Progress towards measles elimination in Singapore |
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| Institution: | 1. Department of Clinical Epidemiology, Tan Tock Seng Hospital, Singapore;2. Public Health Group, Ministry of Health, Singapore;3. Department of Pathology, Singapore General Hospital, Singapore;4. Department of Paediatric Medicine, KK Women''s and Children''s Hospital, Singapore;5. Duke-National University of Singapore Graduate Medical School, Singapore;6. Yong Loo Lin School of Medicine, National University of Singapore, Singapore;7. Saw Swee Hock School of Public Health, National University of Singapore, Singapore;1. Department of Immunology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, United States;2. Department of Veterinary Sciences, The University of Texas M.D. Anderson Cancer Center, Bastrop, TX, United States;3. Department of Pathology and Laboratory Medicine, Emory Vaccine Center, Emory University, Atlanta, GA, United States;4. Department of Internal Medicine, Division of Infectious Diseases, Translational Immunovirology Program, Department of Immunology, Department of Molecular Medicine, Mayo Clinic, Rochester, MN, United States;1. Infectious Disease Service, Department of Paediatric Medicine, KK Women''s and Children''s Hospital, 100 Bukit Timah Road, Singapore 229899, Singapore;2. Department of Pathology and Laboratory Medicine, KK Women''s and Children''s Hospital, 100 Bukit Timah Road, Singapore 229899, Singapore;3. Research & Strategic Planning, Health Promotion Board, 3 Second Hospital Ave, Singapore 168937, Singapore |
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| Abstract: | ObjectiveWe describe the epidemiological trends of measles in Singapore in relation to its progress towards measles elimination and identify gaps in fulfilling the World Health Organization Western Pacific Regional Office regional measles elimination criteria.MethodsEpidemiological data on measles maintained by the Communicable Diseases Division, Ministry of Health from 1981 to 2012 were collated and analysed. Data on measles vaccination coverage were obtained from the National Immunization Registry and School Health Services, Health Promotion Board. To assess the seroprevalence of the population, the findings of periodic seroepidemiological surveys on measles were traced and reviewed.FindingsWith the successful implementation of the National Childhood Immunization Programme using the monovalent measles vaccine, measles incidence declined from 88.5 cases per 100,000 in 1984 to 6.9 per 100,000 in 1991. Resurgences were observed in 1992, 1993 and 1997. A ‘catch-up’ vaccination programme using the trivalent measles, mumps and rubella (MMR) vaccine was conducted in 1997, followed by introduction of the two-dose vaccination schedule in January 1998. Measles incidence subsequently declined sharply to 2.9 per 100,000 in 1998. Vaccination coverage was maintained at 95% for the first dose and 92–94% for the second dose. Seroprevalence surveys showed seropositivity for measles IgG antibodies in over 95% of adults in 2004, and in 83.1% of children aged 1–17 years in 2008–2010. Sporadic cases with occasional clusters of two or more cases continued to occur among the unvaccinated population, especially children aged below 4 years. The predominant measles virus genotype has shifted from D9 to the B3 and G3 genotypes, which are endemic in neighbouring countries.ConclusionSingapore has made good progress towards the elimination of endemic measles. To further eliminate sporadic cases of measles, the national immunisation schedule has recently been amended to vaccinate children with 2 doses of MMR vaccine before 2 years of age. |
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| Keywords: | Measles Immunisation Seroepidemiology Surveillance Genotypes Singapore |
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