Measles in Poland in 2002

In Poland 34 measles cases were registered in 2002 (0.09 per 100,000 population)--99 cases less than in the preceding year. Eleven (32%) cases occurred in unvaccinated persons, 9 (27%) in persons who had received only one dose of the vaccine and 14 (41%) in those vaccinated with two doses. The number of cases among the vaccinated population--23, including one case of vaccine associated measles--together with high vaccination coverage after 1975, indicates high effectiveness of measles vaccines used in Poland. Fifteen cases (44%) were confirmed serologically (IgM). Across the voivodeships the number of cases ranged from 0 in four voivodeships to 5 in the ?laskie voivodeship. In none of the voivodeships, however, did the incidence exceed 0.2 per 100,000. The most affected were infants (incidence 0.85 per 100,000), children in their second year of life (incidence 1.09) and children aged 5 and 6 years--incidence of 0.72 and 0.69 respectively. According to the immunization schedule these were children who should receive their first or subsequent dose of vaccine during the year 2002. Cases among children and adolescents below 15 years of age (26 cases) constituted 77% of all reported cases. Out of all reported cases 13 (38%) were hospitalized. There were no deaths due to measles in Poland in 2002.     

Epidemic measles in an isolated unvaccinated population, India

Between June and September, 1986, an outbreak of measles occurred in Pilkhi Primary Health Centre area (population 56,000) in Tehri Garhwal district, Uttar Pradesh, India. Overall, 1092 cases were identified and 62 died; case-fatality ratio was 5.7%. Illness was restricted primarily to children below 15 years of age; 38% cases were in children under 5 and 58% between 5-14 years of age. To better characterize the outbreak, a survey was conducted in 13 affected villages. The age of the cases ranged from 5 months to 19 years (median = 7.0 years). The age-specific attack rates were 22.4%, 54.5%, 46.2% and 35.3% for children under 1, 1-4, 5-9, 10-14 years of age respectively. In as many as four villages, the attack rate in children below ten was 80% or more. Secondary attack rate among family members was 70%. Overall, 82% of children with measles developed complications which consisted mainly of pneumonia, diarrhoea and dysentery. The age-specific case-fatality ratios in infants and children 1-4 years of age were 23.1% and 11.5% respectively; thereafter the rates tended to decline with increasing age and was higher in females than in males (less than 0.05). Pneumonia which was a complication in 39% of measles cases contributed to 56% of deaths. Traditional beliefs and customs in the area were strong and did not encourage treatment of measles cases. Although a measles vaccination programme has been launched in India since 1985, only 30 districts could be covered during the first year and another 90 during 1986.(ABSTRACT TRUNCATED AT 250 WORDS)     

Measles outbreak in the Republic of the Marshall Islands, 2003

BACKGROUND: Measles is a highly contagious viral infection. Measles transmission can be prevented through high population immunity (>or=95%) achieved by measles vaccination. In the Republic of the Marshall Islands (RMI), no measles cases were reported during 1989-2002; however, a large measles outbreak occurred in 2003. Reported 1-dose measles vaccine coverage among children aged 12-23 months varied widely (52-94%) between 1990 and 2000. METHODS: RMI is a Pacific island nation (1999 population: 50,840). A measles case was defined as fever, rash, and cough, or coryza, or conjunctivitis, in an RMI resident between July 13 and November 7, 2003. A vaccination campaign was used for outbreak control. RESULTS: Of the 826 reported measles cases, 766 (92%) occurred in the capital (Majuro). There were 186 (23%) cases in infants aged <1 year and 309 (37%) of cases in persons aged >or=15 years. The attack rate was highest among infants (Majuro atoll: 213 cases/1,000 infants). Among cases aged 1-14 years, 281 (59%) reported no measles vaccination before July 2003. There were 100 hospitalizations and 3 deaths. The measles H1 genotype was identified. The vaccination campaign resulted in 93% coverage among persons aged 6 months to 40 years. Interpretation Populations without endemic measles transmission can accumulate substantial susceptibility and be at risk for large outbreaks when measles virus is imported. 'Islands' of measles susceptibility may develop in infants, adults, and any groups with low vaccine coverage. To prevent outbreaks, high population immunity must be sustained by maintaining and documenting high vaccine coverage.     

Measles among under-9-month-olds in rural Bangladesh: its significance for age at immunization

Any decision to modify measles immunization strategies away from the use of the conventional vaccine given to children at 9 months of age to the adoption of recently proposed vaccine strains that can be given to 4-6-month-olds will depend on the age distribution of severe cases of measles in the community. Reported are the results of an analysis of two community-based measles surveillance systems in rural Bangladesh, which found that 17% of all measles cases reported for under-5-year-olds in a nonvaccinated population involved infants aged less than 9 months. In a vaccinated population from the same area, 31% of all measles cases reported for under-5-year-olds occurred among under-9-month-olds. Using a rather restrictive definition for measles-related deaths (those occurring within 6 weeks of the onset of the rash), the proportion of measles-related deaths that occurred before 9 months of age was 13% of all such deaths that were reported.     

Measles epidemic in Harare, Zimbabwe, despite high measles immunization coverage rates.

Despite rapidly increasing measles immunization coverage in Harare city, measles remains endemic, and regular outbreaks occur. The most recent occurred in 1988, when the measles immunization coverage was 83%. We have carried out a retrospective study of the clinical and epidemiological features of this outbreak to assess whether the present immunization policy needs to be changed. Of 4357 cases of measles seen at primary health care centres and hospitals in Harare during the outbreak, 1399 (32%) were severe or involved complications that required hospital admission. The peak incidence occurred among under-2-year-olds, followed by that among 5-7-year-olds. Poor nutritional status was significantly more frequent among children who were hospitalized and among those who died. A total of 59% of all cases aged 9-59 months had documented evidence of measles immunization. The most frequent complications, which occurred most often among under-5-year-olds, were diarrhoea with dehydration, pneumonia, laryngotracheobronchitis, and convulsions, which together affected 56% of hospitalized cases. The hospital case fatality rate was low (1.43%). In Harare, measles transmission remains a problem, despite high measles immunization coverage rates; the failure rate for the standard Schwarz measles vaccine also appears to be high. There is a need to reduce the number of measles cases among under-9-month-olds and young children. Further studies into alternative measles vaccines and schedules are required.     

Measles epidemic in Romania, 1996-1998: assessment of vaccine effectiveness by case-control and cohort studies

A measles epidemic occurred in Romania with 32,915 cases and 21 deaths reported between November 1996 and June 1998, despite high vaccination coverage since the early 1980s. Most cases were unvaccinated children aged <2 years and vaccinated school-aged children. A case-control study among preschool children and a cohort study among primary-school children were conducted to estimate effectiveness of Romanian-produced measles vaccine, and to evaluate age at vaccination and waning immunity as risk factors for vaccine failure. Both studies indicated that measles vaccine was highly effective. One dose reduced the risk for measles by 89% (95% confidence interval (CI) 85, 91); two doses reduced the risk by 96% (95% CI 92, 98). Children vaccinated at <1 year of age were not at increased risk for measles compared with children vaccinated at > or =1 year. Waning immunity was not identified as a risk factor since vaccine effectiveness was similar for children vaccinated 6-8, 9-11, and 12-14 years in the past. Because specific groups were not at risk for vaccine failure, an immunization campaign that targets all school-aged children who lack two doses may be an effective strategy for preventing outbreaks. A mass campaign followed by increased first-dose coverage should provide the population immunity required to interrupt indigenous measles virus transmission in Romania.     

Mumps in Poland in 2002

In 2002, 39,978 cases of mumps were reported in Poland. The incidence (104.6 per 100,000) was higher then in 2001 (43.3), which corresponds to a periodical increase of mumps incidence occurring in Poland every 3-4 years. This year's peak is much lower than the previous ones, which can be attributed to the growing vaccine coverage. Even though the mumps vaccine was not included into the national immunization program, the coverage in the 3-year old children reached in 2002 35.5%. Approximately 3.5% of cases were hospitalized (1400) and no mumps deaths were reported. Children 5-9 years old constituted the most affected age group (incidence 965.2 per 100,000). In Poland the MMR vaccine was recommended on voluntary basis in place of measles vaccine for children in their 2nd and 7th year of age. Immunization of 2-years old children is mandatory beginning in 2004.     

Fourteen years of shigellosis in Dhaka: an epidemiological analysis

We examined whether the proportion of Shigellae patients among diarrhoeal cases, the distribution, species, case-fatality rates and hospital visits changed over time in Dhaka. We isolated 19639 Shigella strains from 822812 diarrhoea cases treated at the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), between 1969 and 1982. The number of cases increased from 209 (2.5%) in 1969 to 4833 (7.7%) in 1976. Extrapolating from a 4% vigorous systematic sample of ICDDR,B hospital visits shigellosis cases and their proportion among diarrhoea cases increased to more than 9500 (12.0%) in 1981. The prevalence of various shigellae species altered over time. For example: in 1969 Shigella flexneri predominated in 74% of all Shigella cases; in 1973 Shigella dysenteriae accounted for 56%, and in 1981 Shigella flexneri again predominated (75%). More than 20% of all Shigella isolations were from infants: 60% in males and 40% in females. Over 7% of severe cases of Shigella infection referred from the outpatient department and admitted for treatment died. Nearly 40% of all the Shigella deaths were in infants of less than a year old while 49% were in 1-4 year old children. Increasing prevalence of shigellosis appears to be an important cause of diarrhoea in Dhaka especially among children. Areas with poor sanitation and water supply had higher prevalence. However, hospitalized cases represented a fraction of the actual problem. Resistance to antibiotics appears to be increasing and the development of new drugs and preventive methods within economic reach of less developed countries are crucial for reduction of the disease and related deaths.     

2001-2003年四川省麻疹流行病学分析及控制策略探讨

目的　探讨控制麻疹的策略和措施。方法　对四川省 2 0 0 1- 2 0 0 3年麻疹的发病情况、麻疹暴发疫情、麻疹疫苗接种率、麻疹疫苗强化免疫等进行综合分析。结果　四川省麻疹报告发病率呈上升趋势 ,发病以小年龄组和学龄儿童为主 ,1～ 14岁占 80 %以上 ;发病地域广泛 ,以春季高发 ;暴发病例占总病例的 10 4 4% ;10 73%的报告病例无免疫史 ,5 4 2 5 %免疫史不详。 2 0 0 2年对 8～ 30月龄儿童进行麻疹疫苗强化免疫后 ,根据出生队列分析 ,除 2岁组 (该年龄组全体儿童进行强化免疫 )发病率下降了 31 4 9%外 ,其余各年龄组发病率均较 2 0 0 2年有所上升。未开展麻疹强化免疫的各年龄组发病率上升幅度大于开展部分儿童强化免疫的 1岁和 3岁组发病率。结论　在麻疹常规接种率较低情况下 ,要在短时间内提高易感人群免疫力 ,应尽快对 14岁以下儿童进行麻疹强化免疫 ,以减少暴发 ,降低发病率。     

Measles epidemiology and outbreak response immunization in a rural community in Peru.

Only limited data are available on the impact of measles outbreak response immunization (ORI) in developing countries. We conducted a community survey in Espindola, a rural border community in northern Peru, following a measles outbreak and subsequent ORI to study the epidemiology and impact of the outbreak and to evaluate the costs and benefits of measles ORI. During the outbreak, 150 of the 553 Espindola residents developed clinical cases of measles. Adults accounted for 44.0% of cases, and were frequently identified as primary cases. The attack rate among all susceptible people was 45.5% and was highest (61.2%) for the 16-20 year age group. Among adults, significant risk factors for developing measles included being aged 16-20 years (relative risk [RR] = 3.06, 95% CI = 2.08, 4.49) and being male (RR = 1.73, 95% CI = 1.11, 2.71). Among serologically confirmed cases, 60.7% developed diarrhoea and 32.1% pneumonia. The overall case-fatality rate was 3.3%, but reached 19.1% in the 0-23-month age group. Failure to reach children through either routine immunization or national campaigns made this community vulnerable to the severe and extensive impact of measles virus importation. The ORI campaign targeted non-measles case children aged 6 months to 15 years, regardless of their previous immunization status, and was effective in terminating this measles outbreak and in preventing morbidity, loss of livelihood and death despite the involvement of large numbers of adults in measles transmission. The last measles case occurred within 3 weeks of completing ORI. The ORI campaign, which would have cost approximately US$ 3000 in 1998, saved as many as 1155 person-days of work among 77 adults, prevented an estimated 87 cases of diarrhoea and 46 cases of pneumonia, and averted 5 deaths.     

Measles outbreaks in the Mozambican refugee camps in Malawi: the continued need for an effective vaccine

Between November 1988 and January 1989, measles outbreaks occurred in 11 Mozambican refugee camps in Malawi with five camps principally affected. A total of 1214 cases were reported. Despite the reduction of the age of measles vaccination to six months in 1987, attack rates were highest in children aged 6-9 months (10-26%); rates were also high in the 0-5 month age group (3-21%). The case-fatality rate was high among children less than five years old (15-21%). Children were being inappropriately vaccinated, either being vaccinated at less than six months of age (2-29%) or failing to receive a second dose if vaccinated at six months (0-25%). With vaccine coverage between 66-87%, vaccine efficacy in children less than five years old was estimated to be more than 90% in the camps principally affected. Reduction of the age of vaccination leads to logistical problems in vaccine delivery in refugee situations. These outbreaks again indicate the need to improve vaccine coverage with the existing Schwarz vaccine, and also highlight the urgent need for an effective single dose measles vaccine for children less than nine months of age.     

Mumps in Poland in 2003

In 2003, 87,336 cases of mumps were reported in Poland. The incidence (228,7 per 100,000) was higher then in 2002(104.6), which corresponds to a periodical increase of mumps incidence. According to the natural periodicity the peak incidence would be expected to take place in 2002. The increase of mumps incidence in 2003, still lower however then the previous peaks, can be attributed to the prolongation of the epidemics cycle usually occurring with growing vaccine coverage. Even though the mumps vaccine was not included into the national immunization program, the coverage in 3-year old children in 2003 reached 39.6%. Approximately 4.6% of cases were hospitalized (4,056) and no mumps deaths were reported. Children 5-9 year old constituted the most affected age group (incidence 2,133.1 per 100,000). In Poland the MMR vaccine was recommended on voluntary basis in place of measles vaccine for children in their 2nd and 7th year of age. Immunization of 2-years old children is mandatory beginning in 2004.     

The epidemiology of measles in a partially vaccinated population in an African city: implications for immunization programs

A large outbreak of measles was reported in Pointe-Noire, Congo, between October 1984 and March 1985. An investigation was conducted to determine the epidemiology of measles in this community in which, in 1985, 54% of the children 12-23 months of age had documented evidence of vaccination against measles. The investigation included hospital and clinic record reviews and a community survey. Measles has been continuously transmitted in Pointe-Noire since at least 1979, with seasonal epidemics. In early 1984, the expected epidemic did not occur, and at least 1,000 measles hospital admissions and 100 measles deaths were prevented. Between October 1984 and March 1985, 1,942 measles cases were hospitalized, of which 306 (15.8%) died. During the epidemic, the proportion of nonpreventable cases (cases occurring before nine months of age) was 17%, reflecting the change in age distribution of measles cases in childhood since the immunization program started in Pointe-Noire in 1982. From the community survey, it was estimated that 13% of all children under age five years acquired measles in Pointe-Noire in 1985. Vaccine efficacy was calculated from community and hospital samples to be between 78% and 87%. Our findings suggest that increasing vaccination coverage levels to well above 50% is necessary to substantially reduce measles morbidity and mortality in African cities.     

2007～2009年章丘市麻疹流行特征分析

[目的]掌握章丘市麻疹流行特征,探讨近期高发原因,更好地控制疫情。[方法]对章丘市2007-2009年麻疹疫情资料进行分析。[结果]2007-2009年共报告麻疹141例,排除24例,实验室确诊117例,死亡1例。2007-2009年发病率分别为1.39/10万、7.93/10万、2.27/10万（P〈0.01）,平均为3.87/10万。年均发病率,城区为10.04/10万,乡村为3.36/10万（P〈0.01）;男性为4.53/10万,女性为3.21/10万（P〉0.05）;〈1岁为162.97/10万,≥1岁为2.34/10万（P〈0.01）。117例中,2-6月发病的占64.96%,3-11月龄的占40.17%,散居儿童占54.70%,无麻疹疫苗免疫史或免疫史不详的占88.03%。[结论]2007-2009年章丘市麻疹疫情有所升高,城区为高发地区,婴儿和散居儿童为高发人群。     

兰山区麻疹疫苗强化免疫效果分析

目的：进一步控制兰山区的麻疹疫情。方法：1999年度对该区149 016名8月龄—14岁儿童实施了麻疹疫苗(MV)强化免疫，接种率为97．38％。随后开展了麻疹免疫监测，应用酶联免疫吸附法(EHSA)检测麻疹和风疹IgM抗体，微量血凝抑制试验检测麻疹IgG抗体。结果：强化免疫后麻疹抗体阳转率达100％，GMT从1：5．56上升到1：52．68；经过流行病学观察，强化免疫后麻疹疫情被控制，2a后发病率下降到0．75／10万，麻疹发病数与1999年相比，下降了97．53％。检测79例麻疹疑似病例血清，其中麻疹IgM阳性16例，占20．25％；风疹IgM阳性12例，占15．19％。结论：开展麻疹强化免疫对控制麻疹效果非常显著。     

Evaluating the potential risks and benefits of infant rotavirus vaccination in England

Rotarix^®, a vaccine for the prevention of gastroenteritis in young children, was introduced in England in July 2013. At around this time, an elevated risk of intussusception (a cause of bowel obstruction) was reported among infants vaccinated in Australia and the USA. A risk-benefit analysis compared potential vaccine-related risks (additional intussusception admissions and deaths) with estimated vaccine benefits (prevented rotavirus general practitioner visits, emergency visits, admissions and deaths) in the 2012 birth cohort. Detailed data from England included the incidence of intussusception events aged <2 years by week of age, the coverage of vaccination aged <2 years by week of age, and the incidence of rotavirus gastroenteritis (RVGE) events aged <5 years by week of age. Recent estimates of vaccine-related risk from Australia were applied during the 1–21 day period after the first and second dose of vaccination. Rotarix^® is estimated to cause one additional intussusception admission in every 18,551 vaccinated English infants (5th and 95th percentiles, 6728–93,952), equivalent to 35 (7-98) additional intussusception admissions each year. The vaccine is estimated to prevent three rotavirus deaths, 13,000 rotavirus admissions, 27,000 rotavirus emergency visits and 74,000 rotavirus GP consultations in children aged <5 years, and lead to annual savings of over £11 million, each year. We estimate 375 (136-1900) fewer RVGE admissions for every additional intussusception admission, and 88 (18-852) fewer RVGE deaths for every additional intussusception death. The estimated benefits of Rotarix^® vaccination would greatly exceed the potential risk in England.     

Measles eradication: experience in the Americas

In 1994, the Ministers of Health from the Region of the Americas targeted measles for eradication from the Western Hemisphere by the year 2000. To achieve this goal, the Pan American Health Organization (PAHO) developed an enhanced measles eradication strategy. First, a one-time-only "catch-up" measles vaccination campaign is conducted among children aged 9 months to 14 years. Efforts are then made to vaccinate through routine health services ("keep-up") at least 95% of each newborn cohort at 12 months of age. Finally, to assure high population immunity among preschool-aged children, indiscriminate "follow-up" measles vaccination campaigns are conducted approximately every 4 years. These vaccination activities are accompanied by improvements in measles surveillance, including the laboratory testing of suspected measles cases. The implementation of the PAHO strategy has resulted in a marked reduction in measles incidence in all countries of the Americas. Indeed, in 1996 the all-time regional record low of 2109 measles cases was reported. There was a relative resurgence of measles in 1997 with over 20,000 cases, due to a large measles outbreak among infants, preschool-aged children and young adults in S?o Paulo, Brazil. Contributing factors for this outbreak included: low routine infant vaccination coverage, failure to conduct a "follow-up" campaign, presence of susceptible young adults, and the importation of measles virus, apparently from Europe. PAHO's strategy has been effective in interrupting measles virus circulation. This experience demonstrates that global measles eradication is an achievable goal using currently available measles vaccines.     

保定市2005—2009年麻疹发病的年龄特征

目的分析保定市2005—2009年麻疹发病年龄特征,为消除麻疹采取针对性的措施提供科学依据。方法对麻疹病例年龄构成比和年龄发病率进行描述性流行病学分析。结果 2005—2007、2008—2009年麻疹病例构成比,<8月龄人群构成比分别为12.67%、15.60%;≤2岁人群分别为40.3%、58.01%,呈上升趋势;3～7岁人群构成比分别为14.3%、12.3%,呈减少趋势;≥15岁人群麻疹病例分别占总病例的36.71%、26.40%。2005—2009年0～8岁各年龄发病率均在11.37/10万以上,其中≤1岁发病率最高。结论麻疹发病年龄主要特征是以小年龄为主,主要集中在≤2岁儿童。<8月龄婴儿构成比逐年上升,≥15岁人群麻疹病例占有较高的比例。建议提高2剂麻疹的接种率和8月龄婴儿麻疹及时接种率,适时开展8月龄～14岁儿童麻疹疫苗的强化免疫,加强成人麻疹疫情监测和人群免疫水平监测。     

成都市实施扩大免疫规划后麻疹流行病学特征及消除麻疹策略分析

要:目的 分析成都市麻疹流行病学特征和麻疹防控策略,为消除麻疹提供依据。〖HTH〗方法 对成都市2009-2014年麻疹发病情况进行描述性流行病学分析。结果 2009-2014年成都市确诊麻疹病例422例,无死亡,年平均发病率为5.11/100万,以2011年发病率最高为16.22/100万,发病时间集中在4-6月份占46.45%;＜8月龄儿童和15岁以上人群为发病主要人群:分别占30.81%、37.20%;发病人群儿童和民工占84.59%,户籍人口占60.66%;无免疫史和免疫不详的占80.81%,发病前7-21 d曾到医疗机构就诊占37.68%,基因型以为H1型和A型为主,分别占33.33%、66.67%。结论 成都市消除麻疹工作取得明显进展,应加强6岁以下散居儿童麻疹疫苗的常规免疫及查漏补种,提高8～11月龄儿童麻疹疫苗的及时接种率;加强流动儿童搜索和查漏补种工作;院内感染是麻疹发病的主要危险因素,落实预检分诊和病例隔离治疗措施,根据疫情对青年务工人员开展麻疹疫苗接种。     

洛阳市8月龄内婴儿麻疹流行病学分析

目的了解洛阳市〈8月龄麻疹病例流行病学特征。方法收集洛阳市2000--2006年麻疹监测系统报告的256例〈8月龄婴儿麻疹病例，将流行病学个案调查资料整理后，进行描述性统计分析。结果2000--2006年共发生〈8月龄麻疹病例256例，其中年龄在6～8月龄的196例，占总数的76．56％；全年均有病例发生，3-6月份为发病高峰。结论对未到免疫起始月龄（〈8月龄）的发病儿童要制定针对性措施和方案，以降低〈8月龄婴儿发病率。