• Local discrepancies in measles vaccination opportunities: results of population-based surveys in Sub-Saharan Africa

      Grout, L; Conan, N; Juan Giner, A; Hurtado, N; Fermon, F; N'goran, A; Grellety, E; Minetti, A; Porten, K; Grais, RF (BioMed Central Ltd, 2014)
      The World Health Organization recommends African children receive two doses of measles containing vaccine (MCV) through routine programs or supplemental immunization activities (SIA). Moreover, children have an additional opportunity to receive MCV through outbreak response immunization (ORI) mass campaigns in certain contexts. Here, we present the results of MCV coverage by dose estimated through surveys conducted after outbreak response in diverse settings in Sub-Saharan Africa.
    • Measles in Democratic Republic of Congo: an outbreak description from Katanga, 2010--2011

      Grout, L; Minetti, A; Hurtado, N; François, G; Fermon, F; Chatelain, A; Harczi, G; Ngoie, J; N Goran, A; Luquero, F J; et al. (BioMed Central (Springer Science), 2013-05-22)
      BACKGROUND: The Democratic Republic of Congo experiences regular measles outbreaks. From September 2010, the number of suspected measles cases increased, especially in Katanga province, where Medecins sans Frontieres supported the Ministry of Health in responding to the outbreak by providing free treatment, reinforcing surveillance and implementing non-selective mass vaccination campaigns. Here, we describe the measles outbreak in Katanga province in 2010--2011 and the results of vaccine coverage surveys conducted after the mass campaigns. METHODS: The surveillance system was strengthened in 28 of the 67 health zones of the province and we conducted seven vaccination coverage surveys in 2011. RESULTS: The overall cumulative attack rate was 0.71% and the case fatality ratio was 1.40%.The attack rate was higher in children under 4 and decreased with age. This pattern was consistent across districts and time. The number of cases aged 10 years and older barely increased during the outbreak. CONCLUSIONS: Early investigation of the age distribution of cases is a key to understanding the epidemic, and should guide the vaccination of priority age groups.
    • Measles outbreak response immunization is context-specific: insight from the recent experience of médecins sans frontières.

      Minetti, A; Bopp, C; Fermon, F; François, G; Grais, RF; Grout, L; Hurtado, N; Luquero, F J; Porten, K; Sury, L; et al. (PLoS, 2013-11)
      Andrea Minetti and colleagues compare measles outbreak responses from the Democratic Republic of the Congo and Malawi and argue that outbreak response strategies should be tailored to local measles epidemiology. Please see later in the article for the Editors' Summary.
    • Performance of Small Cluster Surveys and the Clustered LQAS Design to estimate Local-level Vaccination Coverage in Mali

      Minetti, A; Riera-Montes, M; Nackers, F; Roederer, T; Koudika, M H; Sekkenes, J; Taconet, A; Fermon, F; Touré, A; Grais, RF; et al. (2012-08-12)
    • Reaching Hard-to-Reach Individuals: Nonselective Versus Targeted Outbreak Response Vaccination for Measles

      Minetti, A; Hurtado, N; Grais, RF; Ferrari, M (Oxford University Press, 2013-10-16)
      Current mass vaccination campaigns in measles outbreak response are nonselective with respect to the immune status of individuals. However, the heterogeneity in immunity, due to previous vaccination coverage or infection, may lead to potential bias of such campaigns toward those with previous high access to vaccination and may result in a lower-than-expected effective impact. During the 2010 measles outbreak in Malawi, only 3 of the 8 districts where vaccination occurred achieved a measureable effective campaign impact (i.e., a reduction in measles cases in the targeted age groups greater than that observed in nonvaccinated districts). Simulation models suggest that selective campaigns targeting hard-to-reach individuals are of greater benefit, particularly in highly vaccinated populations, even for low target coverage and with late implementation. However, the choice between targeted and nonselective campaigns should be context specific, achieving a reasonable balance of feasibility, cost, and expected impact. In addition, it is critical to develop operational strategies to identify and target hard-to-reach individuals.