Search

Background. To monitor immunization-system strengthening in the Polio Eradication Endgame Strategic Plan 2013–2018 (PEESP), the Global Polio Eradication Initiative identified 1 indicator: 10% annual improvement in third dose of diphtheria- tetanus-pertussis–containing vaccine (DTP3) coverage in polio high-risk districts of 10 polio focus countries. Methods. A multiagency team, including staff from the African Region, developed a comprehensive list of outcome and process indicators measuring various aspects of the performance of an immunization system. Results. The development and implementation of the dashboard to assess immunization system performance allowed national program managers to monitor the key immunization indicators and stratify by high-risk and non–high-risk districts. Discussion. Although only a single outcome indicator goal (at least 10% annual increase in DTP3 coverage achieved in 80% of high-risk districts) initially existed in the endgame strategy, we successfully added additional outcome indicators (eg, decreasing the number of DTP3-unvaccinated children) as well as program process indicators focusing on cold chain, stock availability, and vaccination sessions to better describe progress on the pathway to raising immunization coverage. Conclusion. When measuring progress toward improving immunization systems, it is helpful to use a comprehensive approach that allows for measuring multiple dimensions of the system. more...

Background Measles incidence and mortality rates have significantly decreased since vaccine introduction. Despite this progress, however, there has been a global resurgence of measles. To understand the current global epidemiology, we analyzed measles surveillance data. Methods We analyzed data on measles cases from 2013–2018 reported to the World Health Organization. Univariate analysis was undertaken based on age, vaccination history, onset year, World Health Organization region, and World Bank income status for the country where the case was reported, and a surrogate indicator of the historical strength of the country’s immunization program. Annual incidence and a 2013–2018 mean country incidence per million were calculated. Results From 2013 through 2018, there were 899 800 reported measles cases, of which 57% occurred unvaccinated or undervaccinated persons, with an unknown vaccination history in another 30%. Lower-middle-income countries accounted for 66% of cases, 23% occurred in persons ≥15 years of age. In countries with stronger historical vaccination programs and higher country income, case patients had higher median ages. Conclusions Although most measles case patients are more...

Indigenous wild poliovirus has been eliminated in 98% of endemic countries since 1988, with a decrease from 350 000 cases in 1988 to 223 confirmed cases in 2012 [1]. The success of polio eradication efforts has been dependent on increasing population immunity through routine immunization and supplementary immunization activities and by improving surveillance for acute flaccid paralysis (AFP). AFP surveillance systems are expected to annually identify ≥2 nonpolio AFP (NPAFP) cases per 100 000 population under 15 years of age to demonstrate that their systems are sensitive enough to detect paralytic polio cases [2]. All countries within the Horn of Africa region have successfully eliminated endemic poliovirus circulation, with Kenya successfully presenting in 2005 their complete country documentation outlining polio-free status. However, the region has remained at high risk for reintroduction and has had multiple outbreaks in recent years. An outbreak of 19 cases of wild poliovirus occurred in Turkana, Kenya, in 2009, and was followed by an outbreak of 22 cases in Uganda in 2010. In 2011, another wild poliovirus case was detected in western Kenya and was found to be genetically related to the 2010 outbreak in Uganda. These outbreaks indicated missed circulation within the region over a 3-year period. As of 31 December, 203 confirmed cases of WPV had been confirmed in the Horn of Africa in 2013. All of these outbreaks underscore the regional struggle to achieve the surveillance sensitivity and population immunity necessary to prevent transmission of imported poliovirus. In the midst of these outbreaks, the health system in Kenya has been decentralized, with both increased administrative autonomy at the district level and an increase in number of districts. Following a risk analysis performed in January 2012, which showed that 121 of 159 (77%) of districts in Kenya were at high or medium risk for a polio outbreak, the Kenya Ministry of Public Health and Sanitation (MoPHS) engaged the US Centers for Disease Control and Prevention (CDC), World Health Organization (WHO), United Nations Children’s Fund (UNICEF), and other international partners to assist in a review of the national surveillance and routine immunization systems. The purpose of the review was to identify gaps in the programs, as well as to provide recommendations toward improving detection of imported poliovirus and preventing poliovirus circulation during this period of health system decentralization [3]. more...