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We conducted a survey to determine the accuracy of the clinical diagnosis of measles in Zimbabwe. Between December 1996 and February 1997, we collected blood samples and clinical and demographic information from a sample of 105 children with a clinical diagnosis of measles. A clinical case of measles was defined as a person with a history of fever, rash for three or more days, and either cough, coryza, or conjunctivitis. A laboratory-confirmed case of measles or rubella had IgM antibodies against measles virus or rubella virus respectively. A total of 91% of children met the clinical case definition. Among those who met the clinical case definition for measles, 72% were IgM-positive for measles virus only, 23% were IgM-positive for rubella virus only, 3% were IgM-positive for both measles and rubella viruses, and 2% were IgM-negative for both viruses. This study demonstrates the importance of considering selective laboratory confirmation of measles in periods of high disease incidence when the effectiveness of the vaccine is questioned.

Objectives: Missed opportunities for vaccination occur when a child or woman who is eligible for a vaccination visits a health facility but fails to receive that vaccination. Our study attempted to determine the extent and reasons for missed opportunities occurring in an urban setting in Zimbabwe., Design: This study was carried out using the standard WHO EPI protocol for ascertaining missed opportunities for vaccination., Setting: All four health clinics in Chitungwiza City., Subjects: All appropriate clients (children < 2 years and women of childbearing age) exiting each facility., Results: The study revealed a global missed opportunity rate of six pc for children and 55pc for women of childbearing age. Missed opportunities occurred more frequently when children attended curative services and when women of childbearing age attended preventive services., Conclusions: Vaccination services can be improved by making all vaccines available and by screening children and women at all contacts with health services. Additionally, all women should receive and be encouraged to carry a tetanus toxoid vaccination card when visiting a health facility. In all cases, a vial of vaccine should be opened even if only one child or woman is eligible for vaccination, in accordance with Ministry of Health policy.