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Progress Toward Measles Control --- African Region, 2001--2008

Please note: An erratum has been published for this article. To view the erratum, please click here.

In 2001, the countries of the World Health Organization (WHO) African Region (AFR) became part of a global initiative with a goal of reducing the number of measles deaths by 50% by 2005, compared with 1999. Recommended strategies for measles mortality reduction included 1) increasing routine coverage for the first dose of measles-containing vaccine (MCV1) for all children, 2) providing a second opportunity for measles vaccination through supplemental immunization activities (SIAs), 3) improving measles case management, and 4) establishing case-based surveillance with laboratory confirmation of all suspected measles cases (1). Before introduction of MCV throughout AFR, approximately 1 million measles cases had been reported each year in the early 1980s (2). After strengthening measles-control activities, annual reported cases declined to an estimated 300,000--580,000 during the 1990s. This report summarizes the progress made during 2001--2008 toward improving measles control in AFR. During 2001--2008 estimated MCV1 coverage increased from 57% to 73%, SIAs vaccinated approximately 398 million children, and reported measles cases decreased by 93%, from 492,116 in 2001 to 32,278 in 2008. By 2005, global measles deaths had decreased by 60%, and the AFR goal had been achieved (3); AFR adopted a new goal to reduce deaths by 90%, compared with 2000, and that goal was achieved in 2006 (3,4). However, inaccuracies in reported vaccination coverage exist, surveillance is suboptimal, and measles outbreaks continue to occur in AFR countries. Further progress in measles control will require full implementation of recommended strategies, including validation of vaccination coverage.

Since the 1980s, AFR countries have reported measles vaccination coverage and the number of measles cases each year to the WHO African Regional Office (AFRO), using the WHO and United Nations Children's Fund (UNICEF) Joint Reporting Form. These data are collected through administrative reports from routine vaccination programs and SIAs and routine surveillance systems that provide aggregated case counts based on clinical diagnosis. Estimates of routine coverage with MCV1 are based on review of coverage data from administrative records, surveys, national reports, and consultation with local and regional experts. Coverage achieved during nationwide SIAs against measles are reported on the basis of the reported number of doses administered, divided by the target population.

In 1999, as part of the measles mortality reduction strategy, case-based surveillance with laboratory testing for all suspected measles cases was introduced with support from WHO AFRO. A suspected measles case is defined as 1) any person with generalized maculo-papular rash and fever plus cough or coryza or conjunctivitis or 2) any person in whom a clinician suspects measles. Each suspected measles case should be reported using an individual case-investigation form, and a blood specimen should be collected and sent to the laboratory for measles-specific immunoglobulin M testing. Laboratory confirmation of individual cases is discontinued after an outbreak has been confirmed as measles. An outbreak is confirmed when three or more measles laboratory-confirmed cases are detected in a health facility or district in 1 month; subsequent cases are confirmed by epidemiologic link. An epidemiologic link is defined as a suspected measles case that did not have a specimen collected for laboratory testing and is linked in person, place, and time to a laboratory-confirmed case (i.e., in a patient living in the same district or an adjacent district with a patient with laboratory-confirmed measles where a likelihood of transmission and onset of rash in the two patients within 30 days of each other exists) (5). Case-based surveillance data from AFR countries are shared regularly with WHO AFRO. Data quality is monitored using annualized performance indicators that include the 1) percentage of districts reporting one or more suspected case with a blood specimen (target: >80%) and 2) nonmeasles febrile rash illness rate (target: >2 cases per 100,000).

Routine Vaccination Activities

In AFR, MCV1 is administered through routine services to children at age 9 months. According to WHO and UNICEF estimates, AFR MCV1 coverage increased from 57% in 2001 to 73% in 2008 (Figure). In 2008, among the 46 AFR countries,* three (7%) had MCV1 coverage of <60%, 13 (28%) had coverage of 60%--69%, 11 (24%) had coverage of 70--79%, 10 (22%) had coverage of 80--89%, and nine (20%) had coverage of ≥90% (Table 1). As of 2008, five (10%) countries provided a second dose of MCV (MCV2) through routine services: South Africa and Swaziland reported MCV2 coverage of 70%, Lesotho reported MCV2 coverage of 80%, and Algeria and Seychelles reported MCV2 coverage of >95% in 2008.

SIA Results

SIAs provide a second opportunity for measles immunization to all children, including those not vaccinated with MCV1 and those previously vaccinated; approximately 15% of children vaccinated with a single dose at age 9 months will not develop immunity to measles. The SIA strategy generally consists of a one-time catch-up SIA, targeted to a wide age range, which aims to reduce susceptibility to measles in the population. This is followed by periodic follow-up SIAs targeting children born since the last SIA, thus reducing the accumulation of susceptible children in new birth cohorts.

Before 2000, seven (15%) AFR countries (Botswana, Lesotho, Malawi, Namibia, South Africa, Swaziland, and Zimbabwe) had completed a catch-up SIA, and Namibia and South Africa had completed a follow-up SIA (6). By the end of 2008, 43 AFR countries (all except Algeria, Mauritius, and Seychelles) had completed a catch-up SIA, and all but Comoros and Guinea-Bissau had completed at least one follow-up SIA (Table 2). During 2001--2008, approximately 398 million children were vaccinated during measles SIAs in AFR: 237 million (60%) during catch-up SIAs in 34 countries, and 161 million (40%) during follow-up SIAs in 39 countries (Table 2). Nine countries (Benin, Cameroon, Chad, the Democratic Republic of Congo, Ethiopia, Ghana, Niger, Nigeria, and Tanzania) conducted nationwide SIAs in phases covering different geographic areas implemented over ≥2 years.

Measles Surveillance

By December 2008, all AFR countries except Algeria, Comoros, Guinea Bissau, Mauritius, Sao Tome & Principe, and Seychelles had established measles case-based surveillance in accordance with the WHO AFRO measles surveillance guidelines (5). In 2008, of the 40 countries with case-based surveillance, 21 (53%) met the target of >80% of districts reporting one or more suspected cases; 24 (60%) had a nonmeasles febrile rash illness rate of >2 cases per 100,000 population; and 16 (40%) met both targets.

Monitoring Measles Incidence

Following implementation of the measles mortality reduction strategies during 2001--2008, including introduction of case-based measles surveillance, the number of reported measles cases decreased 93%, from 492,116 in 2001 to 32,278 in 2008 (Figure). Average annual measles incidence in AFR decreased 66%, from 50.2 per 100,000 population during 2001--2004 to 17.2 during 2005--2008 (Table 1). Despite this decrease, during 2005--2008, 14 countries reported outbreaks. Outbreak field investigations conducted during 2003--2007 in South Africa (1,676 cases, 2003--2005) (7), Kenya (2,544 cases, 2005--2007) (8), and Tanzania (1,533 cases, 2006--2007) (9) found that failure to vaccinate was the primary cause. In 2008, outbreaks also contributed to annual case counts in Burkina Faso (395), Cameroon (495), the Democratic Republic of Congo (12,461), Ethiopia (3,511), Niger (1,317), and Nigeria (9,960) (2).

Reported by: Countries in the World Health Organization African Region; Immunization and Vaccine Development, World Health Organization Regional Office for Africa. Dept of Immunization, Vaccines, and Biologicals, World Health Organization, Geneva, Switzerland. Global Immunization Div, National Center for Immunization and Respiratory Diseases, CDC.

Editorial Note:

In 2008, after implementation of the measles mortality reduction strategy, routine measles vaccination coverage in AFR reached 73%, SIAs were conducted in nearly all AFR countries, and reported measles cases decreased to a historic low of 32,278. According to previously published WHO estimates, by 2006 AFR had achieved approximately 90% reduction in measles deaths, compared with 2000 (3). However, despite this progress, vaccination coverage reports remain imprecise, disease surveillance remains suboptimal, and outbreaks continue to occur, even in countries that reported implementation of all recommended components of the measles strategy. Available mathematical models likely overestimate the disease burden and underreporting of measles cases is common, even with high-performing surveillance systems; therefore, caution is recommended when drawing comparisons between reported incidence of measles and estimates of measles deaths generated from models.

SIAs are recommended to provide a second opportunity for immunization and increase the likelihood of vaccinating hard-to-reach children. SIA coverage usually is estimated by an administrative method relying on the reported number of vaccine doses administered and available target population denominator data, both of which often are imprecise. For example, during 2001--2008, several countries reported vaccinating >100% of children targets in SIAs. Improved methods for determining the actual target population size for SIAs are needed; reported coverage also should be routinely validated by independent surveys. In addition, detailed field investigations of outbreaks should be undertaken to identify post-SIA risk factors for measles, and help refine vaccination strategies.

The findings in this report are subject to at least two limitations. First, a change in measles surveillance methods might result in underestimates or overestimates of the disease burden over time. For example, in 1999, AFR countries routinely reported an aggregated number of clinically diagnosed measles cases; however, after implementation of measles case-based surveillance, by 2005, most countries had changed to reporting laboratory-confirmed measles cases (6). Second, although the case definition for suspected measles remained the same, the change in measles reporting practices might have led to either underreporting, because of the additional resources needed to complete individual case investigations and collect blood samples, or overreporting because of overall efforts to strengthen measles surveillance.

In light of progress made toward reducing measles deaths, a more advanced goal was proposed recently for the region with several recommendations to improve vaccination coverage and surveillance performance. The AFR measles technical advisory group met in May 2008 and recommended that AFR countries aim to meet the following targets by 2012: 1) reducing estimated measles deaths by 98%, compared with 2000 estimates; 2) reducing measles incidence to < 5 cases per 1 million population per year; 3) achieving ≥90% routine MCV1 coverage nationwide and >80% in all districts; 4) achieving >95% SIA coverage in all districts; and 5) attaining two primary measles surveillance performance indicator targets (a nonmeasles febrile rash illness rate of >2 cases per 100,000 population per year and one or more suspected measles case investigated with blood specimen in >80% of districts per year); and 6) routine reporting from all districts (10). The group also recommended that AFR countries consider introduction of MCV2 in the routine vaccination schedule if MCV1 coverage of >80% has been achieved and maintained for ≥3 consecutive years and at least one of the two primary measles surveillance indicator targets has been achieved and maintained for at least 2 years. For countries adopting a 2-dose routine measles vaccination schedule, continued follow-up SIAs were recommended for all new birth cohorts every 3--5 years until national MCV2 coverage of ≥90% is sustained for at least 2 years (10).

References

  1. World Health Organization and United Nations Children's Fund. Measles mortality reduction and regional elimination---strategic plan, 2001--2005. Available at http://www.who.int/vaccines-documents/docspdf01/www573.pdf.
  2. World Health Organization. Measles reported cases. (Updated August 10, 2009). Available at http://www.who.int/immunization_monitoring/en/globalsummary/timeseries/tsincidencemea.htm (Accessed August 18, 2009).
  3. CDC. Progress in global measles control and mortality reduction, 2000--2006. MMWR 2007;56:1237--41.
  4. World Health Organization, Regional Office for Africa. Regional strategic plan for the expanded programme on immunization, 2006--2009. Available at http://www.afro.who.int/cah/documents/epi/afro_rc56_epi_sep_2006.pdf.
  5. World Health Organization Regional Office for Africa. Measles surveillance guidelines. Available at http://www.afro.who.int/measles/guidelines.
  6. CDC. Effects of measles-control activities---African Region, 1999--2005. MMWR 2006;55:1017--21.
  7. McMorrow M, Gebremedhin G, van den Heever J, et al. Measles outbreak in South Africa, 2003--2005. S Afr Med J 2009;99:314--9.
  8. CDC. Progress in measles control---Kenya 2002--2007. MMWR 2007;56:969--72.
  9. Goodson JL, Wiesen E, Perry RT, et al. Impact of measles outbreak response vaccination campaign in Dar es Salaam, Tanzania. Vaccine 2009;27:5870--4.
  10. World Health Organization Regional Office for Africa. Report of the second meeting of the African regional measles technical advisory group (TAG). Available at http://www.afro.who.int/measles/2ndtagmeeting/final_report.pdf.

* Algeria, Angola, Benin, Botswana, Burkina Faso, Burundi, Cameroon, Cape Verde, Central African Republic, Chad, Comoros, Congo, Côte d'Ivoire, Democratic Republic of Congo, Equatorial Guinea, Eritrea, Ethiopia, Gabon, Gambia, Ghana, Guinea, Guinea-Bissau, Kenya, Lesotho, Liberia, Madagascar, Malawi, Mali, Mauritania, Mauritius, Mozambique, Namibia, Niger, Nigeria, Rwanda, Sao Tome and Principe, Senegal, Seychelles, Sierra Leone, South Africa, Swaziland, Togo, Uganda, United Republic of Tanzania, Zambia, and Zimbabwe.

Angola, Benin, Burkina Faso, Cameroon, Democratic Republic of Congo, Equatorial Guinea, Ethiopia, Kenya, Mali, Niger, Nigeria, South Africa, Tanzania, and Uganda.

FIGURE. Number of reported measles cases* and coverage with the first dose of measles-containing vaccine (MCV1) among children aged <1 year --- World Health Organization (WHO) African Region, 2001--2008

Alternative Text: The figure above shows the number of reported measles cases and coverage with the first dose of measles-containing vaccine (MCV1) among children aged aged <1 year in the African Region (AFR) for 2001-2008, according to the World Health Organization (WHO). According to WHO and UNICEF estimates, AFR MCV1 coverage increased from 57% in 2001 to 73% in 2008.

* N = 1.9 million. Confirmed cases of measles reported by member states to WHO and the United Nations Children's Fund (UNICEF) through the Joint Reporting Form.

Data are from WHO and UNICEF measles vaccination coverage estimates; these estimates are based on reviews of surveys and national reports of administrative coverage. Administrative coverage is calculated by dividing the number of doses of vaccine administered through routine health services by the birth cohort of the previous year.

Alternative Text: The figure above shows the number of reported measles cases and coverage with the first dose of measles-containing vaccine (MCV1) among children aged aged <1 year in the African Region (AFR) for 2001-2008, according to the World Health Organization (WHO). According to WHO and UNICEF estimates, AFR MCV1 coverage increased from 57% in 2001 to 73% in 2008.

TABLE 1. Routine measles vaccination coverage* and measles incidence, by country --- World Health Organization (WHO) African Region, 2001--2008

Country

% coverage with first dose measles vaccine (MCV1)

Average annual measles incidence per 100,000 population

2001

2008

2001--2004

2005--2008

WHO African Region

54

73

50.2

17.2

Algeria

81

83

21.4

2.6

Angola

72

79

37.0

3.3

Benin

70

61

28.5

4.9

Botswana

91

94

0.9

0.2

Burkina Faso

54

75

18.0

1.3

Burundi

76

84

4.6

3.3

Cameroon

47

80

40.9

1.9

Cape Verde

75

96

0.0

0.0

Central African Republic

35

62

36.4

3.2

Chad

26

23

160.4

5.0

Comoros

70

76

0.0

40.4

Congo

35

79

94.1

2.6

Côte d'Ivoire

75

63

31.1

0.2

Democratic Rep. of Congo

49

67

47.5

137.2

Equatorial Guinea

51

51

64.9

16.7

Eritrea

84

95

6.7

1.1

Ethiopia

53

74

2.2

2.1

Gabon

55

55

105.0

1.7

Gambia

89

91

6.7

0.0

Ghana

81

86

34.2

1.1

Guinea

44

64

34.9

0.5

Guinea-Bissau

72

76

89.7

0.2

Kenya

73

90

9.4

3.2

Lesotho

70

85

3.2

0.0

Liberia

58

64

13.9

0.2

Madagascar

57

81

176.8

0.0

Malawi

82

88

2.9

0.6

Mali

53

68

12.9

0.5

Mauritania

58

65

96.3

1.4

Mauritius

98

90

16.3

0.7

Mozambique

74

77

66.8

15.6

Namibia

58

73

25.9

0.3

Niger

37

80

436.8

7.0

Nigeria

35

62

72.9

21.9

Rwanda

69

92

14.9

1.8

Sao Tome & Principe

75

93

0.0

0.0

Senegal

48

77

99.6

0.0

Seychelles

99

95

0.0

3.3

Sierra Leone

50

60

10.0

0.5

South Africa

69

62

1.8

0.4

Swaziland

72

95

9.9

0.0

Tanzania

83

88

14.1

6.2

Togo

53

77

11.7

1.0

Uganda

61

68

123.5

7.9

Zambia

84

85

98.7

2.4

Zimbabwe

73

66

3.7

1.8

* WHO and United Nations Children's Fund (UNICEF) estimates of routine measles vaccination coverage are based on reviews of surveys and national reports of administrative coverage. Administrative coverage is calculated by dividing the number of doses of vaccine administered through routine health services by the birth cohort of the previous year.

Measles incidence is calculated using confirmed measles cases reported by member states to WHO and UNICEF through the Joint Reporting Form and population estimates from: World population prospects: the 2008 revision, United Nations Population Division, available at http://esa.un.org/unpp.


TABLE 2. Measles supplementary immunization activities (SIAs), by type and country --- World Health Organization (WHO) African Region, 2001--2008

Children reached in targeted age group

Country

Year

Target age group

Type of SIA*

No.

Administrative coverage (%)

Algeria

NA§

NA

NA

NA

NA

Angola

2003

9 mos--14 yrs

Catch-up

7,226,105

95

2006

9--59 mos

Follow-up

3,210,160

97

Benin

2001

9 mos--14 yrs

Catch-up

950,780

>100

2003

9 mos--14 yrs

Catch-up

2,299,583

>100

2005

9--59 mos

Follow-up

1,137,163

>100

2008

9--59 mos

Follow-up

1,272,621

>100

Botswana

2005

9--59 mos

Follow-up

179,202

99 

Burkina Faso

2001

9 mos--14 yrs

Catch-up

4,943,115

96

2004

9--59 mos

Follow-up

2,882,208

>100

2007

9--59 mos

Follow-up

3,145,255

>100

Burundi

2002

9 mos--14 yrs

Catch-up

2,767,054

90

2006

9--59 mos

Follow-up

1,226,689

>100

Cameroon

2001

9 mos--14 yrs

Catch-up

2,789,542

93

2002

9 mos--14 yrs

Catch-up

4,570,817

90

2006

9--59 mos

Follow-up

1,249,041

99

2007

9--59 mos

Follow-up

1,763,167

91

Cape Verde

2005

9--59 mos

Follow-up

46,889

93

Central African Republic

2005

9 mos--14 yrs

Catch-up

1,183,583

91 

2006

9 mos--14 yrs

Catch-up

515,956

96 

2008

9--59 mos

Follow-up

683,302

>100

Chad

2005

9 mos--14 yrs

Catch-up

1,641,896

80 

2006

9 mos--14 yrs

Catch-up

2,735,760

>100

2008

9--59 mos

Follow-up

1,782,689

96

Comoros

2005

6 mos--14 yrs

Catch-up

109,815

99

2007

6 mos--14 yrs

Catch-up

231,263

81

Congo

2004

9 mos--14 yrs

Catch-up

1,356,625

78

2007

9--59 mos

Follow-up

677,390

95

Côte d'Ivoire

2005

9 mos--14 yrs

Catch-up

7,894,327

 88

2008

9--59 mos

Follow-up

3,082,438

95

Democratic Republic of the Congo

2002

9 mos--14 yrs

Catch-up

5,554,824

96

2004

6 mos--14 yrs

Catch-up

8,604,754

86

2005

6 mos--14 yrs

Catch-up

6,957,653

 89

2006

9 mos--14 yrs

Catch-up

6,970,229

---**

2006

9--59 mos

Follow-up

5,723,858

99 

2007

9--59 mos

Follow-up

3,768,794

 >100

2008

9--59 mos

Follow-up

2,811,092

99

Equatorial Guinea

2005

9 mos--14 yrs

Catch-up

119,462

44 

Eritrea

2003

9 mos--14 yrs

Catch-up

1,047,862

82

2006

9--59 mos

Follow-up

387,479

95

Ethiopia

2003

9 mos--14 yrs

Catch-up

5,101,001

91

2004

6 mos--14 yrs

Catch-up

7,422,074

84

2005

6 mos--14 yrs

Catch-up

136,935

69

2005

9 -- 59 mos

Follow-up

987,221

92

2006

9--59 mos

Follow-up

10,169,187

87

2007

6--59 mos

Follow-up

1,072,701

98

2008

6--59 mos

Follow-up

10,848,474

92

Gabon

2004

9 mos--14 yrs

Catch-up

502,959

80

2007

9--59 mos

Follow-up

190,035

83

Gambia

2003

9 mos--14 yrs

Catch-up

677,830

92

2007

9--59 mos

Follow-up

241,214

96

Ghana

2001

9 mos--14 yrs

Catch-up

790,798

99

2002

9 mos--14 yrs

Catch-up

7,827,605

>100

2006

9--59 mos

Follow-up

3,994,052

 79

See Table 2 footnotes on page 1041.


TABLE 2. Measles supplementary immunization activities (SIAs), by type and country --- World Health Organization (WHO) African Region, 2001--2008

Children reached in targeted age group

Country

Year

Target age group

Type of SIA*

No.

Administrative coverage (%)

Guinea

2003

9 mos--14 yrs

Catch-up

3,202,848

98

2006

9--59 mos

Follow-up

1,707,633

97 

Guinea-Bissau

2006

6 mos--14 yrs

Catch-up

590,602

85

Kenya

2002

9 mos--14 yrs

Catch-up

13,302,991

98

2006

9--59 mos

Follow-up

5,260,241

>100

Lesotho

2003

9--59 mos

Follow-up

178,522

87

2007

9--59 mos

Follow-up

196,490

92

Liberia

2004

---

---

---

---

2007

9--59 mos

Follow-up

629,676

97 

Madagascar

2004

9 mos--14 yrs

Catch-up

8,900,657

99

2007

9--59 mos

Follow-up

3,053,702

100

Malawi

2002

9--59 mos

Follow-up

1,906,985

>100

2005

9--59 mos

Follow-up

2,110,341

>100

2008

9--59 mos

Follow-up

2,087,375

100

Mali

2001

9 mos--14 yrs

Catch-up

4,998,491

99

2004

9--59 mos

Follow-up

2,426,497

>100

2007

9--59 mos

Follow-up

2,562,537

>100

Mauritania

2004

9 mos--14 yrs

Catch-up

1,167,307

>100

2008

9--59 mos

Follow-up

464,564

98

Mauritius

NA

NA

NA

NA

NA

Mozambique

2005

9--59 mos

Catch-up

8,222,157

97 

2008

9--59 mos

Follow-up

3,342,280

>100

Namibia

2003

9--59 mos

Follow-up

318,240

94

2006

9--59 mos

Follow-up

318,905

97

Niger

2004

9 mos--14 yrs

Catch-up

5,071,149

99

2005

9 mos--14 yrs

Catch-up

332,318

>100

2008

9--59 mos

Follow-up

2,942,498

100

Nigeria

2005

9 mos--14 yrs

Catch-up

28,538,974

96 

2006

9 mos--14 yrs

Catch-up

26,353,793

83 

2008

9--59 mos

Follow-up

28,363,479

>100

Rwanda

2003

6 mos--14 yrs

Catch-up

3,082,583

>100

2006

9--59 mos

Follow-up

1,380,870

>100

Sao Tome & Principe

2007

9 mos--14 yrs

Catch-up

64,487

>100

Senegal

2003

9 mos--14 yrs

Catch-up

4,854,077

98

2006

9--59 mos

Follow-up

1,833,931

99 

Seyechelles

NA

NA

NA

NA

NA

Sierra Leone

2003

9 mos--14 yrs

Catch-up

2,404,882

93

2006

9--59 mos

Follow-up

751,107

100 

South Africa

2004

9--59 mos

Follow-up

3,501,447

---

2007

9--59 mos

Follow-up

3,784,440

87 

Swaziland

2002

9--59 mos

Follow-up

127,829

81

2006

9--59 mos

Follow-up

140,143

100

Tanzania

2001

9 mos--14 yrs

Catch-up

3,687,390

>100

2002

7--14 yrs

Catch-up

6,739,197

97

2005

9--59 mos

Follow-up

6,036,865

99

2008

6 mos--10 yrs

Catch-up

10,826,519

86

Togo

2001

9 mos--14 yrs

Catch-up

2,393,700

99

2004

9--59 mos

Follow-up

887,668

100

Uganda

2001

9 mos--14 yrs

Catch-up

614,516

>100

2003

6 mos--14 yrs

Catch-up

13,457,127

>100

2006

9--59 mos

Follow-up

5,301,424

100


TABLE 2. Measles supplementary immunization activities (SIAs), by type and country --- World Health Organization (WHO) African Region, 2001--2008

Children reached in targeted age group

Country

Year

Target age group

Type of SIA*

No.

Administrative coverage (%)

Zambia

2002

6 mos--14 yrs

Catch-up

729,469

>100

2003

6 mos--14 yrs

Catch-up

4,955,687

>100

2007

9--59 mos

Follow-up

2,204,553

 >100

Zimbabwe

2002

9--59 mos

Follow-up

1,537,263

85

2006

9--59 mos

Follow-up

1,407,510

95

Total

397,625,156

* SIAs include one-time catch-up vaccination campaigns targeting a wide age range with the aim to reduce susceptibility to measles in the population and periodic follow-up SIAs targeting children born since the last SIA, thus reducing the accumulation of susceptible children in new birth cohorts. SIAs provide an initial dose of measles vaccine for children who do not access routine services and a second dose for those previously vaccinated.

Administrative coverage is calculated by dividing the number of doses of vaccine administered during the SIA by the targeted number of children. The number of targeted children is usually determined by using projections of available census data.

§ Not applicable; country did not conduct any SIAs.

Administrative coverage >100% usually is attributed to either an underestimation of the number of children in the targeted age group (low denominator), or vaccination of children from nontargeted geographic areas or age groups (high numerator).

** Not available.

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Date last reviewed: 9/24/2009

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