Cobertura y factores asociados a la vacunación contra el sarampión en niños de 12 a 59 meses en Perú: estimación basada en la encuesta demográfica y de salud familiar 2017 / Coverage and factors associated with measles vaccination in children aged 12-59 months in Peru: estimate based on the 2017 demographic and family health survey

RESUMEN Objetivos . Estimar la cobertura y determinar los factores asociados a la vacunación contra el sarampión en Perú. Materiales y métodos . Realizamos un estudio de fuente secundaria utilizando la Encuesta Demográfica y de Salud Familiar (ENDES) del 2017, la unidad informante fue una mujer en edad fértil de 15 a 49 años; la unidad de análisis fue un niño de 12 a 59 meses (para la primera dosis) o niño de 18 a 59 meses (para la dosis de refuerzo) y que contaba con datos de vacunación. Los datos de cobertura fueron obtenidos de la tarjeta de vacunación. Resultados . Según la tarjeta de vacunación, la cobertura para la primera dosis fue del 70,2% (IC95%: 68,8-71,6), para la dosis de refuerzo del 52,0% (IC95%: 50,5-53,6). Los niños de 24-35 meses tuvieron más probabilidades de ser vacunados para la primera dosis (OR: 1,59; IC95%: 1,28-1,97) y dosis de refuerzo (OR:2,04; IC95%: 1,62-2,56) comparado con los niños de 12-23 meses y 18-23 meses respectivamente. Los niños cuyo control de crecimiento y desarrollo fue en el sector privado tuvieron menores probabilidades de ser vacunados para la primera dosis (OR: 0,30; IC95%: 0,21-0,43) y dosis de refuerzo (OR: 0,26; IC95%: 0,17-0,40) comparado con los que se controlaron en el sector público. Conclusiones . Según la ENDES 2017, Perú y ninguna de sus regiones alcanzó una cobertura del 95,0% para la primera dosis y su refuerzo. El control de crecimiento y desarrollo en establecimientos del sector público está asociado con la vacunación de sarampión en su primera dosis y refuerzo.

ABSTRACT Objectives . To estimate coverage and determine factors associated with measles vaccination in Peru. Materials and Methods . We conducted a secondary source study using the 2017 Demographic and Family Health Survey (ENDES). The reporting unit was a woman of childbearing age, 15 to 49 years; the unit of analysis was a child, 12 to 59 months (for the first dose), or a child, 18 to 59 months (for the booster dose) who had vaccination information. Coverage data were obtained from the vaccination card. Results . According to the vaccination card, coverage for the first dose was 70.2% (95% CI: 68.8-71.6); for the booster dose, 52% (95% CI: 50.5-53.6). Children aged 24-35 months were more likely to be vaccinated for the first dose (OR 1.59, 95% CI: 1.28-1.97) and booster dose (OR 2.04, 95% CI: 1.62-2.56), compared with children aged 12-23 months and 18-23 months respectively. Children with growth and development check-ups performed in the private sector were less likely to be vaccinated for the first dose (OR 0.30, 95% CI: 0.21-0.43) and booster dose (OR 0.26, 95% CI: 0.17-0.40), compared to those being monitored in the public sector. Conclusions . According to ENDES 2017, Peru and none of its regions achieved 95.0% coverage for the first and booster doses. Growth and development monitoring in public sector facilities is associated with measles vaccination in terms of first and booster doses.

Sarampión: antecedentes históricos y situación actual / Measles: historical background and current situation

Resumen: El sarampión sigue siendo una causa importante de morbilidad y mortalidad en el niño. Durante estos últimos años, se ha convertido en un problema de salud pública mundial, que se atribuye a bajas coberturas de vacunación observadas en diferentes países. Para su control se dispone de una vacuna a virus vivo, altamente eficaz, que fue empleada por primera vez en Chile en 1964, logrando cobertura en prácticamente todo el país en un breve plazo. Esta fue la primera experiencia mundial, imitada lue go por otros países que resulto en una importante caída de las tasas de morbilidad y de mortalidad. Su eficacia ha sido ampliamente demostrada, pero requiere de la mantención de coberturas superiores a 95%. En Chile persistió una situación de endemia de menor magnitud hasta el año 1993. En años recientes, ha habido algunos brotes reducidos y casos esporádicos vinculados a contactos con casos importados, sin embargo, según datos recientes, el sarampión está circulando ahora en más de 160 países en un nivel de propagación sin precedentes, siendo los viajeros infectados el principal vehículo de transmisión. En Chile, el Ministerio de Salud ha decidido reforzar y poner al día la vacunación de grupos susceptibles, en especial viajeros. En esta actualización se revisan aspectos históricos y la información actual de esta enfermedad que ha resurgido mostrando su alto impacto epidemiológico en la población pediátrica y adulta a nivel global.

Abstract: Measles is still a major cause of child morbidity and mortality. In recent years, it has become a global public health problem, attributed to low vaccination coverage observed in different countries. In order to control it, a highly effective live virus vaccine is available, which was used for the first time in Chile in 1964, covering practically the whole country in a short period of time. This was the first world experience, which was later imitated by other countries leading to a significant drop in mor bidity and mortality rates. Its effectiveness has been amply demonstrated, but it requires coverage maintenance higher than 95%. In Chile, minor endemic situation persisted until 1993. In recent years, there have been some reduced outbreaks and sporadic cases linked to contacts with imported cases, however, according to recent data, measles is now circulating in more than 160 countries at an unprecedented spread level, where infected travelers are the main vehicle of transmission. In Chile, the Ministry of Health has decided to strengthen and update the vaccination of susceptible groups, especially travelers. This update reviews historical aspects and current information on this re-emer ging disease, showing its high epidemiological impact on the pediatric and adult population globally.

Actualización situacion sarampion y acciones intensificadas de vigilancia y control / Update to measles situation and intensified actions on surveillance and control

El 28 de marzo de 2018 se confirmó un caso de sarampión en un bebe de 8 meses, residente de la Ciudad de Buenos Aires. En función de ello, y teniendo como escenario posible lo que está ocurriendo en la actualidad, desde el Ministerio de Salud de la CABA, se comenzaron a diseñar estrategias de abordaje de carácter preventivo, para promover el control de este evento en la población en general y, en particular, en los niños susceptibles: por un lado, todos los menores de 6 años que cuentan -o deberían contar- con al menos una dosis de triple viral (entre el año de vida y el inicio escolar) y, principalmente, aquellos que por calendario, no les corresponde vacunación (los menores de un año). El 19 de julio de 2018, a poco menos de 3 meses del caso confirmado previo (categorizado como "relacionado con la importación", luego de haber hallado la fuente de infección proveniente de Asia), se notificaron dos casos confirmados que se atendieron en efectores públicos de la Ciudad de Buenos Aires, un residente de CABA y otro de Provincia de Buenos Aires. En este apartado se actualiza la situación epidemiológica a la fecha y se detallan las acciones realizadas y por realizar para la prevención y control de este evento.(AU)

Progress towards elimination of measles in Kenya, 2003-2016

Introduction: measles is targeted for elimination in the World Health Organization African Region by the year 2020. In 2011, Kenya was off track in attaining the 2012 pre-elimination goal. We describe the epidemiology of measles in Kenya and assess progress made towards elimination.Methods: we reviewed national case-based measles surveillance and immunization data from January 2003 to December 2016. A case was confirmed if serum was positive for anti-measles IgM antibody, was epidemiologically linked to a laboratory-confirmed case or clinically compatible. Data on case-patient demographics, vaccination status, and clinical outcome and measles containing vaccine (MCV) coverage were analyzed. We calculated measles surveillance indicators and incidence, using population estimates for the respective years.Results: the coverage of first dose MCV (MCV1) increased from 65% to 86% from 2003-2012, then declined to 75% in 2016. Coverage of second dose MCV (MCV2) remained < 50% since introduction in 2013. During 2003-2016, there were 26,188 suspected measles cases were reported, with 9043(35%) confirmed cases, and 165 deaths (case fatality rate, 1.8%). The non-measles febrile rash illness rate was consistently > 2/100,000 population, and "80% of the sub-national level investigated a case in 11 of the 14 years. National incidence ranged from 4 to 62/million in 2003-2006 and decreased to 3/million in 2016. The age specific incidence ranged from 1 to 364/million population and was highest among children aged < 1 year.Conclusion: Kenya has made progress towards measles elimination. However, this progress remains at risk and the recent declines in MCV1 coverage and the low uptake in MCV2 could reverse these gains

Measles Elimination Activities in the Western Pacific Region: Experience from the Republic of Korea

We describe the global status of measles control and elimination, including surveillance and vaccination coverage data provided by the World Health Organization (WHO). Since 2000, two doses of measles vaccine (MCV2) became recommended globally and the achievement of high vaccination coverage has led to dramatic decrease in the measles incidence. Our finding indicates that, in the Western Pacific Region (WPR), substantial progress has been made to control measles transmission in some countries; however, the measles virus continues to circulate, causing outbreaks. The Republic of Korea (ROK) experienced a series of resurgence of measles due to the importation and healthcare-associated transmission in infants, however overall incidence and surveillance indicators met the WHO criteria for measles elimination. The ROK was verified to be measles-free along with Australia, Mongolia, and Macau, China in 2014. One of the effective elimination activities was the establishment of solid keep-up vaccination system in school settings. The lessons learnt from the measles elimination activities in Korea may contribute to enhancing the surveillance schemes and strengthening of vaccination programs in member countries and areas of WPR.

Panorama atual do sarampo no mundo: Risco de surtos nos grandes eventos no Brasil / Current landscape of measles in the world: risk of outbreaks in major events in Brazil

O sarampo é considerado uma das doenças infecciosas mais contagiosas do mundo (1), capaz de atingir todos os grupos etários, com risco particular em menores de cinco e naqueles entre 15 e 29 anos de idade (2), sendo uma das principais causas de morte evitáveis por vacina entre crianças (3). Frente aos recentes surtos de sarampo ocorridos no mundo, estaria o Brasil, que desde 2000 conseguiu eliminar a circulação do sarampo e na atualidade vem lidando apenas com surtos de pequena monta de casos importados, sob risco de grandes surtos durante a Copa do Mundo de 2014 e as Olimpíadas de 2016? Através de análises dos últimos surtos ocorridos em todo o mundo e pesquisa da cobertura vacinal no Brasil, os autores respondem a estas questões.

Measles is considered one of the most contagious diseases in the world (1). It’s able to reach all of age groups with particular risk in under five and 15-29 years old (2). It’s one of the main causes for evitable deaths for vaccine between children (3). According to recents measles outbreaks occurred in the world, Brazil is included in it, since 2000 has eliminated measles circulation and actually has been dealing with outbreaks of little dimension of imported cases, at risk of large outbreak during the World Cup 2014 and The Olympics Games 2016? Through analysis of the latest outbreaks ocurred all over the world and research of vaccine coverage in Brazil, the authors will answer to these questions.

Evaluation of a mass measles vaccination campaign among school childrenaged 7-14 years old in Denizli, Turkey.

Objective. To determine the pre-campaign level of measles seropositivity and to evaluate the effect of a mass measles vaccination campaign on measles seroposivity among primary school children in Denizli, Turkey. Methods. The study was completed in two socioeconomically different areas of Denizli, Turkey, with a sample size of 520 students. One primary school from each area and one classroom from each grade were randomly included in the sample. Before and 2-months after the measles mass vaccinations, blood samples were collected from the students and measles specific IgGs were studied. Results. The pre-campaign overall seropositivity was 74.7%. Post-campaign overall seropositivity increased to 96.5%. Precampaign seropositivity among 8-graders was significantly lower than that in other grades (57.5%, p<0.001) and the difference was explained by the number of vaccinations 8-graders received. Except for the number of vaccination doses, other factors did not have any effect on seropositivity. Conclusions. The mass measles vaccination programs have a potential to control measles for developing countries. In addition, more than one dose of measles vaccination is required for developing countries.

Measles vaccination response during kosi floods, Bihar, India 2008.

The Kosi floods of Bihar in 2008 led to initial rapid displacement followed by rehabilitation of the affected population. Strategically planned phase-wise activity of supplementary as well as primary measles vaccination combined with a variety of other interventions proved to be successful in preventing outbreaks and deaths due to measles. While 70% supplementary measles vaccination coverage was achieved in relief camps, the coverage of primary measles doses in the latter phases was dependant on accessibility of villages and previous vaccination status of eligible beneficiaries. The integrated diseases surveillance system, which became operational during the floods, also complemented the vaccination efforts by providing daily figures of cases with fever and rash. The overall response was not only successful in terms of preventing measles mortality, but also provided vital lessons that may be useful for planning future vaccination responses in emergency settings.

Two doses of measles vaccine reduce measles deaths.

Two doses of measles vaccine to children reduce measles related deaths. The first dose is delivered through the routine immunization system to infants and the 2nd dose through campaigns or routine immunization system, whichever strategy reaches the highest coverage in the country. Experience in 46 out of 47 measles priority countries has shown that measles vaccination using mass vaccination campaigns can reduce measles related deaths, even in countries where routine immunization system fails to reach an important proportion of children. The gradual adoption of this strategy by countries has resulted in 74% reduction in measles related deaths between 2000 and 2007. The 2010 goal to reduce measles mortality by 90% compared with 2000 levels is achievable if India fully implements its plans to provide a second dose measles vaccine to all children either through campaigns in low coverage areas or through routine services in high coverage areas. Full implementation of measles mortality reduction strategies in all high burden countries will make an important contribution to achieving Millennium Development Goal 4 to reduce child mortality by two thirds in 2015 as compared to 1990.

Seroprevalence of antibodies to measles, mumps, and rubella among Thai population: evaluation of measles/MMR immunization programme.

Stored serum specimens, from four regions of Thailand, of healthy children attending well baby clinics and of healthy people with acute illnesses visiting outpatient clinics were randomly sampled and tested for IgG antibody to measles, mumps, and rubella (MMR). The immunity patterns of rubella and mumps fitted well with the history of rubella and MMR vaccination, seroprotective rates being over 85% among those aged over seven years. A high proportion of younger children acquired the infection before the age of vaccination. MMR vaccination should preferably be given to children at an earlier age. For measles, 73% seroprotective rates among children, aged 8-14 years, who should have received two doses of measles/MMR vaccine, were lower than expected. This finding was consistent with the age-group reported in outbreaks of measles in Thailand. The apparent ineffectiveness (in relation to measles) of MMR immunization of 1st grade students warrants further studies.

Validity of Measles Immunization Certificates Submitted upon Enrollment in an Elementary School in Korea / 예방의학회지

OBJECTIVES: To increase the booster vaccination rate, the Korean government legislated a measles vaccination for elementary school students in 2001, requiring parents to submit a certificate of vaccination upon the admission of the students to elementary school. The purpose of this study was to evaluate the validity of measles vaccination certificates which were issued to parents. METHODS: Using questionnaire survey data of 890 general practitioners and 9,235 parents in 2005, we investigated the evidence for booster vaccination certificates of measles. RESULTS: In the survey of general practitioners, 59.5% of the certificates depended on the medical records of clinic, 13.5% was immunization booklets, 23.7% was re-immunizations, 1.9% was confirmation of record of other clinics, and 1.4% was parents' statements or requests without evidence. In the survey of parents, 36.2% of the certificates depended on the medical records of clinic, 43.4% was immunization booklets, 18.0% was reimmunizations, and 2.4% was parents statements or requests without evidence. CONCLUSIONS: Our findings show that a majority of the booster vaccination certificates of measles was issued on the basis of documented vaccinations and it means that the implementation of the law requiring the submission of elementary school students' vaccination certificates has been very successful in Korea.

Measles related complications and the role of vitamin A supplementation.

OBJECTIVE: Measles is associated with high rate of complications and contributes to a major proportion of childhood morbidity and mortality. The role of vit A supplementation (VAS) in the case management of measles and prevention of complications is partially understood and not sufficiently supported by epidemiological data. This paper analyses the possible role of vit A supplementation in prevention of measles related complications and associated fatality. METHODS: A cross sectional study was carried out during an outbreak of measles in Shivpuri, India. A total population of 193,000 was covered by house to house visit and, the caregivers of total 1204 measles cases, including 214 cases with complications, were interviewed using a semi structured interview schedule. The analysis of data was done using Epi Info. RESULTS: The attack rate of 6.7% and rate of complications at 17.8% were found in this investigation. The coverage with routine measles vaccine and the vit A supplementation was 18.3% and 28.9% respectively. The management of measles cases was poor with only 15.8% cases receiving therapeutic doses of vit A. Both complications and case fatality rate was higher amongst children who had not received vit A supplementation in previous 6 months (p<0.05). Measles vaccine also found to have preventive effect on development of complications (p<0.05). CONCLUSION: Routine vit A supplementation and measles vaccination reduce the chances of complications amongst cases of measles. The role of VAS becomes more important when the case management is poor. While, measles is frequently associated with complications in the Indian setting, there is a need of enhancing the efforts to improve the delivery of vit A supplementation and measles vaccine to the children in rural areas.

Congenital rubella syndrome in infants of women vaccinated during or just before pregnancy with measles-rubella vaccine.

BACKGROUND & OBJECTIVE: Measles and Rubella Control Campaign was conducted in Iran in December 2003 targeting both males and females 5 to 25 yr old using measles-rubella vaccine. During the campaign, some pregnant women received vaccine during the first trimester of pregnancy or some others became pregnant shortly thereafter. The goal of this study was to evaluate the risk of congenital rubella syndrome (CRS) among the infants born to the vaccinated mothers. METHODS: A total of 106 pregnant women, who had received vaccine during the first trimester of pregnancy or become pregnant less than three months after vaccination were included in the study for comparison 40 pregnant women without rubella vaccine were also included. The mothers' blood samples at the time of delivery, infants' cord blood and blood samples at the end of the second month of birth of sixty children whose parents agreed about blood sampling, were tested for rubella IgM and IgG antibodies using ELISA method. RESULTS: There were 107 live births in the exposed group and 42 in the control group. Serological study showed no IgM rubella antibody in the maternal and infant cord blood; it was not found in the second blood specimens of 60 infants tested at 8 wk of age. IgG rubella antibody was positive in all infants' cord blood but it decreased in the second blood specimens of the infants. None of the children exhibited signs of congenital rubella syndrome. INTERPRETATION & CONCLUSION: Finding of our study showed that none of the infants born to mothers vaccinated by MR vaccine during the first trimester of pregnancy or had become pregnant within three months after vaccination, had CRS.

Factors affecting compliance with the measles vaccination schedule in a Brazilian city / Fatores que afetam a adesão ao calendário de vacinação contra o sarampo numa cidade brasileira

CONTEXT AND OBJECTIVE: The success of vaccination campaigns depends on the degree of adherence to immunization initiatives and schedules. Risk factors associated with children's failure to receive the measles vaccine at the correct age were studied in the city of São Paulo, Brazil. DESIGN AND SETTING: Case-control and exploratory study, in the metropolitan area of São Paulo. METHODS: The caregivers of 122 children were interviewed regarding their perceptions and understanding about the measles vaccination and the disease. RESULTS: The results showed that age, region of residence, marital status and education level were unrelated to taking measles vaccines adequately. Most individuals remembered being informed about the last annual vaccination campaign by television, but no communication channel was significantly associated with vaccination status. The answers to questions about knowledge of the disease or the vaccine, when analyzed alone, were not associated with taking measles vaccinations at the time indicated by health agencies. The results showed that, when parents felt sorry for their children who were going to receive shots, they delayed the vaccination. Most of the children did not take the measles vaccination on the exactly recommended date, but delayed or anticipated the shots. CONCLUSION: It is clear that there is no compliance with the government's recommended measles vaccination schedule (i.e. first dose at nine and second at 15 months of age, as recommended in 1999 and 2000). Feeling sorry for the children receiving shots can delay vaccination taking.

CONTEXTO E OBJETIVO: O sucesso das campanhas de vacinação depende da adesão às iniciativas e ao calendário de imunização. Fatores de risco associados com não tomar a vacina contra o sarampo na idade recomendada foram estudados na cidade de São Paulo. TIPO DE ESTUDO E LOCAL: Estudo caso-controle e exploratório, realizado na área metropolitana de São Paulo. MÉTODO: Cuidadores de 122 crianças foram entrevistados sobre sua percepção e compreensão sobre a vacina contra o sarampo e sobre a doença. RESULTADOS: Os resultados mostraram que idade, região de residência, status marital ou nível educacional não se relacionaram com a tomada adequada das vacinas contra o sarampo. A maioria dos indivíduos lembrou-se de ter sido informada sobre a última campanha nacional de vacinação na televisão, mas nenhum canal de comunicação se associou significativamente com o status vacinal. As respostas às questões sobre conhecimentos a respeito da doença e da vacina, quando analisadas em separado, não se associaram à tomada das vacinas nas datas indicadas pelas instituições de saúde. Os resultados mostraram que quando os pais sentiam dó ao verem os filhos tomando as injeções, eles atrasavam a vacinação por pelo menos 20 dias. A maioria das crianças não toma a vacina contra o sarampo exatamente no dia recomendado, mas atrasa ou antecipa as injeções. CONCLUSÃO: Esta claro que não há aderência ao calendário governamental recomendado de vacinação contra o sarampo (i.e. primeira dose aos 9 e segunda dose aos 15 meses de idade, como recomendado em 1999 e 2000). Sentir pena de ver a criança recebendo uma injeção pode atrasar a tomada da vacina.

Epidemiological Investigation of a Measles Outbreak in a Preschool in Incheon, Korea, 2006 / 예방의학회지

OBJECTIVES: This study describes a plan that was designed to prevent a measles outbreak that showed a changed outbreak pattern. This study is based on the epidemiological investigation of a measles outbreak in a preschool in Incheon, Korea, 2006. METHODS: The subjects were 152 students at a preschool where a measles outbreak occurred. A questionnaire survey was conducted and serological testing for measlesspecific IgM was preformed. RESULTS: Of the fifteen confirmed, identified cases, eleven patients had been vaccinated with one dose, one patient had received two doses and three patients were unvaccinated. The three unvaccinated cases consisted of one 5-year-old child, one 3-year-old child and one 16-month-old infant. For the cases with one dose of the vaccination, there were 11 cases, which consisted of six 5-year-old children, two 4-year-old children, two 3-year-old children and one 2-year-old child. The case with two doses of the vaccination was one 4-year-old child. The attack rate of measles was 100% in the 0-dose group, 11.2% in the 1-dose group and 2.0% in the 2-dose group. The vaccine's efficacy was 88.8% in the 1-dose group and 98.0% in the 2-dose group. The vaccine effectiveness for the 2-dose group was higher than that of the 1-dose group. CONCLUSIONS: High coverage with a 2-dose vaccination should be maintained, and the vaccination should be given at the suitable time to prevent a measles outbreak with a changed outbreak pattern.