EPIDEMIOLOGY OF MEASLES

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• EPIDEMIOLOGY OF MEASLES
• IN SOUTH AFRICA
• NESI MEETING, CAPE TOWN
• 14 OCTOBER 2004
• Neil Cameron Dept Com. Health Stellenbosch Univ.
• Johann van den Heever EPI(SA) Manager

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Nine Provinces
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Measles Immunization in SA

• 1974 Measles Vaccine introduced 9m 15m
• 1983 1986 6m 15m
• 1986 9m 15m
• 1991 1992 High-titre EZ vaccine at 6m
• 1992 Swartz stain vaccine 9m 18m with DTP
• Coverage 1989 1990 63
• 10 000 20 000 reported cases /year 1979 1990
• Epidemiological Comments 19 7 July 1992

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Measles Immunization in SA

• 1990 Measles Strategy launched
• Aim increase coverage of all immunizations,
• no national days timing left to provincial,
  local government and homeland health
  authorities
• Epidemiological Comments 19 7 July 1992

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Epidemiological Comments October 1995
Correspondence Dr Robin Biellik
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1994 Democratic elections National Review of SA
Immunization Programme EPI (SA)
launched 1995 Measles Elimination
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MEASLES ELIMINATION SOUTH AFRICA 1995 Strategy

• High coverage at 9/12
• National campaign 9/12 - 14 years
• Periodic (4 year) campaign 9/12 5 years
• Case based surveillance with lab confirmation

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33 deaths p.a.
16,823 cases 325 deaths /annum
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Christa van den Berg, District Health
Directorate, Department of Health
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Measles surveillance NICD

• Case-based measles surveillance since 1998
• Specimens from 7/9 provinces in 2003
• Blood specimens IgM for measles rubella
• Urine specimens Isolation/PCR
• Laboratory requirements
• 90 of blood results 7 days of receipt
• Monthly e-mailing of database to WHO
• National Institute for Communicable Diseases

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Case-based measles IgM surveillance 2003 NICD
received 3 933 specimens 7/ 9 provinces(Rash
Fever 1 of the 3 Cs)
48 positive for rubella IgM
Jo McAnerney, Bernice Harris NICD
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Measles IgM positive results 1985 - 2003
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Measles Mortality Reduction and Regional
Elimination Strategic Plan 2001-2005

• Reduce deaths by half
• Interrupt indigenous transmission
• Provide dose one
• Ensure second opportunity
• Quality Surveillance and Good Case management
• Consider adding
• Vit A
• Rubella vaccine

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Annex 1 Eliminating Measles No quick fix -
Nigel Gay

• 3 Strategies
• 1. High coverage periodic follow-up campaigns
  (Americas)
• 2. Coverage levels 2 doses gt 95 (USA
  Finland)
• 3. Initial catch-up high coverage (UK Oman)

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campaigns need to be followed by high routine
coverage to prevent the re-accumulation of
susceptible to levels that will permit sustained
measles transmission...recent outbreaks in
Argentina, Bolivia and the Dominican Republic
despite campaigns demonstrate that ....it is
easier to achieve impressive progress initially
than sustain elimination in the long term.
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South Africa 53 Health Districts (47
District Councils 6 Metropolitan Councils)253
sub-districts
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BACKGROUND conti

• Statistics SA mid-year population estimates 2003

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South Africa Overall Performance Fully
Immunised Coverage 2003
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RSA Fully Immunised (annualised) by District 2003
Key Yellow 60 - 79 Green 80 Red 0 - 59
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Gauteng Province Fully Immunised (annualised) 2003
City of Tshwane
Mestweding DM
West Rand DM
Ekurhuleni Metro
Sedibeng DM
Key Red 0-59 Yellow 60-79 Green 80
City of Johannesburg
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2004 CAMPAIGN RATIONALE

• SA has not yet reached ?90 OPV and measles
  coverage
• Pockets of low coverage data still unreliable in
  some areas
• Build-up of susceptibles necessitates campaign
  every 3-4 years
• Threat of importations from neighbouring
  countries (undocumented immigrants) where
  services have collapsed/coverage is low/measles
  programmes not advanced
• Participation in Global Southern African
  Regional strategies to eradicate polio
  eliminate measles

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MEASLES IgM POSITIVE RESULTS PER WEEK 2004
Start of mass campaign
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MEASLES 2004GAUTENG PROVINCE

• 94 of RSA Measles IgM case load
• Joburg Metro mostly affected 81
• Nosocomial outbreaks reported from major
  hospitals,clinics, childrens homes
• 6 measles-related deaths (5 HIV children) CFR
  1.4 (previously no measles-related deaths
  reported from 1999 - 2003)

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CHILDRENS HOMES AFFECTED (7 OUT OF 53 IN JOBURG
METRO)
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HOSPITALS CLINICS AFFECTED IN GAUTENG IN 2004

• Chris Hani Baragwanath
• Coronation
• Johannesburg Hospital
• Alex 7th Avenue
• Tembisa
• Tambo Memorial
• Bophelong
• Noordgesig
• Rosettenville, etc.

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INTERVENTIONS

• Increased improved surveillance notification
  outbreak response laboratory involvement
• 2003 October National Policy Document to Contain
  Measles Emergency Meetings Gauteng, CHOMP local
  responses intensified
• National Mass Immunisation Campaign against
  Measles and Polio
• August 2004 Emergency Meeting National Outbreak
  Response Team involvement (Measles Outbreak
  Response Team)
• September 2004 Fact-finding visits to Gauteng
  affected facilities/institutions to review
  status provide additional support data
  consolidation recommendations

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CHALLENGES

• Implement recommendations immunise all children
  gt6 months - ? 15 years provide guidelines re
  case management and outbreak response details
• Capacity building
• Improving data population denominator data
  surveillance completion of case investigation
  forms confidential death enquiries
• Hospital infection control
• Isolation facilities and procedures
• Improve routine coverage identify and target
  areas and populations with low coverage health
  promotion social mobilisation community
  involvement communication training
• Decrease dropout rates

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AGE DISTRIBUTION OF PATIENTS WITH MEASLES PRE-
vs POST-CAMPAIGN
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PROGRESS WITH MEASLES CONTROL IN SOUTH AFRICA

• The 2003/4 Gauteng outbreak has dealt a
  significant blow to measles control elimination
  in SA
• Up to September 2003, SA was considered to have
  virtually eliminated measles due to significant
  progress made
• There had been no measles-related deaths since
  1999
• Measles incidence was down to below 30 cases/
  year
• 2004 mass immunisation campaign was planned to
  sustain achievements

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WHAT NEEDS TO DRIVE PROGRAMMES

• Rational programme design
• Good data
• Sound analysis
• Ongoing evaluation

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.

• Overriding global goal is sustainable measles
  mortality reduction

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Thanks for protecting us against these
terrible diseases Youre doing a great job!