Academic journal article Bulletin of the World Health Organization

Monitoring Progress towards the Elimination of Measles in China: An Analysis of Measles Surveillance data/Suivre Les Progres Vers L'elimination De la Rougeole En Chine: Une Analyse Des Donnees De Surveillance De la rougeole/Controlar El Progreso Hacia la Erradicacion del Sarampion En China: Un Analisis De Los Datos De Vigilancia del Sarampion

Academic journal article Bulletin of the World Health Organization

Monitoring Progress towards the Elimination of Measles in China: An Analysis of Measles Surveillance data/Suivre Les Progres Vers L'elimination De la Rougeole En Chine: Une Analyse Des Donnees De Surveillance De la rougeole/Controlar El Progreso Hacia la Erradicacion del Sarampion En China: Un Analisis De Los Datos De Vigilancia del Sarampion

Article excerpt

Introduction

Measles is a highly infectious disease that causes enormous morbidity and mortality among children in many parts of the world. For example, it has been estimated that measles and its complications led to the deaths of more than 164 000 children in 2008 (1) and about 139 300 children in 2010. (2)

The availability of safe and effective vaccines makes the global elimination of measles possible, at least in theory. By 2011, the Region of the Americas of the World Health Organization (WHO) had sustained measles elimination status for more than a decade. Four of WHO s other regions have adopted measles elimination targets, while the South-East Asia Region has set itself the task of greatly reducing its measles-related mortality--to less than 5% of the estimated value for the year 2000--by 2015. (3,4)

In 2005, the Regional Committee for WHO's Western Pacific Region resolved to attempt to eliminate measles from the Western Pacific Region by 2012. (5) In setting this target, the Committee defined measles elimination as the absence of endemic measles transmission in a defined geographical area for at least 12 months, in the presence of a well performing surveillance system. (6)

China has a mainland population of more than 1.3 billion and an area of 9.6 million [km.sup.2] and is the largest country in WHO's Western Pacific Region. Despite substantial efforts to eliminate measles from China in recent years, measles virus continues to circulate and cause significant morbidity in the country and China accounts for a large proportion of the measles cases reported in the Western Pacific Region. (7,8) The elimination of measles in China is therefore critical to achieving the goal of regional measles elimination.

In 1978, China established the national Expanded Programme on Immunization and began to implement a standard schedule for routine immunization that included a dose of measles vaccine administered at 8 months of age. A second routine dose of measles vaccine, at 7 years of age, was recommended in 1986. The 1997 national plan of action for accelerated measles control called for measles vaccine coverage of at least 90%. The recommended age for a child to receive a second dose of measles vaccine was lowered to between 18 and 24 months in 2005. (9) The mean annual measles incidence reported in China, in cases per 100 000 population, was 572.0 between 1960 and 1969, 355.3 between 1970 and 1979, 52.9 between 1980 and 1989, and 7.6 between 1990 and 1999,"'and it has remained below 10 since 2000.

In 2006, China endorsed the 2006-2012 national action plan for measles elimination. Subsequently, the country followed a comprehensive strategy for measles elimination, which included immunization, measles surveillance and infection control. Estimated coverage with the first dose of a vaccine containing measles virus increased from 80.4% in 2000 to 91.1% in 2009, while coverage with the second dose of such a vaccine increased from less than 80% before 2005 to 84.3% in 2009. (6) Between 2003 and 2009, 27 of the 31 mainland provinces of China conducted unsynchronized province-wide supplementary immunization activities against measles, with 185.7 million children targeted. (6) In September 2010, China conducted synchronized nationwide supplementary immunization activities against measles. These nationwide activities, which ignored vaccination status, achieved a reported coverage of 97.52%. (11)

A national case-based system of measles surveillance with laboratory support has been operational in China since 2009. Over the intervening years, the performance indicators for this system have steadily improved. (12) In 2011, the percentage of suspected measles cases investigated within 48 hours of reporting (93.30%), the percentage of suspected measles cases providing an adequate serum specimen (90.37%) and the percentage of serum specimens with laboratory results reported within 7 days of specimen collection (93. …

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