd.ac.za/pubs/communique/c ... #heading02>


Measles outbreak update
-----------------------
The number of positive measles IgM specimens increased markedly during
September [2009] with 246 positive cases compared to 99 in August [2009],
bringing the total for the year to 414. The majority (372; 90 per cent) of
these patients were from Gauteng. Of the Gauteng patients, 296 (80 per
cent) were from the Tshwane district. During the past month, however, there
have been 35 and 31 cases in Ekurhuleni and Johannesburg, respectively.
Ages were known for 405 patients (98 per cent) and ranged from 2 months to
54 years with a median of 12 years.

There is a broad differential diagnosis for patients presenting with fever
and morbilliform rash, particularly in teenagers and young adults. Measles
is often not considered. During this outbreak, a number of patients were
initially misdiagnosed as having Coxsackie [virus] infections. All patients
presenting at health facilities with suspected measles should be isolated
on admission to prevent nosocomial spread. If a diagnosis of measles is
suspected (fever over 39 degrees C [102.2 degrees F], rash, and one of the
following: cough, coryza, conjunctivitis), together with a possible history
of contact with a confirmed measles case, a blood and urine/throat swab
should be taken, and the new measles case investigation form should be
completed by the person diagnosing the patient. It is important to indicate
the date of onset of rash, the demographic details, age, and physical
address of the patient for follow-up purposes and outbreak response. The
measles case investigation form should accompany the specimens on ice to
the National Institute for Communicable Diseases, the regional
WHO-accredited laboratory. All specimens submitted to the NICD are tested
at no charge (the private sector included) as part of the National Expanded
Programme on Immunisation surveillance.

All close household contacts of the patient should receive a measles
vaccination (excluding pregnant women) within 72 hours of contact -- this
may provide some protection against measles infection. This primary
vaccination response should occur prior to the availability of the results,
to prevent as much spread as possible. Once a positive result is notified
by the laboratory, further investigation of possible spread should be
conducted and wider outbreak response vaccination offered, such as in
schools and creches. All positive cases should be notified to the local
authority health services' Communicable Disease Control directorates, as
required under the Health Act.

(Source: Epidemiology Division, Respiratory Virus and Viral Diagnostics
Units, Molecular Measles Unit, NICD; Communicable Disease Directorate,
Tshwane District and Gauteng Province)

--
communicated by:
ProMED-mail
<promed@promedmail.org>

[A breakdown of the data in terms of Measles IgM positive results per South
African province, measles IgM positive results by district of Gauteng
province, and by patient age can be viewed at
<http://www.nicd.ac.za/measles_out/measles_current.pdf>. The breakdown of
the data by week suggest that the outbreak in Gauteng provnce has now peaked.

A map of Gauteng province, which embraces Pretoria [now named Tshwane] and
Johannesburg, can be accessed at
<http://www.sa-venues.com/maps/gauteng_regional.htm>. The HealthMap/
ProMED-mail interactive map of South Africa is available at
<http://healthmap.org/r/00TQ>. - Mod.CP]

MEASLES - SOUTH AFRICA (06): (GAUTENG) PRISONERS
***********************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

[1]
Date: Sun 25 Oct 2009
Source: The Times Live [edited]
<http://www.timeslive.co.za/news/article166110.ece>


As 1135 cases of measles have been confirmed in South Africa -- 1034
of them in Gauteng [province] -- laboratory tests confirmed an
outbreak in Johannesburg Prison. Gauteng Health spokesman Mandla Sidu
said 8 prisoners who were admitted to Soweto's Baragwanath Hospital
last week have measles "The situation will have to be assessed to
stop the spread of the epidemic in the facility. In the meantime, we
will continue to roll out our immunisation campaign," he told The
Times on Sunday [25 Oct 2009]. Last week, the Department of
Correctional Services immunised babies and toddlers staying with
mothers incarcerated in the prison's women's section.

The Gauteng Health Department has, over the past few weeks, been
conducting a measles vaccination campaign at creches and schools in
the province. "The immunisation drive has been going well, but we are
still calling for parents to make sure that their child is taken for
the vaccine, because measles can be fatal if not treated," Sidu said.

The Health Ministry confirmed 4 deaths from measles since the
beginning of September [2009], including a 56-year-old woman,
children aged 4 and 2, and a baby aged 7 months.

During the 1st 8 months of this year [2009], there were 48 cases of
measles in Gauteng, but this has shot up to 1034 since September 2009.

[Byline: Nivashni Nair]

--
Communicated by:
ProMED-mail <promed@promedmail.org>

******
[2]
Date: Mon 26 Oct 2009
Source: Eye Witness News [edited]
<http://www.eyewitnessnews.co.za/article ... x?id=24838>


A measles outbreak at the Johannesburg Prison is worsening by the
day, with around 20 more prisoners diagnosed with the highly
infectious disease just this weekend alone. Those affected have been
isolated, while prison officials and inmates will be vaccinated from
Monday [26 Oct 2009].

Correctional Services Minister Nosiviwe Mapisa-Nqakula met
authorities at the facility on Sunday [25 Oct 2009]. She announced a
decision not to admit new inmates for the next few days. The effort
is part of a 10-day quarantine programme which starts on Monday [26
Oct 2009].

Mapisa-Nqakula said alternative arrangements have been made. "We are
requesting the police at the Johannesburg Central Police Station to
keep those people in holding cells. We are trying to take all steps
to make sure we contain the spread of the disease," said the minister.

[Byline: Imraan Karolia]

--
Communicated by:
HealthMap Alerts via
ProMED-mail <promed@promedmail.org>

[The measles outbreak in South Africa continues to escalate, with at
least 1134 cases and the deaths of an adult and 3 children in Gauteng
province alone. More than 20 prisoners in a Johannesburg prison have
contracted measles virus infection, which suggests that an
appreciable proportion of the adult population has escaped
immunisation and is at risk of infection.

A map of Gauteng province, which embraces Tshwane (Pretoria) and
Johannesburg, can be accessed at
<http://www.sa-venues.com/maps/gauteng_regional.htm>. The
HealthMap/ProMED-mail interactive map of South Africa is available at
<http://healthmap.org/r/00TQ>. - Mod.CP]

Südafrika - Masern
02.11.2009

Die Zahl der Masern-Erkrankungen stieg auch im Oktober weiter deutlich an. Inzwischen wurden landesweit 1.355 Fälle registriert. Fast alle Erkrankungen (90%) werden aus der Provinz Gauteng, insbesondere aus der Hauptstadt Tshwane (früher Pretoria) gemeldet. Auch Johannesburg meldete steigende Fallzahlen, in einem Gefängnis erkrankten hier zuletzt 20 Insassen. Bisher verstarben 4 Personen (ein Erwachsener und 3 Kinder) an Masernkomplikationen. Nach dem südafrikanischen Impfkalender wird gegen Masern im Alter von 9 Monaten und 18 Monaten geimpft. Nach dem deutschen Impfkalender sind 2 MMR-Impfungen für alle Kinder vorgesehen. Ein fehlender Impfschutz kann auch später jederzeit, z.B. anlässlich einer Reise, nachgeholt werden. / crm