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CSU 74/2009: FOUR ON MEASLES
The Measles Initiative is a partnership committed to reducing measles
deaths globally. Launched in 2001, the Measles Initiative-led by the
American Red Cross, the United Nations Foundation, the U.S. Centers for
Disease Control and Prevention, UNICEF and the World Health
Organization-provides technical and financial support to governments and
communities on vaccination campaigns worldwide. After more than a year's
worth of work, the Measles Initiative has re-launched
www.MeaslesInitiative.org . The new design features improved navigation,
enhanced internal search engine capabilities, a comprehensive multimedia
library and interactive map. We've also added a substantial amount of
updated content to better showcase this public health partnership's work
around the world. We encourage you to visit the site to learn how the
Measles Initiative is helping reduce global measles deaths as well as to
access journal articles, presentations and campaign reports.
1) TRAINING PACKAGE FOR MEASLES CONTROL
From James Cheyne, PATH, comes the news of a new training tool for measles
control.
A new online tool for Strategic Planning for Measles Control
The Advanced Immunization Management (AIM) e-Learning website has recently
launched a new module to support the World Health Organization's
computer-based Measles Strategic Planning (MSP) tool. The MSP was developed
to help countries develop measles vaccination strategies to meet their
measles control goals given resource limitations. The Measles Strategic
Planning tool is ready for use – loaded with country-specific data that can
be updated by the user.
The module can be used to:
· Serve as a technical resource about measles
epidemiology and vaccination strategies.
· Download WHO’s MSP tool and guide users on how to run
the tool and interpret its results.
· Inform and defend a measles vaccination strategy based
on current population susceptibility to measles and
vaccination cost and management limitations.
· Help decision-makers and donors compare the estimated
costs and impacts of different measles control strategies at
the national level and, for India, at the state level.
· Access resources for further study in measles control.
Developed by WHO, PATH and partners, the MSP module provides information on
disease characteristics and epidemiology that is critical for formulating
effective measles control strategies. Users can review the costs and
practical implications of measles vaccination programs and test their
understanding with a case study using the WHO Measles Strategic Planning
Tool. The e-Learning module and planning tool are primarily aimed at
immunization program managers but will also be useful for country level
program officers, health care providers, public health educators, and
public health managers.
The module on Strategic Planning for Measles Control can be found on
http://aim.path.org/en/measles/index.html
The module is also available on CD upon request to info@aim.path.org.
The broader Advanced Immunization Management e-Leaning site also has
modules on:
· Meningitis A vaccine (also in French)
· Rotavirus vaccine
· Hepatitis B vaccine (also in French and Russian)
· Japanese encephalitis vaccine
· Immunization financing (also in French, Russian and
Bahasa Indonesia). and
· an Excel tutorial (also in French)
The AIM homepage is www.aim.path.org
2) MEASLES MORTALITY REDUCTION IN AFRICA
In this recent article from The Lancet, reproduced below, Biellik
and Brown argue for use of simplified new serology tests to permit
more accurate assessment of susceptibles in populations. This, in
turn, would permit governments and partners more accurately to
assess the correct interval between successive national measles
campaigns.
3) THE PREVENTION OF NOSOCOMIAL MEASLES TRANSMISSION
Perhaps it is time to update this 1997 article on nosocomial measles
transmission. Full text is at
http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=9342896
The abstract: “As a result of the highly contagious nature of measles
before the onset of rash, nosocomial transmission will remain a threat
until the disease is eradicated. However, a number of strategies can
minimize its nosocomial spread. It is therefore vital to maximize awareness
among health care staff that an individual with measles can enter a health
facility at any time and that a continual risk of the nosocomial
transmission of measles exists. The present review makes two groups of
recommendations: those which are generally applicable to all countries, and
certain additional recommendations which may be suitable only for
industrialized countries."
4) What is the 10th lesson I have omitted?
Ten Lessons learned from African Measles Campaigns
The following conclusions are drawn from a review of 2008 and 2009 campaign
experiences in Cote d’Ivoire, Kenya, Mozambique, Rwanda, Tanzania, and
Uganda.
1. There is, in some settings, a 10 percent measles SIA coverage
difference between districts with and without house visiting
(Nampula, Mozambique in 2008 and Kenya, 2009).
2. Targeting of districts is best done by manual spreadsheet
analysis of district returns from the most recent datasets, based,
for example, on BCG minus measles, yielding the number of
undervaccinated infants in each district (Kenya, Rwanda, Tanzania,
Uganda). This sidesteps denominator problems by comparing only
numerator data across districts.
3. Well planned campaigns can go awry when rumors are
disseminated quickly by modern mass media (the praziquantel stories
disseminated from one district of Tanzania, affecting performance in
the whole country)
4. Urban areas do not reliably outperform rural areas in SIAs.
In fact, the reverse is sometimes true (74 percent in Dar es Salaam
during the SIA; 87 percent, lowest in the country, in Kigali for
precampaign routine). Urban areas may require special attention, both
in terms of areas to be targeted for the campaign and in terms of
close follow-up (Kampala, Kigali, Nairobi).
5. Good precampaign social mobilization, coupled with failure to
preposition all supplies on the day before the campaign, is a lethal
mix (Kampala). Hundreds of mothers are left waiting for noontime
deliveries of supplies which should have been there the previous
night.
6. An imprest fund for unanticipated expenditures is useful
(municipality charges for hanging banners in Kampala and Nairobi)
7. House visiting tends to have an impact. The impact is
probably greater in large cities, where traditional village authority
structures are absent.
8. Linkage of measles vaccination to LLIN distribution tends to
raise vaccination coverage in some settings (Ivoirian coverage data
from LLIN and non-LLIN districts).
9. The newest kid on the block, SMS messaging for social
mobilization, remains unevaluated (Uganda).
Good reading.
BD