ProMED Digest Friday, September 21 2007 Volume 2007 : Number 485
In this issue:
PRO/AH/EDR> Ebola hemorrhagic fever - Congo DR (05): WHO
PRO/AH/EDR> Rabies, bat - Canada (ON) (02)
PRO/EDR> Chikungunya - Italy (Emilia Romagna) (06)
PRO/PL> Stripe rust, wheat - Australia (SA): new strain
PRO/AH/EDR> Avian influenza (159): Nigeria (Nasarawa)
PRO/EDR> Measles - Kenya: 2002-2007 update
See the end of the digest for information on how to retrieve back issues.
----------------------------------------------------------------------
Date: Thu, 20 Sep 2007 17:58:34 -0400 (EDT)
From: ProMED-mail
Subject: PRO/AH/EDR> Ebola hemorrhagic fever - Congo DR (05): WHO
EBOLA HEMORRHAGIC FEVER - CONGO DR (05): WHO
********************************************
A ProMED-mail post
ProMED-mail is a program of the
International Society for Infectious Diseases
Date: Thu 20 Sep 2007
Source: World Health Organization (WHO), CSR, Disease Outbreak News [edited]
As of Thu 20 Sep 2007, The Ministry of Health (MoH) of the Democratic
Republic of the Congo (DRC), with the support of international partners, is
continuing field investigations to determine the extent of the outbreak of
Ebola haemorrhagic fever in the Province of Kasai Occidental. Active
surveillance is under way to investigate recent deaths in the affected
communities, to identify other suspected cases, and to follow up all
contacts. Case numbers associated with the outbreak continue to rise, and
the situation has become further complicated by concomitant reports of
cases of typhoid and _Shigella dysenteriae_ type 1.
Isolation wards have been established in the area with the ongoing support
of a field team from Medecins Sans Frontieres (Belgium) [MSF]. Additional
isolation wards are also being established in 3 district hospitals.
Epicentre has deployed an epidemiologist to support the MSF team in the field.
Outbreak response field teams are being strengthened, and operational bases
have been reinforced and established in 3 towns in the affected area. A
central logistics platform is being finalized to provide support to local
field communications, to put in place field accommodation facilities and to
ensure basic living conditions. The United Nations Department of
Peacekeeping Mission in the Democratic Republic of Congo (MONUC) is
providing additional logistics support.
Epidemiologists, virologists, laboratory experts, and logisticians from the
MoH, WHO, the US Centers for Disease Control and Prevention (CDC), and the
Public Health Agency of Canada (PHAC) are in the field. Laboratory
equipment and outbreak response materials are also being delivered by air
with the assistance of MONUC, MSF-chartered flights, and by Interchurch
Medical Assistance (IMA World Health), an international non-governmental
organization.
MONUC has also assisted WHO in deploying vehicles and other outbreak
related response equipment from its Outbreak Logistics Mobility Unit in
Dubai. Further shipments of Personal Protective Equipment and specialist
communications equipment including satellite phones and radios are also
being sent to the country.
Social mobilization activities are being implemented by national field
teams with the support of the national Red Cross, the International
Federation of Red Cross and Red Crescent Societies and UNICEF. A medical
anthropologist has been identified by the Centre National de Recherche
Scientifique, Paris to work with the social mobilization teams to develop
culturally appropriate information concerning Ebola and to ensure the
population is provided with information to reduce the risk of transmission
of the disease.
Experts in infection control from the Swiss Agency for Development and
Cooperation, the Hopital Cantonal in Geneva, and WHO Headquarters are being
deployed to strengthen infection control in the affected area. Precautions
are also being put in place in health care settings in areas beyond the
outbreak zone to reduce the risk of any amplification of the outbreak.
Other partners from the Global Outbreak Alert and Response Network are also
providing support to the MoH, including the African Field Epidemiology
Network, the Bernard Nocht Institute, the Centre International de
Recherches Medicales de Franceville, the European Centre for Disease
Control, the Institute Pasteur, the London School of Hygiene and Tropical
Medicine, the National University of Singapore, the Swedish Institute for
Infectious Disease Control, Training Programs in Epidemiology and Public
Health Interventions Network Inc. and Tulane University School of Public
Health and Tropical Medicine, USA.
The WHO Country Office in Kinshasa has been strengthened to provide support
to the MoH in responding to external requests for information on this outbreak.
- --
communicated by:
ProMED-mail rapporteur Marianne Hopp
[A clear statement of the extent of the Ebola haemorrhagic fever outbreak
in the Democratic Republic of Congo is still lacking. The most recent
information seems to be that contained in the introduction to the BBC News
website "Diary from DR Congo's Ebola frontline"
from Wed 19 Sep 2007,
in which Zoe Young of Medecins Sans Frontieres (MSF) shares her diary with
the BBC News website from the Democratic Republic of Congo. It is stated
that, since the 1st MSF team arrived in Kampungu at the beginning of
September 2007, 25 severe cases suspected to be Ebola haemorrhagic fever
have been hospitalised at Kampungu's health centre. Of these, 8 patients
have already died.
Further information is awaited. A map of the Democratic Republic of the
Congo can be accessed at
. Kampungu is
located in the Kasai Occidentale Province of the Democratic Republic of the
Congo. - Mod.CP]
[see also:
Ebola hemorrhagic fever - Congo DR (04) 20070916.3076
Ebola hemorrhagic fever - Congo DR (03): WHO 20070914.3049
Ebola hemorrhagic fever - Congo DR (02) 20070912.3026
Ebola hemorrhagic fever - Congo DR 20070910.2996
Undiagnosed illness - Congo DR (Kasai Occidental): WHO, RFI 20070901.2882
Viral hemorrhagic fever - Congo DR (Kasai Occidental): susp. 20070829.2837]
......................cp/msp/sh
------------------------------
Date: Fri, 21 Sep 2007 02:50:40 -0400 (EDT)
From: ProMED-mail
Subject: PRO/AH/EDR> Rabies, bat - Canada (ON) (02)
RABIES, BAT - CANADA (ONTARIO) (02)
***********************************
A ProMED-mail post
ProMED-mail is a program of the
International Society for Infectious Diseases
Date: Thu 20 Sep 2007
From: Allan Grill
re: ProMED-mail Rabies, bat - Canada (ON): alert 20070914.3059
- --------------------------------------------------------------
In follow-up to the posting from 14 Sep 2007, Toronto Public Health has
located the woman who had delivered an injured bat to the Toronto Wildlife
Centre that later tested positive for rabies. Finding her proved to be very
challenging as the Wildlife Centre did not have her updated demographic
information. After several attempts to locate her, including a media
release, proved to be unsuccessful, one of the communications staff at
Toronto Public Health suggested using the website "Facebook.com".
The woman's name came up on the website through its search feature, and a
message was posted for her outlining the above scenario along with an
immediate request to contact Toronto Public Health. Within 2 hours she
contacted our office and has been started on rabies post-exposure
prophylaxis given her close contact with the rabid bat.
Our team wishes to emphasize to other public health units that
"Facebook.com" should be considered a new and helpful form of communication
in challenging cases requiring contact tracing.
- --
Allan Grill, MD, CCFP, MPH
Medical Consultant
Division of Healthy Environments
Toronto Public Health
44 Victoria Street, 18th Floor
Toronto, Ontario, M5C 1Y2
[ProMED-mail thanks Dr Grill for 2 pieces of interesting information:
1. the woman who submitted the rabid bat, and then disappeared, was located
and timely post-exposure anti-rabies treatment was started, and
2. a popular communication technology, "Facebook"
, to which 10-15 per cent of Canadians are
subscribed, was used to locate her. The facility may have possible
application to locating individuals in other public health situations. -
Mod.TY]
[see also:
Rabies, bat - Canada (ON): alert 20070914.3059
Rabies, human, bat - Canada (AB)(02) 20070430.1404
Rabies, multi-species - Canada (ON) (02) 20070406.1154
Rabies, multi-species - Canada (ON): RFI 20070323.1011
Rabies, human, bat - Canada (AB) 20070304.0766
2003
- ---
Rabies, human - Canada (British Columbia) (03) 20030308.0574
Rabies, human - Canada (British Columbia) (02) 20030307.0568
Rabies, human - Canada (British Columbia) 20030306.0555]
.................ty/mj/sh
------------------------------
Date: Fri, 21 Sep 2007 02:53:24 -0400 (EDT)
From: ProMED-mail
Subject: PRO/EDR> Chikungunya - Italy (Emilia Romagna) (06)
CHIKUNGUNYA - ITALY (EMILIA ROMAGNA) (06)
*****************************************
A ProMED-mail post
ProMED-mail is a program of the
International Society for Infectious Diseases
Date: Thu 20 Sep 2007
From: Michele Dottori
re: ProMED-mail Chikungunya - Italy (Emilia Romagna) (05) 20070918.3102
- -----------------------------------------------------------------------
In reference to [this posting] regarding CHIK virus outbreak in Italy, I
want to define precisely that chikungunya virus has been isolated on 12nd
[sic] Sep [2007] from _Aedes albopictus_ mosquitoes collected in the
affected areas by the Central Unit of Istituto Zooprofilattico della
Lombardia Emilia e Romagna located in Brescia by Dr Paolo Cordioli
(veterinary virologist). The sequence of whole viral genome region
codifying for E1 and E2 glycoprotein will be ready in the next days. [It is
not clear if these isolates were made on 2 or on 12 Sep 2007, as Dr
Cottori's message was distorted electronically on transmission to
ProMED-mail. - Mod.TY]
- --
Dr Michele Dottori
Istituto Zooprofilattico Lombardia e dell' Emilia Romagna
Sezione Diagnostica di Reggio Emilia Reggio Emilia
Italy
[ProMED-mail thanks Dr Dottori for the additional information on the
chikungunya virus isolates from _Aedes albopictus_. It is hoped that there
is a centralized chikungunya virus repository so that genetic analyses of
isolates from this Italian outbreak can be compared with the Indian Ocean
area massive outbreak.
A map of the Emilia Romagna region and its location in Italy can be
accessed at . -
Mod.TY]
[see also:
Chikungunya - Italy (Emilia Romagna) (05) 20070918.3102
Chikungunya - Italy (Emilia Romagna) (04) 20070907.2957
Chikungunya - Italy (Emilia Romagna) (03) conf. 20070903.2899
Chikungunya - Italy (Emilia Romagna) (02) conf. 20070902.2889
Chikungunya - Italy (Emilia Romagna): susp. 20070901.2877
Chikungunya, imported, risk of transmission 20070125.0338
Chikungunya - Indian Ocean update (23): sequelae, RFI 20070821.2727
Chikungunya - Indian Ocean update (22): India (West Bengal) 20070815.2671
2006
- ---
Chikungunya - Indian Ocean update (05): spread to Europe 20060304.0695
Chikungunya - Indian Ocean Update (33): Maldives 20061224.3598
Chikungunya - Indian Ocean update (32) 20061014.2953
Chikungunya - Indian Ocean update (09): islands, India 20060320.0864]
.................ty/mj/sh
------------------------------
Date: Fri, 21 Sep 2007 09:52:40 -0400 (EDT)
From: ProMED-mail
Subject: PRO/PL> Stripe rust, wheat - Australia (SA): new strain
STRIPE RUST, WHEAT - AUSTRALIA (SOUTH AUSTRALIA): NEW STRAIN
************************************************************
A ProMED-mail post
ProMED-mail is a program of the
International Society for Infectious Diseases
Date: Thu 20 Sep 2007
Source: FarmOnline [edited]
South Australian wheat crops are under pressure from the new strain of
stripe rust -- with virulence for the Yr17 resistance gene -- discovered in
Victoria and New South Wales last year [2006].
SARDI [South Australian Research and Development Institute] pathologist Dr
Hugh Wallwork says the new strain of stripe rust could be more damaging
than all previous strains, and reminds growers that allowing rust to
develop on susceptible wheat varieties increases the rate at which new
strains evolve. Stripe rust has recently been identified at a number of
sites in SA.
- --
communicated by:
J Allan Dodds
former ProMED-mail plant disease moderator
[Wheat stripe rust (also called yellow rust) is caused by the fungus
_Puccinia striiformis_ var. _striiformis_ and occurs worldwide mostly in
cooler climates. It causes yellow leaf stripes, stunting of plants, and
reduced grain number and size on developing heads. Yield losses may vary
from 40 up to 100 per cent. It affects wheat, some barley varieties,
triticale, and a number of grass species. Spores are wind dispersed in
several cycles during the cropping season. The fungus needs living plants
to survive between seasons, it cannot survive on seed, stubble, or in soil.
Volunteer plants may generate a "green bridge" providing inoculum to infect
new crops. Disease management strategies include the use of resistant
varieties, fungicide applications and control of volunteer wheat plants.
Since the fungus interferes with seed development, infection early in the
crop cycle is more damaging than infection after seed fill has concluded.
Early discovery of infection at any stage of the crop cycle is important so
action can be taken to limit the spread of the pathogen as well as build-up
of inoculum.
The Australian Cereal Rust Control Program monitors the occurrence of
cereal rust pathotypes each year and in 2003, for example, 6 pathotypes of
stripe rust were identified throughout Australia. The new strain reported
here has apparently overcome one of the major stripe rust resistance genes
used in wheat breeding and may pose a serious problem to farmers in eastern
Australia.
Maps
Australia:
South Australia:
Pictures
Stripe rust leaf symptoms on wheat:
and
Symptom comparison on resistant and susceptible wheat cultivars:
Links
Grains Research and Development Corporation media release at:
Information on wheat stripe rust:
,
and
Stripe rust management:
_P. striiformis_ taxonomy:
General information on wheat diseases and pathogens:
Explanation of strains, pathotypes, and races of rusts:
SARDI:
. - Mod.DHA]
[see also:
Stripe rust, wheat & wheat streak mosaic - Australia (SA, WA) 20070830.2860
Fungal diseases, wheat & pulses - Australia (SA) 20070821.2729
Stripe rust, wheat - USA, Australia 20070614.1950
2005
- ---
Stripe rust, wheat - Australia 20051031.3173
2004
- ---
Wheat stripe rust - Australia (NSW) 20040928.2683
Wheat stripe rust - Australia (NSW): alert 20040810.2215
2003
- ---
Wheat stripe rust, new strains - Australia (SA) 20030930.2465
Wheat stripe rust - Australia (WA) 20030624.1553
2002
- ---
Wheat stripe rust - Australia (Western): alert 20020831.5198]
.................dha/mj/sh
------------------------------
Date: Fri, 21 Sep 2007 09:56:25 -0400 (EDT)
From: ProMED-mail
Subject: PRO/AH/EDR> Avian influenza (159): Nigeria (Nasarawa)
AVIAN INFLUENZA (159): NIGERIA (NASARAWA)
*****************************************
A ProMED-mail post
ProMED-mail is a program of the
International Society for Infectious Diseases
[1]
Date: Thu 20 Sep 2007
Source: AllAfrica, Daily Trust (Abuja) report [edited]
Over 1052 birds have so far been culled in Panda Development Area of
Nasarawa State in the wake of avian influenza (bird flu) that affected the
area just as the people of the area were commended for reporting early
signs of the flu.
UNICEF (UN Children's Fund) field officer for avian influenza, Alhaji Bala
Hassan, who visited the affected area from their headquarters in Bauchi
said the efforts of the people of the area in reporting cases of sick or
dead birds as well as their contributions towards the depopulation exercise
was commendable.
Bala who was in Nasarawa weekend [sic] and visited Kondoro and Panda
district areas where the incident occurred, cautioned the people against
taking sick or dead birds for granted and [to] ensure that poultry meat and
eggs are properly cooked before consumption.
He particularly advised parents to keep their children away from sick or
dead birds and advised them to always imbibe the culture of washing their
hands whenever they come in contact with sick or dead birds to avoid the
spread of the flu.
Presenting posters, pamphlets, and other educative materials on avian
influenza to the district head of the area as well as the people, Bala
called on them to spread the message among themselves and outside their
communities so as to create awareness that would lead to the prevention of
the disease.
The UNICEF focal person on avian influenza control in the Ministry of
Information, Mallam Abubakar Tanko, who also accompanied the UNICEF field
officer to the area, advised the people to keep away from using poultry
droppings as manure following the dangers associated with the confirmation
of H5N1 virus in the area.
The district head of Kondoro, Alhaji Muha-mmeadu Habu, [thanked the UNICEF
officers] for their philanthropic gestures in curbing not only the flu but
in the area of child survival and other programmes. He also called on the
state government to come to their aid in the payment of compensations due
to the birds they have lost.
[byline: Ahmed Tahir]
- --
communicated by:
Nati Elkin
[News about an H5N1 outbreak in poultry was reported in May 2007 from
Nigeria's northern state of Zamfara (see ProMED-mail 20070526.1680);
earlier, in January 2007, Nigeria reported west Africa's 1st human bird flu
death.
Nigeria's last follow-up report on avian influenza to the OIE (Office
International des Epizooties; World Organisation for Animal Health) was
submitted on 2 Apr 2006. A summary of the H5N1 in Nigeria during 2006, with
map, is available at
.
A new update is anticipated.
For the genotyping of previous H5N1 isolates from Nigeria and their
possible origin(s), see ProMED-mail 20070729.2432. For the location of
Nasarawa state in Nigeria, see map at
. - Mod.AS]
[see also:
Avian influenza (134): African sublineages 20070729.2432
Avian influenza (87): Nigeria, India (RFI), Pakistan 20070526.1680
Avian influenza (55): Nigeria, Viet Nam, Myanmar, Japan, Thailand
20070320.0986
Avian influenza, human (28): Nigeria, WHO 20070201.0408
Avian influenza, human (27): Nigeria 20070131.0397
2006
- ---
Avian influenza (220): Nigeria, China, S. Korea, Viet Nam 20061221.3579
Avian influenza (155) - Nigeria 20060711.1897
Avian influenza (153) - Nigeria: multiple strains 20060707.1864
Avian influenza (147) - Africa: FAO Update 20060704.1837
Avian influenza, human - worldwide (13): India, Malaysia, Nigeria
20060222.0575]
.................arn/mj/sh
------------------------------
Date: Fri, 21 Sep 2007 10:05:55 -0400 (EDT)
From: ProMED-mail
Subject: PRO/EDR> Measles - Kenya: 2002-2007 update
MEASLES - KENYA: 2002-2007 UPDATE
*********************************
A ProMED-mail post
ProMED-mail is a program of the
International Society for Infectious Diseases
Date: Fri 21 Sep 2007
Source: CDC. MMWR Morb Mortal Wkly Rep 2007; 56(37); 969-72 [edited]
Progress in measles control - Kenya: 2002-2007
- -----------------------------------------------
In 2000, countries represented by the World Health Organization (WHO)
Regional Office for Africa established a goal to reduce, by the end of
2005, measles mortality to 50 per cent of the 506 000 deaths from measles
estimated in 1999 (1). Strategies adopted included strengthening routine
vaccination, providing a 2nd opportunity for measles vaccination through
supplemental immunization activities (SIAs), monitoring disease trends, and
improving measles case management. In Kenya, an east African country with a
population estimated at 33.4 million in 2005, the Kenya Expanded Programme
on Immunization (KEPI) in the Ministry of Health began implementing these
strategies in 2002 with a wide age range catch-up SIA and reduced the
number of reported measles cases by more than 99 per cent, from 11 304 in
2001 to 20 in 2004. [The WHO Regional Office for Africa recommends an
initial, nationwide catch-up SIA targeting all children aged 9 months--14
years and periodic nationwide follow-up SIAs targeting all children born
since the last SIA] A follow-up SIA, initially scheduled for July 2005, was
postponed to 2006 to include concurrent distribution of long-lasting
insecticide-treated bednets (LLINs).
This report documents progress made in reducing measles morbidity and
mortality in Kenya and describes the consequences of a large measles
outbreak, beginning in September 2005, on the integrated measles follow-up SIA.
Immunization activities
- -----------------------
KEPI was established within the Kenya Ministry of Health in 1980, with the
goal of immunizing all children in the country against 6
vaccine-preventable diseases [tuberculosis, diphtheria, tetanus, pertussis,
poliomyelitis, and measles]. National coverage with one dose of measles
vaccine (provided at age 9 months) increased in the early 1990s to 84 per
cent of children aged 12 months but decreased to 72 per cent in 2002 [see
figure in original text]. To accelerate measles control, goals were
established in 2002 to achieve and maintain national average measles
vaccination coverage at 90 per cent, with every district expected to attain
coverage greater than 85 per cent. Since then, reported national measles
vaccination coverage increased to 77 per cent in 2006, and the proportion
of districts with coverage greater than 85 per cent increased from 10 per
cent in 2002 (8 of 77 districts) to 35 per cent in 2006 (27 of 78
districts) [In 2003, the number of districts in Kenya was increased from 77
to 78]. To provide a 2nd opportunity for measles vaccination, a nationwide
measles catch-up SIA was conducted in June 2002, targeting children aged 9
months-14 years; about 13 million children were vaccinated, 98 per cent of
the estimated target population. A multistage cluster survey provided a
similar estimate of national measles SIA coverage at 94 per cent, with 7 of
9 provinces achieving coverage greater than 90 per cent. The 2 exceptions
were North East Province at 84 per cent and Coast Province at 90 per cent.
Measles surveillance
- --------------------
After the 2002 measles catch-up SIA, Kenya implemented a system of
case-based surveillance for measles within the existing surveillance
network for acute flaccid paralysis. In this system, for each suspected
measles patient who visits a health facility, a measles case report form is
completed, and a blood specimen is taken for measles immunoglobulin M
testing at the national measles laboratory. In an outbreak, defined as 5 or
more cases reported from the same health area in a month, specimens are
collected from 5 cases. If 3 or more test positive, the outbreak is
confirmed as measles, untested cases are confirmed by epidemiologic
linkage, and specimen collection stops after throat swabs are collected for
viral genotyping.
In 2003, a total of 1791 suspected measles cases were reported through this
case-based surveillance system, including 59 cases that were confirmed by
laboratory or epidemiologic linkage. In 2004, a total of 1968 suspected
cases were reported, including 20 that were confirmed; in 2005, a total of
1061 suspected cases were reported, including 151 that were confirmed.
During 2003-2005, more than 99 per cent of suspected cases were reported
with a blood specimen, and the proportion of districts reporting at least
one suspected measles case increased from 69 per cent in 2004 to 99 per
cent in 2005. [WHO Regional Office for Africa performance indicators for
quality measles surveillance include collection of blood specimens from
more than 80 per cent of persons with suspected measles (to assess
specificity) and reporting of at least one suspected measles case with a
patient blood specimen from more than 80 per cent of districts (to assess
sensitivity)].
Measles outbreak and follow-up SIA
- ----------------------------------
A follow-up measles SIA had been planned for July 2005, about 36 months
after the initial catch-up SIA in June 2002, an interval between SIAs
recommended by the African Regional Measles Technical Advisory Group (2).
However, to expedite meeting the 2005 World Health Assembly target of 80
per cent of children aged less than 5 years sleeping under an
insecticide-treated bednet, the Kenya Ministry of Health and the
Inter-Agency Coordinating Committee decided to integrate distribution of
LLINs with the measles follow-up SIA. Raising additional funds for
procurement and distribution of the LLINs required postponement of the SIA,
initially to July 2006.
In September 2005, a cluster of laboratory-confirmed measles cases was
reported from a predominantly Somali immigrant community in Nairobi. During
September 2005-May 2007, this outbreak grew to a total of 2544 confirmed
measles cases reported from 71 (91 per cent) of the 78 districts, with peak
monthly totals of 375 and 332 confirmed cases reported in April and August
2006, respectively [illustrated by a figure in the original text]. Viruses
were isolated from specimens collected from about 80 people and identified
as genotype B3, with one additional virus from Rift Valley Province
identified as D4.
Of the 2544 confirmed outbreak cases, 944 (37 per cent) were in people aged
9-59 months, 491 (19 per cent) were in people aged 5-14 years, and 658 (26
per cent) were in people aged more than 15 years. A history of measles
vaccination was provided by 466 (18 per cent) of the patients, including
220 (23 per cent) of the 944 children aged 9-59 months and 95 (26 per cent)
of the 366 children aged 5-9 years. Vaccination status was unknown for 1192
people (47 per cent) [see figure in original text]. During the outbreak, 24
measles deaths were documented; 17 of the decedents were children aged less
than 5 years, and 9 had a history of measles vaccination.
In response to this outbreak, the planned follow-up SIA was moved forward
from July to April 2006. Because adequate funds were not available to
support a nationwide measles campaign in April and the full shipment of
LLINs purchased for the SIA had not arrived, the SIA was divided into 2
phases. Phase I, conducted during 29 Apr-5 May 2006, covered the 16
districts most affected by measles outbreaks and most at risk for
poliovirus importation from neighboring Somalia and Ethiopia (3). All the
districts administered measles vaccination to children aged 9-59 months,
vitamin A to children aged 6-59 months, and monovalent type 1 oral polio
vaccine (mOPV1) to children aged 0-59 months. Each intervention reached
more children than expected, based on population estimates; 670 016
received measles vaccine (120 per cent of the 558 699 targeted), 785 180
received mOPV1 (119 per cent of the 663 949 targeted), and 717 829 received
vitamin A (120 per cent of the 597 794 targeted).
Phase II was conducted during 8-12 Jul 2006, in the 62 remaining districts.
Overall, 4 590 225 children received measles vaccine (110 per cent of the 4
180 330 targeted), and 4 716 471 received vitamin A (105 per cent of the 4
486 266 targeted). 4 districts with an estimated combined population of 181
434 (4 per cent of the total) did not achieve 90 per cent reported coverage
with measles vaccine. 6 districts also provided mOPV1 to 490 974 children
(99.6 per cent of the 492 813 targeted).
LLINs were distributed to children aged less than 5 years in one district
in April [2006] from preexisting stock and in 21 districts in July [2006]
after the shipment of LLINs had arrived, reaching 1741 005 children (104
per cent of the estimated target population of 1 761 582). In September
2006, an additional 2 million LLINs were distributed in the remaining 23
malaria-endemic districts in Kenya. These SIAs were conducted with the
support of the Measles Initiative and other partners.
[reported by: T Kamau, MBBS, I Mugoya, MBChB, Kenya Expanded Programme on
Immunization; M Duale, MD, Kenya Country Office, World Health Organization;
M Eshetu, MD, Intercountry Support Team for Eastern and Southern Africa,
World Health Organization, Nairobi, Kenya. BG Masresha, MD, Measles
Program, Regional Office for Africa, World Health Organization,
Brazzaville, Congo. P Strebel, MBChB, A Dabbagh, PhD, Dept of Immunization,
Vaccines, and Biologicals, World Health Organization, Geneva, Switzerland.
RT Perry, MD, T Hyde, MD, Global Immunization Div, National Center for
Immunization and Respiratory Diseases, CDC.]
MMWR editorial note
- -------------------
Implementation of the WHO Regional Office for Africa strategies for measles
mortality reduction achieved in 2004 the goal of reducing deaths caused by
measles by half, both regionally and globally, from 1999 to 2005 (4). In
Kenya, accelerated measles-control activities resulted in a greater than 99
per cent decrease in measles cases to an incidence of 6 to 29 cases per 1
million population during the 36 months after the catch-up SIA of June
2002. Achieving high levels of vaccination coverage during that SIA, even
though routine coverage was less than 80 per cent, likely led to the rapid
reduction in measles.
In multiple countries, integrating high-priority health interventions with
vaccination campaigns has attracted political support, allowed for pooling
of resources, and increased community participation (5, 6, 7). Achieving
high coverage with insecticide-treated bednets is a key strategy for
reducing the burden of malaria. In Kenya, delaying the measles follow-up
SIA by one year enabled distribution of LLINs to more than 90 per cent of
children aged less than 5 years in the target districts. Kenya, therefore,
joins the ranks of countries that have rapidly increased coverage with
insecticide-treated bednets by integrating bednet distribution with measles
SIAs (5-7).
However, Kenya's experience also highlights a disadvantage of delaying a
follow-up SIA beyond the recommended interval. This delay likely resulted
in a nationwide measles outbreak in 2005 that ultimately produced about
2500 laboratory-confirmed cases and 24 deaths.
Surveillance data indicate that the heaviest burden of disease was in
children born after the 2002 catch-up SIA, who would have received a 2nd
opportunity for measles vaccination during the follow-up SIA. With less
than 80 per cent routine coverage since 1997 and the delay in the follow-up
SIA, population immunity was low enough in Kenya to sustain a large
outbreak after a measles importation.
Successful control of measles in Kenya will depend on continued improvement
of routine vaccination services; conducting regular, periodic, and
high-quality follow-up SIAs; improving measles case management; and
monitoring success by using case-based surveillance with laboratory
confirmation. The intervals between SIAs must be based not only on disease
epidemiology and SIA coverage but also on estimated routine coverage (2).
In addition, despite the documented advantages of integrating measles SIAs
with other life-saving interventions, in some countries, consideration
should be given to the risks of delaying measles SIAs to gain the benefits
from the other interventions.
References
- -----------
1. World Health Organization, United Nations Children's Fund. Measles
mortality reduction and regional elimination strategic plan 2001-2005.
Geneva, Switzerland: WHO; 2001. Available at
.
2. WHO. Report on the 1st consultation of the Technical Advisory Group on
Measles and Rubella Control in the African Region. Harare, Zimbabwe: World
Health Organization Regional Office for Africa; 2005. Available at
.
3. WHO. Outbreak news: Poliomyelitis, Ethiopia and Somalia. Wkly Epidemiol
Rec 2006; 81: 350.
4. Wolfson LJ, Strebel PM, Gacic-Dobo M, Hoekstra EJ, McFarland JW, Hersh
BS. Measles initiative: Has the 2005 measles mortality reduction goal been
achieved? A natural history modelling study. Lancet 2007: 369: 191-200.
5. Grabowsky M, Nobiya T, Ahun M, et al. Distributing insecticide-treated
bednets during measles vaccination: a low-cost means of achieving high and
equitable coverage. Bull World Health Organ 2005; 83: 195-201.
6. CDC. Distribution of insecticide-treated bednets during an integrated
nationwide immunization campaign-Togo, West Africa, December 2004. MMWR
2005; 54: 994-6.
7. Grabowsky M, Farrell N, Hawley W, et al. Integrating insecticide-treated
bednets into a measles vaccination campaign achieves high, rapid and
equitable coverage with direct and voucher-based methods. Trop Med Int
Health 2005; 10: 1151-60.
- --
communicated by:
ProMED-mail
[A remarkable achievement, but the maintenance of routine vaccination will
be an equivalent challenge. - Mod.CP
A map of Kenya is available at
. - CopyEd.MJ]
[see also:
2006
- ---
Measles, control activities - Africa: 1999-2005 20060921.2700
2005
- ---
Measles, nosocomial - Kenya (Nairobi) 20051231.3718
Measles, refugee children - Kenya (Nairobi) 20051027.3131]
.................cp/mj/sh
------------------------------
End of ProMED Digest V2007 #485