Table 2 Mass vaccination response details *

AMERICAS

Bolivia

MV1: 1998 4 m after 1^st case

Nonselective

Nationwide

6 m -5 y

85%

Persistent cases

Epidemic ended after multiple immunization activities

MV2: 1999

house-to-house Nationwide

6 m - 4 y + 6 m - 14 y in 2 dpts

98%

Persistent cases but decreased over time

MV3: 2000

House-to-house

in high risk municipalities

N/A

N/A

N/A

MV4: 2002

House to house

6 m - 4 y

95%

Transmission stopped

Haiti

MV1: < 4 w after 1^st case

Nonselective

Provincial city

6 m - 14 y

95%

No cases in city within 2 w of end of campaign; spread to rest of island

Epidemic ended after multiple immunization activities

MV2: N/A

Departments

6 m - 14 y

65 - 95%

No cases after early August in department

MV3: 5-9/00

Port-au-Prince

6 m - 14 y

82%

MV4: 11/00-1/01

Port-au-Prince neighborhood

6 m - 14 y

80 - 90%

Reduced number of

cases island-wide

MV5: 9-12/01

Nationwide

N/A

> 85%

Measles transmission interrupted

Colombia

Various

door to door vaccination in high risk municipalities

6 m-5 y

N/A

N/A but editorial suggests proactive response averted large outbreak

Compared to outbreak in neighboring Venezuela, prompt, door to door targeted vaccination and surveillance may have prevented a large outbreak in a country where EPI is limited by long term conflict

ASIA

Afghanistan

12/2001-5/2002

Nonselective, Central region districts and returning refugees in catchment area. Revaccination in districts with low coverage

6 m-12 y

77% (62-90%) by May 2002

63-92% by December 2002

Impact on incidence not assessed.

Campaign achieved high coverage despite many obstacles. Authors recommend vaccinating extended age groups in complex emergencies.

Unable to assess impact from data provided, but from WHO records measles incidence decreased dramatically for next 2 years.

India

Soon after flood began

Flood area, areas of congregation then cut-off villages

6 m to 14 y

Catch-up

75%

Catch-up:60%

Qualitative analysis on the vaccination in multiple stages. Initial one prevented large scale measles o/b and death, later stages contained smaller o/b and high mortality was prevented with a joint surveillance system

Insufficient data

India

Dec 29, 04 to Jan 9, 05

Non-selective, 58 villages in Namil-Tadu district, Eastern India

6 m to 60 m

No catch-up

117.2%

Qualitative analysis transmission continued despite vaccine coverage and was unrelated to tsunami. Target age was too restrictive, recommendation to vaccinate children up to 14 years during complex emergencies like tsunami.

Insufficient data

Sri Lanka

N/A

Nonselective

Refugee camps,

welfare centers,

preschools, & slums

Children " < 10 y"

N/A

N/A

Not clear

AFRICA

Niger

Outreach services in some health centers

N/A

N/A

N/A

Impact not specified but authors discuss the need to include older than 5 y children in vaccination campaigns due to high CFR in this group.

Insufficient information to determine impact

Tanzania

Epidemic started in March, ORI were in April, June and August in 3 camps

Nonselective, refugee camps.

ORI:

6 m-5 y.

But new arrivals 6 m-15 y are routinely vaccinated

N/A

6 m-5 y campaign prevented cases and deaths, but to halt transmission, campaigns targeting a wider age group would have been more effective

May have influenced epidemic. given large proportion of cases in older age groups, vaccinating up to age 15 early in the epidemic would have likely shortened the duration of the outbreaks.

Ethiopia

Within 1 month

Nonselective

9 m -5 y

Despite ORI in February measles cases continued to be reported in the district including among vaccinated. Recommend extending vaccinated age group to 12-15 y in acute emergencies. Epidemic was not halted until August when a vaccination campaign with grater coverage and efficacy implemented

The authors calculate low coverage and poor efficacy of vaccine in February campaign. These alone could have allowed outbreak to continue, but including a wider age range for vaccination may have been useful in containing the outbreak. No age breakdown of cases available.

Mozambique

Varied reactive SIAs

Nonselective, targeted urban

(province capitals)

9 m-4 y

Measles campaigns had limited impact. Recommend increasing target age group and including rural areas linked to cities via transport routes.

Campaigns may have had some impact, as noted by reduced caseload in subsequent years. Targeting a wider age group in catch up and outbreak campaigns could have had greater impact.

Niger

Wk 24 after o/b

LQAS selection, 46 lots of 65 children

6 m - 5 y

Other SIAs after the survey: 99%

SIA are a first response to reinforcement of routine immunization activities (children under 5)

CFR = 3.3% (global o/b)

No data otherwise

Nigeria

Wk 18 after o/b

Non-selective

6 m - 5 y

Other SIAs after the survey: 80%

same

Chad

Wk 22 after o/b

Non-selective

6 m - 5 y

Other SIAs after the survey: 96%

same

South Africa

Jan 04

Non-selective

6 m to 14 y

Catch-up: 9 m-4 y

Catch-up: 86%

Importance of maintaining high immunity by means of routine immunization to prevent transmission following importation of the virus

N/A

Tanzania

11 wks after o/b

Non-selective

6 m to 14 y

882789 doses given

Administrative: 100%

Measured: 66%

Measles incidence declined in the targeted age group

Incidence would have been high in the target group without intervention

Sudan

06/05/04

North Darfur only

9 m - 15 y

93% of the accessible pop

77% of the global

The restricted access to population and the low coverage explains that measles cases still occurred after the vaccination campaign.

North Darfur: CFR = 17%

West Darfur: CFR = 14%

Similar results to other studies in comparable situations

EUROPE

Albania

2 wks after o/b

Only two districts (Kukes and Has)

6 m - 5 y

90%

Surveillance system allowed for early epidemic detection

N/A