Epidemiology of rubella infection in Cameroon : a 7-year experience of measles and rubella case-based surveillance, 2008–2014

CITATION: Nimpa Mengouo, M. et al. 2017. Epidemiology of rubella infection in Cameroon: a 7-year experience of measles and rubella case-based surveillance, 2008–2014. BMJ Open, 7(4):e012959. doi:10.1136/bmjopen-2016-012959.The original publication is available at https://bmjopen.bmj.com/Objective The aim of this study was to estimate the proportion of rubella disease in a measles case-based surveillance in Cameroon prior to rubella vaccine introduction into the national immunisation programme. Design This was a cross-sectional study for rubella infection in Cameroon for the period 2008 to 2014. Setting Patients suspected with measles from the 10 regions of Cameroon were recruited according to the WHO measles case definition and were tested for rubella IgM antibodies accompanied with the case report/investigation forms. Participants All persons with rash and fever within 14 days of onset of rash according to the standard WHO African Regional Office (WHO/AFRO) case definition for a suspected measles case. Outcome measures Descriptive analyses and simple logistic regressions were performed. OR were estimated. Results A total of 9907 serum samples from people with fever and rash were received in the laboratory from 2008 to 2014. A total of 7489 (75.59%) measles-negative samples were tested for rubella; 699 (9.3%) were positive for rubella IgM antibodies. Logistic regression analysis was done using IgM antibodies detection as the outcome variable. Age, sex and setting were explanatory variables. Logistic regression analysis revealed that, comparing the proportion of rubella IgM seropositivity status by age, the association to a positive rubella IgM increased with age from 1 to 4 years (OR 7.11; 95% CI 4.35 to 12.41; p<0.0001), through 5 to 9 years (OR 13.07; 95% CI 7.93 to 22.93; p<0.001), to 10 to 14 years of age (OR 13.86; 95% CI 8.06 to 25.12; p<0.001). Persons aged ≥15 years were also more likely to have rubella infection than children under one (OR 3.69; 95% CI 1.85 to 7.48; p=0.0001). There were also significant associations with sex, with males being less associated to a positive rubella serology than females (OR 1.33; 95% CI 1.14 to 1.56; p=0.0001). No statistically significant difference in proportion of rubella cases was observed between urban and rural populations (OR 1.11; 95% CI 0.94 to 1.31; p=0.208). Conclusions This study reveals that rubella virus circulates in Cameroon, with important number of cases in children under 15 years. This finding supports the planned introduction of rubella-containing vaccines into the Expanded Program on Immunization.publishers versio

Challenges related to resources mobilization for measles outbreak response: Madagascar experience during the 2018-2019 measles outbreak

Introduction:&nbsp;on October 4th, 2018, a measles outbreak was declared in Madagascar. This study describes challenges related to resources mobilization for the outbreak response. Methods:&nbsp;data were collected using minutes of coordination committee meetings, activities reports, operational action plans and situation reports. Results:&nbsp;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. Conclusion:&nbsp;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

Prevalence of Trachoma in the Far North Region of Cameroon: Results of a Survey in 27 Health Districts

<div><p>Background</p><p>Cameroon is known to be endemic with trachoma. To appreciate the burden of the disease and facilitate the national planning of trachoma control in the integrated control program for the neglected tropical diseases, an epidemiological mapping of trachoma was conducted in the Far North region in 2010–11.</p><p>Methodology</p><p>A cross-sectional, cluster random sampling survey was carried out. The survey focused on two target populations: children aged 1 to 9 years for the prevalence of active trachoma and those aged 15 and over for the prevalence of trichiasis (TT). The sample frame was an exhaustive list of villages and neighborhoods of Health Districts (HDs). The World Health Organization simplified trachoma grading system was used for the recognition and registration of cases of trachoma.</p><p>Principal Findings</p><p>48,844 children aged 1 to 9 years and 41,533 people aged 15 and over were examined. In children aged 1–9 years, the overall prevalence of trachomatous inflammation–follicular (TF) was 11.2% (95% confidence intervals (CI): 11.0–11.5%). More girls were affected than boys (p = 0.003). Thirteen (13) of 27 HDs in the region showed TF prevalence of ≥10%. The overall TT prevalence was 1.0% (95% CI: 0.9–1.1%). There were estimated 17193 (95% CI: 12576–25860) TT cases in the region. The prevalence of blindness was 0.04% (95% CI: 0.03–0.07%) and visual impairment was 0.09% (95% CI: 0.07–0.13%).</p><p>Conclusions/Significance</p><p>The survey confirmed that trachoma is a public health problem in the Far North region with 13 HDs qualified for district-level mass drug administration with azithromycin. It provided a foundation for the national program to plan and implement the SAFE strategy in the region. Effort must be made to find resources to provide the surgical operations to the 17193 TT cases and prevent them from becoming blind.</p></div

Reasons for Being “Zero-Dose and Under-Vaccinated” among Children Aged 12–23 Months in the Democratic Republic of the Congo

(1) Introduction: The Democratic Republic of the Congo (DRC) has one of the largest cohorts of un- and under-vaccinated children worldwide. This study aimed to identify and compare the main reasons for there being zero-dose (ZD) or under-vaccinated children in the DRC. (2) Methods: This is a secondary analysis derived from a province-level vaccination coverage survey conducted between November 2021 and February 2022; this survey included questions about the reasons for not receiving one or more vaccines. A zero-dose child (ZD) was a person aged 12–23 months not having received any pentavalent vaccine (diphtheria–tetanus–pertussis–Hemophilus influenzae type b (Hib)–Hepatitis B) as per card or caregiver recall and an under-vaccinated child was one who had not received the third dose of the pentavalent vaccine. The proportions of the reasons for non-vaccination were first presented using the WHO-endorsed behavioral and social drivers for vaccination (BeSD) conceptual framework and then compared across the groups of ZD and under-vaccinated children using the Rao–Scott chi-square test; analyses were conducted at province and national level, and accounting for the sample approach. (3) Results: Of the 51,054 children aged 12–23 m in the survey sample, 19,676 ZD and under-vaccinated children were included in the study. For the ZD children, reasons related to people’s thinking and feelings were cited as 64.03% and those related to social reasons as 31.13%; both proportions were higher than for under-vaccinated children (44.7% and 26.2%, respectively, p p < 0.001). The distribution of reasons varied between provinces, e.g., 12 of the 26 provinces had a proportion of reasons for the ZD children relating to practical issues that was higher than the national level. (4) Conclusions: reasons provided for non-vaccination among the ZD children in the DRC were largely related to lack of parental/guardian motivation to have their children vaccinated, while reasons among under-vaccinated children were mostly related to practical issues. These results can help inform decision-makers to direct vaccination interventions