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IJE Advance Access published online on January 19, 2005
International Journal of Epidemiology, doi:10.1093/ije/dyi001
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IJE © International Epidemiological Association 2005; all rights reserved.
Accepted November 22, 2004

Original paper

Migration as a risk factor for measles after a mass vaccination campaign, Burkina Faso, 2002{dagger}

K. Robert Yaméogo 1, Robert T. Perry 2*, André Yaméogo 3, Chantal Kambiré 4, M. Kader Kondé 4, Déogratias Nshimirimana 5, Robert Kezaala 5, Bradley S. Hersh 6, K. Lisa Cairns 2, and Peter Strebel 2

1 Health Information System, Directorate of Studies and Planning, Ministry of Health, Ouagadougou, Burkina Faso
2 Global Immunization Division, National Immunization Program, Centres for Disease Control and Prevention, 1600 Clifton Road, NE MS-E05, Atlanta, GA 30333, USA
3 Service for Vaccine Prevention, Directorate of Preventive Medicine, Ministry of Health, Ouagadougou, Burkina Faso
4 Office of the World Health Organization Representative, Ouagadougou, Burkina Faso
5 World Health Organization Office for Africa, Vaccine Preventable Diseases, Harare, Zimbabwe
6 Expanded Programme on Immunization, World Health Organization, Geneva, Switzerland

* To whom correspondence should be addressed.
Robert T. Perry, E-mail: RPerry{at}cdc.gov


  Abstract

Background Shortly after a measles supplementary immunization activity (SIA) targeting children from 9 months to 14 years of age that achieved high coverage, Burkina Faso had a large, serologically confirmed measles outbreak. To investigate the causes of this first reported failure of a widely successful measles control strategy we conducted a case-control study.

Methods Serologically confirmed measles cases aged ≥9 months at the time of the SIA in 6 heavily affected districts were frequency matched on age to 3 controls recruited from people frequenting health centres in the same districts.

Results Between January and July 2002, 1287 measles cases were reported throughout Burkina Faso. Of the 707 cases that were serologically confirmed, 358 (51%) were from 9 months to 14 years of age and 265 (37%) were ≥15 years of age. Among cases and controls from 9 months to 14 years of age significant risk factors for measles were lack of measles vaccination and, in the unvaccinated, recent travel to Côte d'Ivoire. Of the recent measles cases in Côte d'Ivoire 54% were there when exposed to measles. Among adults, risk factors included nonvaccination and the lack of school attendance during childhood. Vaccine effectiveness was estimated to be 98%.

Conclusions Migration of children between Côte d'Ivoire and Burkina Faso played a major role in the failure of the SIA to interrupt measles transmission. Synchronization of measles control activities should be a high priority in countries with regions where much migration occurs.

Keywords: Measles; migration; Burkina Faso; Côte d'Ivoire; outbreak investigation; retrospective study; surveillance; risk factors.
{dagger} The results of this study were presented in part at the Third Annual Meeting of Partners for Measles Advocacy in Washington, DC, in February 2003.
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Migration and measles
Int. J. Epidemiol., December 1, 2005; 34(6): 1443 - 1444.
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