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© 1994 Oxford University Press

research-article

Measles Control in Kinshasa, Zaire Improved with High Coverage and Use of Medium Titre Edmonston Zagreb Vaccine at Age 6 Months

F T CUTTS*,, O OTHEPA**, A A VERNON**,{dagger}, B NYANDU**, L E MARKOWITZ*, A DEFOREST{ddagger}, K WILKINS** and B OKWO**

*Division of Immunization, Centera for Disease Control Atlan1 GA, USA
**Combatting Childhood Communicable Disease Project, Ministry of Health Zaire
{dagger}International Health Program Office, Centera for Disease Control Atlanta, GA, USA
{ddagger}Virus Loboratory, St Christophers Hospital for Children Philadelphia, PA, USA

Reprint requesta to. Dr Felicity Cutts, Communicable Disease Epidemiology Unit, School of Hygiene and Tropical Medicine, Keppel St. London. WCIE 7HT, UK

Background. To improve measles control in Kinshasa, Zaire, a project to increase vaccine coverage was begun in 1988, and in 1989, the city vaccination programme changed measles vaccination policy from Schwartz vaccine at age 9 months to medium titre Edmonston Zagreb (EZ) vaccine at age 6 months. We report the Impact of the programme on measles Incidence and mortality.

Methods. Data on vaccine coverage were obtained from cluster sample surveys conducted every 1–2 years and from routine reports of vaccine doses administered. Data on measles Incidence and mortality were obtained from sentinel surveillance sites. The serological response to EZ measles vaccine was evaluated at a health centre in 1989 and in a community survey in 1990.

Results. Measles vaccine coverage estimated in cluster surveys increased from 50% of the 1984 bIrth cohort to 89% of the 1989 bIrth cohort, accepting either a home-based record or a verbal history of vaccination. Reported measles incidence per 100 000 population decreased by over 90%, from 37.5 in 1980 (early vaccination years) to 1.6 in 1991. There was a relative decrease In the proportion of cases aged < 9 months (32% of cases in 1986–1987 and 23% of cases in 1990–1991) and an increase in the proportion aged > 23 months (29% of cases In 1986–1987 and 43% in 1990–1991). AccordIng to ELISA assays, 74–76% of children seroresponded to EZ vaccine administered at age 6–7 months under routine programme conditions.

Conclusions. Measles can be controlled In urban areas, although it is difficult to determine how great a contribution vaccination at age 6 months makes over and above the achievement of high coverage.

Received 1 November 1993


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