clove and Measles

Quantitative estimates of the impact of infectious disease outbreaks are required to develop measured policy responses. In many low- and middle-income countries, inadequate surveillance and incompleteness of death registration are important barriers.. Here, we characterize how large an impact on mortality would have to be for being detectable using the uniquely detailed mortality notification data from the city of Antananarivo, Madagascar, with application to a recent measles outbreak.. The weekly mortality rate of children during the 2018-2019 measles outbreak was 161% above the expected value at its peak, and the signal can be detected earlier in children than in the general population. This approach to detect anomalies from expected baseline mortality allows us to delineate the prevalence of COVID-19 at which excess mortality would be detectable with the existing death notification system in Antananarivo.. Given current age-specific estimates of the COVID-19 fatality ratio and the age structure of the population in Antananarivo, we estimate that as few as 11 deaths per week in the 60-70 years age group (corresponding to an infection rate of approximately 1%) would detectably exceed the baseline. Data from 2020 will undergo necessary processing and quality control in the coming months. Our results provide a baseline for interpreting this information.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Child; Child, Preschool; COVID-19; Disease Outbreaks; Female; Humans; Infant; Infant, Newborn; Limit of Detection; Madagascar; Measles; Middle Aged; Prevalence; SARS-CoV-2; Young Adult

Topics: Armed Conflicts; Betacoronavirus; Child; Coronavirus Infections; COVID-19; Democratic Republic of the Congo; Developing Countries; Disease Eradication; Disease Outbreaks; Humans; Immunization Programs; Madagascar; Measles; Measles Vaccine; Pandemics; Pneumonia, Viral; Poliomyelitis; SARS-CoV-2; Ukraine; Vitamin A Deficiency; World Health Organization

In October 4. Data have been collected using line list developed for the outbreak. Serum samples were collected within 30 days of rash onset for laboratory testing; confirmation was made by detection of measles immunoglobulin M (IgM) antibody.. A total of 2,930 samples were analysed in the laboratory among which 1,086 (37%) were laboratory confirmed. Measles cases age ranged from a minimum of 1 month to a maximum of 88 years. The median and the mean were 7 years and 9 years respectively. Children between 1 to 9 years accounted for 50.6% of measles cases. Attack rate (39,014 per 1,000,000 inhabitants) and case fatality rate (1.2%) were highest among children aged 9-11 months. A total of 67.2% cases were unvaccinated. As of March 14. Measles outbreak in Madagascar showed that the country is not on the track to achieve the goal of measles elimination by 2020.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Child; Child, Preschool; Disease Outbreaks; Female; Humans; Immunoglobulin M; Infant; Madagascar; Male; Measles; Measles Vaccine; Middle Aged; Public Health; Young Adult

on October 4. data were collected using a line list and vaccination tally sheet. Serum samples were collected within 30 days of rash onset for laboratory testing; confirmation was made by detection of measles immunoglobulin M antibody.. from September 2018 to May 2019, a total of 146,277 measles cases were reported which included 1394 (1%) laboratory-confirmed cases and 144,883 (99%) epidemiological link-confirmed cases. The outbreak affected equally males (72,917 cases; 49.85%) and females (73,233 cases; 50.06%). The sex was not specified for 127 (0.09%) cases. Case fatality rate and attack rate were high among children less than 5 years. Responses interventions include effective coordination, free of charge case management, reactive vaccination, strengthened real-time surveillance, communication and community engagement and the revitalization of the routine immunization. Reactive vaccination was implemented in different phases. A total of 7,265,990 children aged from 6 months to 9 years were vaccinated. Post campaign survey coverage was 95%, 96% and 97% for phase 1, 2, 3 respectively.. elimination of measles will be challenging in Madagascar because of low routine immunization coverage and the absence of a second dose of measles vaccine in the routine immunization schedule.

Topics: Child; Child, Preschool; Disease Outbreaks; Epidemiological Monitoring; Female; Humans; Immunization Programs; Immunization Schedule; Immunoglobulin M; Infant; Madagascar; Male; Measles; Measles Vaccine; Vaccination; Vaccination Coverage

Topics: Disease Outbreaks; Humans; Madagascar; Measles

on October 4. data were collected using minutes of coordination committee meetings, activities reports, operational action plans and situation reports.. the total cost of the outbreak response was estimated to US$ 11,281,381. Operational cost was the leading cost driver (42.45%) followed by vaccine cost (33.74%). Cases management, epidemiological surveillance, communication and social mobilization and routine immunization strengthening represented 23.81% of the total cost. The main funder of the outbreak response was the measles and rubella initiative.. good coordination, open dialogue, good use of financial resources and accountability of government and partners have enabled to gain the confidence of national and international donors.

Topics: Disease Outbreaks; Humans; Immunization Programs; Madagascar; Measles; Measles Vaccine; Vaccination

Topics: Child; Child Mortality; Child, Preschool; Delivery of Health Care; Disease Outbreaks; Female; Growth Disorders; Humans; Hygiene; Madagascar; Malnutrition; Maternal Mortality; Measles; Political Systems; United Nations; Vaccination Coverage

Measles elimination depends on the successful deployment of measles containing vaccine. Vaccination programs often depend on a combination of routine and non-routine services, including supplementary immunization activities (SIAs) and vaccination weeks (VWs), that both aim to vaccinate all eligible children regardless of vaccination history or natural infection. Madagascar has used a combination of these activities to improve measles coverage. However, ongoing massive measles outbreak suggests that the country was in a "honeymoon" period and that coverage achieved needs to be re-evaluated. Although healthcare access is expected to vary seasonally in low resources settings, little evidence exists to quantify temporal fluctuations in routine vaccination, and interactions with other immunization activities.. We used three data sources: national administrative data on measles vaccine delivery from 2013 to 2016, digitized vaccination cards from 49 health centers in 6 health districts, and a survey of health workers. Data were analyzed using linear regressions, analysis of variance, and t-tests.. From 2013 to 2016, the footprint of SIAs and VWs is apparent, with more doses distributed during the relevant timeframes. Routine vaccination decreases in subsequent months, suggesting that additional activities may be interfering with routine services. The majority of missed vaccination opportunities occur during the rainy season. Health facility organization and shortage of vaccine contributed to vaccination gaps. Children born in June were the least likely to be vaccinated on time.. Evidence that routine vaccination coverage varies over the year and is diminished by other activities suggests that maintaining routine vaccination during SIAs and VWs is a key direction for strengthening immunization programs, ensuring population immunity and avoiding future outbreaks.. Wellcome Trust Fund, Burroughs Wellcome Fund, Gates Foundation, National Institutes of Health.

Topics: Child, Preschool; Disease Outbreaks; Female; Health Personnel; Health Services Administration; Humans; Immunization Programs; Infant; Infant, Newborn; Madagascar; Male; Measles; Measles Vaccine; Seasons; Surveys and Questionnaires; Vaccination Coverage

Madagascar reports few measles cases annually and high vaccination campaign coverage. However, the underlying age profile of immunity and risk of a measles outbreak is unknown. We conducted a nested serological survey, testing 1,005 serum samples (collected between November 2013 and December 2015 via Madagascar's febrile rash surveillance system) for measles immunoglobulin G antibody titers. We directly estimated the age profile of immunity and compared these estimates with indirect estimates based on a birth cohort model of vaccination coverage and natural infection. Combining these estimates of the age profile of immunity in the population with an age-structured model of transmission, we further predicted the risk of a measles outbreak and the impact of mitigation strategies designed around supplementary immunization activities. The direct and indirect estimates of age-specific seroprevalence show that current measles susceptibility is over 10%, and modeling suggests that Madagascar may be at risk of a major measles epidemic.

Topics: Adolescent; Adult; Age Distribution; Antibodies, Viral; Child; Child, Preschool; Disease Outbreaks; Enzyme-Linked Immunosorbent Assay; Female; Humans; Immunoglobulin G; Infant; Madagascar; Male; Measles; Measles Vaccine; Middle Aged; Models, Statistical; Rubella; Seroepidemiologic Studies; Young Adult

To evaluate the effect of integrating ITN distribution on measles vaccination campaign coverage in Madagascar.. Nationwide cross-sectional survey to estimate measles vaccination coverage, nationally, and in districts with and without ITN integration. To evaluate the effect of ITN integration, propensity score matching was used to create comparable samples in ITN and non-ITN districts. Relative risks (RR) and 95% confidence intervals (CI) were estimated via log-binomial models. Equity ratios, defined as the coverage ratio between the lowest and highest household wealth quintile (Q), were used to assess equity in measles vaccination coverage.. National measles vaccination coverage during the campaign was 66.9% (95% CI 63.0-70.7). Among the propensity score subset, vaccination campaign coverage was higher in ITN districts (70.8%) than non-ITN districts (59.1%) (RR=1.3, 95% CI 1.1-1.6). Among children in the poorest wealth quintile, vaccination coverage was higher in ITN than in non-ITN districts (Q1; RR=2.4, 95% CI 1.2-4.8) and equity for measles vaccination was greater in ITN districts (equity ratio=1.0, 95% CI 0.8-1.3) than in non-ITN districts (equity ratio=0.4, 95% CI 0.2-0.8).. Integration of ITN distribution with a vaccination campaign might improve measles vaccination coverage among the poor, thus providing protection for the most vulnerable and difficult to reach children.

Topics: Bedding and Linens; Child; Child Welfare; Child, Preschool; Cross-Sectional Studies; Delivery of Health Care, Integrated; Female; Health Promotion; Health Status; Humans; Infant; Insecticide-Treated Bednets; Madagascar; Malaria; Male; Mass Vaccination; Measles; Measles Vaccine; Mosquito Control; Poverty; Preventive Health Services; Socioeconomic Factors

The performance of routine and supplemental immunization activities is usually measured by the administrative method: dividing the number of doses distributed by the size of the target population. This method leads to coverage estimates that are sometimes impossible (e.g., vaccination of 102% of the target population), and are generally inconsistent with the proportion found to be vaccinated in Demographic and Health Surveys (DHS). We describe a method that estimates the fraction of the population accessible to vaccination activities, as well as within-campaign inefficiencies, thus providing a consistent estimate of vaccination coverage.. We developed a likelihood framework for estimating the effective coverage of vaccination programs using cross-sectional surveys of vaccine coverage combined with administrative data. We applied our method to measles vaccination in three African countries: Ghana, Madagascar, and Sierra Leone, using data from each country's most recent DHS survey and administrative coverage data reported to the World Health Organization. We estimate that 93% (95% CI: 91, 94) of the population in Ghana was ever covered by any measles vaccination activity, 77% (95% CI: 78, 81) in Madagascar, and 69% (95% CI: 67, 70) in Sierra Leone. "Within-activity" inefficiencies were estimated to be low in Ghana, and higher in Sierra Leone and Madagascar. Our model successfully fits age-specific vaccination coverage levels seen in DHS data, which differ markedly from those predicted by naïve extrapolation from country-reported and World Health Organization-adjusted vaccination coverage.. Combining administrative data with survey data substantially improves estimates of vaccination coverage. Estimates of the inefficiency of past vaccination activities and the proportion not covered by any activity allow us to more accurately predict the results of future activities and provide insight into the ways in which vaccination programs are failing to meet their goals. Please see later in the article for the Editors' Summary.

Topics: Cross-Sectional Studies; Ghana; Health Care Surveys; Humans; Madagascar; Measles; Retrospective Studies; Sierra Leone; Vaccination

Topics: Adolescent; Child; Child, Preschool; Diagnostic Tests, Routine; Humans; Immunization Programs; Infant; Madagascar; Measles; Measles Vaccine; Measles virus; Population Surveillance; Program Evaluation