ABSTRACT
BACKGROUND:The World Health Organization; African Region; set the goal of achieving measles elimination by 2020. Namibia was one of seven African countries to implement an accelerated measles control strategy beginning in 1996. Following implementation of this strategy; measles incidence decreased; however; between 2009 and 2011 a major outbreak occurred in Namibia.METHODS:Measles vaccination coverage data were analysed and a descriptive epidemiological analysis of the measles outbreak was conducted using measles case-based surveillance and laboratory data.RESULTS:During 1989 - 2008; MCV1 (the first routine dose of measles vaccine) coverage increased from 56% to 73% and five supplementary immunisation activities were implemented. During the outbreak (August 2009 - February 2011); 4 605 suspected measles cases were reported; of these; 3 256 were confirmed by laboratory testing or epidemiological linkage. Opuwo; a largely rural district in north-western Namibia with nomadic populations; had the highest confirmed measles incidence (16 427 cases per million). Infants aged =11 months had the highest cumulative age-specific incidence (9 252 cases per million) and comprised 22% of all confirmed cases; however; cases occurred across a wide age range; including adults aged =30 years. Among confirmed cases; 85% were unvaccinated or had unknown vaccination history. The predominantly detected measles virus genotype was B3; circulating in concurrent outbreaks in southern Africa; and B2; previously detected in Angola.CONCLUSION:A large-scale measles outbreak with sustained transmission over 18 months occurred in Namibia; probably caused by importation. The wide age distribution of cases indicated measles-susceptible individuals accumulated over several decades prior to the start of the outbreak
Subject(s)
Adult , Disease Outbreaks , MeaslesABSTRACT
INTRODUCTION: The protective effects of breastfeeding on early life respiratory infections are established, but there have been conflicting reports on protection from asthma in late childhood. The association of breastfeeding duration and lung function was assessed in 10-year-old children. METHODS: In the Isle of Wight birth cohort (n = 1456), breastfeeding practices and duration were prospectively assessed at birth and at subsequent follow-up visits (1 and 2 years). Breastfeeding duration was categorised as "not breastfed" (n = 196); "<2 months" (n = 243); "2 to <4 months" (n = 142) and ">or=4 months" (n = 374). Lung function was measured at age 10 years (n = 1033): forced vital capacity (FVC), forced expiratory volume in 1 s (FEV(1)), FEV(1)/FVC ratio and peak expiratory flow (PEF). Maternal history of asthma and allergy was assessed at birth. The effect of breastfeeding on lung function was analysed using general linear models, adjusting for birth weight, sex, current height and weight, family social status cluster and maternal education. RESULTS: Compared with those who were not breastfed, FVC was increased by 54.0 (SE 21.1) ml (p = 0.001), FEV(1) by 39.5 (20.1) ml(p = 0.05) and PEF by 180.8 (66.1) ml/s (p = 0.006) in children who were breastfed for at least 4 months. In models for FEV(1) and PEF that adjusted for FVC, the effect of breastfeeding was retained only for PEF (p = 0.04). CONCLUSIONS: Breastfeeding for at least 4 months enhances lung volume in children. The effect on airflow appears to be mediated by lung volume changes. Future studies need to elucidate the mechanisms that drive this phenomenon.
