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To evaluate economic implications of conducting a “catch-up” measles vaccination campaign, we conducted an economic analysis of the 1996–1997 measles immunization campaign in two provinces of South Africa comparing the baseline two-dose routine immunization program to the combined vaccination strategy (routine two-dose immunization program, plus the 1996–1997 campaign). The study findings indicate that the 1996–1997 mass measles immunization campaign was cost-effective in both study provinces, and cost-saving in the province with higher pre-campaign disease incidence and lower routine vaccination coverage. An early investment in effective vaccination strategies that rapidly reduce disease burden apparently results in better returns, both epidemiologically and economically. [Copyright &y& Elsevier]

Abstract: Objective: We investigated a large measles outbreak that occurred in 2009 in Burkina Faso in order to describe the epidemic, assess risk factors associated with measles, and estimate measles vaccine effectiveness. Methods: We reviewed national surveillance and measles vaccine coverage data, and conducted a case–control study in three geographic areas. Case-patients were randomly selected from the national case-based measles surveillance database or, when a case-patient could not be traced, were persons in the same community who experienced an illness meeting the WHO measles clinical case definition. Controls were matched to the same age stratum (age 1–14 years or age 15–30 years) and community as case-patients. Risk factors were assessed using conditional logistic regression. Results: Lack of measles vaccination was the main risk factor for measles in all three geographic areas for children aged 1–14 years (adjusted matched odds ratio [aMOR] [95% confidence interval (CI)], 19.4 [2.4–155.9], 5.9 [1.6–21.5], and 6.4 [1.8–23.0] in Bogodogo, Zorgho, and Sahel, respectively) and persons aged 15–30 years (aMOR [95% CI], 3.2 [1.1–9.7], 19.7 [3.3–infinity], 8.0 [1.8–34.8] in Bogodogo, Zorgho, and Sahel, respectively). Among children aged 1–14 years, VE of any measles vaccination prior to 2009 was 94% (95% CI, 45–99%) in Bogodogo, 87% (95% CI, 37–97%) in Zorgho, and 84% (95% CI, 41–96%) in Sahel. Main reasons for not receiving measles vaccination were lack of knowledge about vaccination campaigns or need for measles vaccination and absence during vaccination outreach or campaign activities. Conclusion: These results emphasize the need for improved strategies to reduce missed opportunities for vaccination and achieve high vaccination coverage nationwide in order to prevent large measles outbreaks and to continue progress toward measles mortality reduction. [Copyright &y& Elsevier]

Abstract: The overall and indirect effects of immunizing school children with influenza A (H1N1) 2009 pandemic virus vaccine prior to and during the peak of virus circulation were evaluated on student and teacher school absenteeism. We used records collected from late 2009 through early 2010 from schools in four Maine counties. Mixed logistic regression models were used to estimate the daily association between school-level immunization coverage and absenteeism by level of influenza activity, after adjusting for the proportion of students receiving reduced-cost lunches, student minority status, absences adjacent to weekends and Thanksgiving, rural school location, and the circulation of other respiratory viruses. Increasing student immunization coverage was associated with reduced absenteeism during periods of high influenza activity. For example, as immunization coverage during the peak week of pandemic virus circulation increased from 38% to 69% (the 10th and 90th percentiles of observed coverage, respectively), relative reductions in daily absenteeism among all students, unimmunized students, and teachers were 8.2% (95% confidence interval [CI]: 6.5, 9.9), 5.7% (95% CI: 4.2, 7.3), and 8.7% (95% CI: 1.3, 16), respectively. Increased vaccination coverage among school-aged Maine children had modest overall and indirect effects on student and teacher absenteeism, despite vaccination occurring just prior and during peak pandemic virus circulation. [Copyright &y& Elsevier]

Abstract: We conducted an investigation of two outbreaks of poliomyelitis in Angola during 2007–2008 due to wild poliovirus (WPV) genetically linked to India. A case-control study including 27 case-patients and 76 age- and neighborhood-matched control-subjects was conducted to assess risk factors associated with paralytic poliomyelitis, and epidemiologic links to India were explored through in-depth case-patient interviews. In multivariable analysis, case-patients were more likely than control-subjects to be undervaccinated with fewer than four routine doses of oral poliovirus vaccine (adjusted matched odds ratio [aMOR], 4.1; 95% confidence interval [CI], 1.2–13.6) and have an adult household member who traveled outside the province of residence in the 2 months preceding onset of paralysis (aMOR, 3.2; 95% CI, 1.2–8.6). No epidemiologic link with India was identified. These findings underscore the importance of routine immunization to prevent outbreaks following WPV importations and suggest a possible role of adults in sustaining WPV transmission. [Copyright &y& Elsevier]