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Further efforts needed to achieve measles elimination in Germany: results of an outbreak investigation.

ABSTRACT: OBJECTIVE:To determine morbidity and costs related to a large measles outbreak in Germany and to identify ways to improve the country's national measles elimination strategy. METHODS:We investigated a large outbreak of measles in the federal state of North Rhine-Westphalia (NRW) that occurred in 2006 after 2 years of low measles incidence (< 1 case per 100,000). WHO's clinical case definition was used, and surveillance data from 2006 and 2001 were compared. All cases notified in Duisburg, the most severely affected city, were contacted and interviewed or sent a questionnaire. Health-care provider costs were calculated using information on complications, hospitalization and physician consultations. FINDINGS:In NRW, 1749 cases were notified over a 48-week period. Compared with 2001, the distribution of cases shifted to older age groups (especially the 10-14 year group). Most cases (n = 614) occurred in Duisburg. Of these, 81% were interviewed; 15% were hospitalized and two died. Of the 464 for whom information was available, 80% were reported as unvaccinated. Common reasons for non-vaccination were parents either forgetting (36%) or rejecting (28%) vaccination. The average cost per measles case was estimated at 373 euros. CONCLUSION:An accumulation of non-immune individuals led to this outbreak. The shift in age distribution has implications for the effectiveness of measles control and the elimination strategy in place. Immediate nationwide school-based catch-up vaccination campaigns targeting older age groups are needed to close critical immunity gaps. Otherwise, the elimination of measles in Germany and thus in Europe by 2010 will not be feasible.

SUBMITTER: Wichmann O

PROVIDER: S-EPMC2636188 | biostudies-literature | 2009 Feb

REPOSITORIES: biostudies-literature

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Further efforts needed to achieve measles elimination in Germany: results of an outbreak investigation.

Wichmann Ole O Siedler Anette A Sagebiel Daniel D Hellenbrand Wiebke W Santibanez Sabine S Mankertz Annette A Vogt Georg G Treeck Ulrich van Uv Krause Gérard G

Bulletin of the World Health Organization 20090201 2

<h4>Objective</h4>To determine morbidity and costs related to a large measles outbreak in Germany and to identify ways to improve the country's national measles elimination strategy.<h4>Methods</h4>We investigated a large outbreak of measles in the federal state of North Rhine-Westphalia (NRW) that occurred in 2006 after 2 years of low measles incidence (< 1 case per 100,000). WHO's clinical case definition was used, and surveillance data from 2006 and 2001 were compared. All cases notified in D ...[more]

PMID: 19274362

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Project description:BackgroundTremendous progress has been made in the last ten years in reducing morbidity and mortality caused by malaria, in part because of increases in global funding for malaria control and elimination. Today, many countries are striving for malaria elimination. However, a major challenge is the neglect of cross-border and regional initiatives in malaria control and elimination. This paper seeks to better understand Global Fund support for multi-country initiatives.MethodsDocuments and proposals were extracted and reviewed from two main sources, the Global Fund website and Aidspan.org. Documents and reports from the Global Fund Technical Review Panel, Board, and Secretariat documents such as guidelines and proposal templates were reviewed to establish the type of policies enacted and guidance provided from the Global Fund on multi-country initiatives and applications. From reviewing this information, the researchers created 29 variables according to eight dimensions to use in a review of Round 10 applications. All Round 10 multi-country applications (for HIV, malaria and tuberculosis) and all malaria multi-country applications (6) from Rounds 1 - 10 were extracted from the Global Fund website. A blind review was conducted of Round 10 applications using the 29 variables as a framework, followed by a review of four of the six successful malaria multi-country grant applications from Rounds 1 - 10.FindingsDuring Rounds 3 - 10 of the Global Fund, only 5.8% of grants submitted were for multi-country initiatives. Out of 83 multi-country proposals submitted, 25.3% were approved by the Technical Review Panel (TRP) for funding, compared to 44.9% of single-country applications. The majority of approved multi-country applications were for HIV (76.2%), followed by malaria (19.0%), then tuberculosis (4.8%). TRP recommendations resulted in improvements to application forms, although guidance was generally vague. The in-depth review of Round 10 multi-country proposals showed that applicants described their projects in one of two ways: a regional 'network approach' by which benefits are derived from economies of scale or from enhanced opportunities for mutual support and learning or the development of common policies and approaches; or a 'cross-border' approach for enabling activities to be more effectively delivered towards border-crossing populations or vectors. In Round 10, only those with a 'network approach' were recommended for funding. The Global Fund has only ever approved six malaria multi-country applications. Four approved applications stated strong arguments for a multi-country initiative, combining both 'cross-border' and 'network' approaches.ConclusionWith the cancellation of Round 11 and the proposal that the Global Fund adopt a more targeted and strategic approach to funding, the time is opportune for the Global Fund to develop a clear consensus about the key factors and criteria for funding malaria specific multi-country initiatives. This study found that currently there was a lack of guidance on the key features that a successful multi-country proposal needs to be approved and that applications directed towards the 'network' approach were most successful in Round 10. This type of multi-country proposal may favour other diseases such as HIV, whereas the need for malaria control and elimination is different, focusing on cross-border coordination and delivery of interventions to specific groups. The Global Fund should seek to address these issues and give better guidance to countries and regions and investigate disease-specific calls for multi-country and regional applications.

Project description:Background: Measles transmissions due to case importations challenge public health systems globally and herd immunities in all countries. In 2019, an imported measles case and its subsequently outbreak was found in the Zhoushan Islands. Here, the process of epidemiological investigation and virus tracing were summarized to provide references for the prevention and control of measles in the future. Materials and methods: The data on the demographic, epidemiological, and clinical manifestation of measles cases in this outbreak were collected. The 450 bp fragments of the measles virus (MeV) N gene were amplified and sequenced. The genome of the first imported case was further isolated. Then, the maximum-likelihood and time-scaled phylogenetic analysis was conducted. Results: A total of 28 measles cases were confirmed. Their onsets were between March 13 and May 18, 2019. The first patient was from the Ukraine. He was confirmed at the Fever Clinic in Zhoushan hospital on March 15, 2019 and at the same time, another patient had visited the hospital due to another illness and 10 days later, this second case had onset (March 25, 2019). The epidemic curve shows sustained community transmission. The majority of the following cases (19/26) were clustered on the Donggang street which was close to where the second case worked. The 22 measles virus strains successfully isolated from this outbreak all belonged to the D8.2a sub-cluster and clustered with the KY120864/MVs/GirSomnath.IND/42.16/[D8] which was the predominant genotype in the Ukraine during 2018-2019. The analysis of the complete D8 genotype genome pointed to the fact that this prevailing strain originated from India in 2015 and its substitution rate was estimated as 6.91 × 10-4 (5.64-7.98 × 10-4) nucleotide substitutions/site/year. Conclusion: This outbreak was caused by an imported case from the Ukraine. There was a possible nosocomial infection between the first case and the second case. Then, the second case played an important role in the spread of virus due to her occupation. The molecular phylogenetic analysis could help to track the origin of the virus. Increasing and maintaining the high level of vaccination coverage (?95%) and an efficient response to imported cases are essential to prevent and control the recurrence and outbreak of measles virus.

Project description:BackgroundMeasles is one of the most contagious diseases caused by an acute viral illness called Morbillivirus that usually occurs as an outbreak in low-income countries. As of May 2016 measles suspected outbreak was reported from Sekota Zuria district. We investigated the outbreak to identify its possible sources and risk factors of acquiring the infection in the district.MethodWe conducted a 1:2 unmatched case-control study in May 2016 in Sekota Zuria district, Northern Ethiopia. Cases involved in the study were lab confirmed and epidemiologically linked. Controls were those who had no clinical signs of measles and residing in the same communities where the cases were identified. An interviewer-administered questionnaire was used to collect the data. Data were cleaned and entered to Epi-info7 and analyzed using SPSS-20. A logistic regression analysis was conducted to identify risk factors associated with measles infection at a p-value ≤0.05.Results29 cases were identified during the outbreak investigation. The probable source of an outbreak was an index case who had a travel history to a district with a measles epidemic. Five samples were collected for confirmation of the diagnosis. No measles-related deaths were reported. The median age of cases and controls was 15 years (SD ± 7.8) and 11 years (SD ± 9.8), respectively. More than 55% of the cases were in age ≥ 15 years. In the multivariable analysis, being previously vaccinated for measles reduced the risk of measles infection by 83% (AOR, 95%CI = 0.17, 0.05-0.53) and having a contact history increased the risk of measles infection by 3.44 times (AOR, 95%CI = 3.44, 1.26-9.38).ConclusionWe confirmed a measles outbreak in Sekota Zuria district. The majority of the cases were in age ≥ 15 years. Being un-vaccinated and having a contact history with confirmed or suspected cases were increased the risk of measles infection. To catch up with missed children at the time of the first dose of measles vaccine and reduce their susceptibility, supplementary immunization activities (SIAs) or immunization campaigns shall be strengthened.

Project description:BackgroundThe Syrian conflict has dramatically changed the public health landscape of Syria since its onset in March of 2011. Depleted resources, fractured health systems, and increased security risks have disrupted many routine services, including vaccinations, across several regions in Syria. Improving our understanding of infectious disease transmission in conflict-affected communities is imperative, particularly in the Syrian conflict. We utilize surveillance data from the Early Warning Alert and Response Network (EWARN) database managed by the Assistance Coordination Unit (ACU) to explore trends in the incidence of measles in conflict-affected northern Syria and analyze two consecutive epidemics in 2017 and 2018.MethodsWe conducted a retrospective time-series analysis of the incidence of clinically suspected cases of measles using EWARN data between January 2015 and June 2019. We compared regional and temporal trends to assess differences between geographic areas and across time.ResultsBetween January 2015 and June 2019, there were 30,241 clinically suspected cases of measles reported, compared to 3193 cases reported across the whole country in the decade leading up to the conflict. There were 960 regional events that met the measles outbreak threshold and significant differences in the medians of measles incidence across all years (p-value < 0.001) and in each pairwise comparison of years as well as across all geographic regions (p-value < 0.001). Although most governorates faced an elevated burden of cases in every year of the study, the measles epidemics of 2017 and 2018 in the governorates of Ar-Raqqa, Deir-Ez-Zor, and Idlib accounted for over 71% of the total suspected cases over the entire study period.ConclusionsThe 2017 and 2018 measles epidemics were the largest since Syria eliminated the disease in 1999. The regions most affected by these outbreaks were areas of intense conflict and displacement between 2014 and 2018, including districts in Ar-Raqqa, Deir-Ez-Zor, and Idlib. The spread of measles in northern Syria serves as an indicator of low immunization coverage and limited access to care and highlights the Syrian peoples' vulnerability to infectious diseases and vaccine preventable diseases in the setting of the current conflict.

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Further efforts needed to achieve measles elimination in Germany: results of an outbreak investigation.

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Further efforts needed to achieve measles elimination in Germany: results of an outbreak investigation.

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