The Effort to Attain Measles Pre-elimination Targets by 2012 and to Eliminate Measles in the African Region by 2020

Reduction in measles mortality contributes significantly towards attaining the Millennium Development Goal 4 (MDG 4); which aims to reduce overall under-five childhood deaths by two thirds by 2015; compared with 1990 levels. Routine measles immunization coverage is a key indicator for measuring progress towards attainment of this goal. Implementation of measles mortality reduction strategies in the African Region has led to major achievements; notably a reduction of estimated measles deaths by 92between 2000 and 2008. Despite the progress made; renewed commitment by countries is required to attain the pre-elimination targets and subsequently reach the ultimate goal of measles elimination by 2020. Countries will need to strengthen their immunization systems through ensuring that quality immunization services reach the hard-to-reach populations in addition to scaling up implementation of proven approaches and strategies such as the Reaching-Every-District approach. Gaps in the mobilization of resources have had a negative impact on the ability of countries to attain and sustain a high level of routine immunization and supplemental immunization activities coverage. Countries will also need to adopt a stepwise approach towards achieving the measles elimination goal by 2020; beginning with the attainment by 2012 of the proposed pre-elimination targets

Propositions pour une stratégie alternative de lutte contre la trypanosomiase humaine africaine en Afrique Centrale

Autour de l'execution du Programme National de Lutte contre la Trypanosomiase en Republique Centrafricaine au cours de la periode 1990-1992 s'est instauree une reflexion valant proposition pour une approche strategique differente. La chaine de prospection alors utilisee reposait sur des methodes classiques de depistage immunologique; de recherche parasitologique et de traitement des trypanosomes averes. Un piegeage etait par ailleurs entrepris. En depit des contraintes habituelles; politiques et techniques; qui pesent sur les programmes de lutte; le Programme National a connu un deroulement satisfaisant pendant deux ans. Pourtant; du fait de la strategie utilisee dans le foyer hyper-endemique de Nola; de nombreux suspects immunologiques ne rentraient pas en traitement; en meme temps que restait stable l'incidence. La nouvelle strategie proposee consiste a instaurer un traitement pour tous les suspects immunologiques meme si la recherche parasitaire reste negative. L'inconvenient principal de cette approche se situe au niveau du traitement a la Pentamidine de sujets consideres a tort en phase I (faux positifs immunologiques). Le risque iatrogene discute est celui d'un diabete potentiellement induit. D'autres contraintes; logistiques; d'acceptabilite et de faisabilite doivent etre apprecies. Pourtant; face a un foyer hyper-endemique; il semble judicieux de proposer aux autorites nationales ce changement strategique