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Priorities in global measles control: report of an outbreak in N'Djamena, Chad

  • A. Ndikuyeze (a1), A. Cook (a2), F. T. Cutts (a2) and S. Bennett (a2)

In N'Djamena, capital of Chad, measles vaccination coverage of 12–23-month-old children fell from 61% in 1990 to 15% in 1993. A community survey of measles after an outbreak in 1993 showed that among children < 5 years of age, the mean monthly attack rate was 37 per 1000 (95% CI, 32–43) and the mean case fatality rate was 7·4%. Measles incidence was highest (77/1000/month) in children aged 9–11 months and fell among children > 3 years of age. Incidence rates were high (56/1000/month) among 6–8-month-old children, but only 3 deaths occurred in this age group. Measles vaccine efficacy, estimated by comparing attack rates in unvaccinated and vaccinated children, was 71 % (95% CI, 59–80%). Extrapolation of the results to the city population indicated that an estimated 19000 cases and > 1000 measles-associated deaths occurred in 1993. This preventable morbidity and mortality, in a city where coverage was formerly among the highest in Africa, shows the need for sustained global commitment to preventive health care.

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1.World Declaration on the survival, protection and development of children and plan of action for implementing the World Declaration on the survival, protection and development of children in the 1990s. World Summit for Children. United Nations. New York, 1990.
2.Morbidity Mortality Weekly Report. Absence of reported measles. United States. November 1993. MMWR 1993; 42 925–6.
3.Peltola H, Heinonen OP. Valle M et al. , The elimination of indigenous measles, mumps and rubella from Finland by a 12-year, two-dose vaccination program. N Engl J Med 1994; 331: 1397–402.
4.Snedecor GW. Cochran WG. Statistical methods. Ames: Iowa State University Press. 1968; 515.
5.Rothman KJ. Modern epidemiology. Boston: Little, Brown and Company, 1986; 213.
6.Cutts FT. Markowitz LE. Successes and failures in measles control. J Infect Dis 1994; 170 (suppl 1): 832841.
7.Orenstein WA. Bernier RH. Hinman AR. Assessing vaccine efficacy in the field. Further observations. Epidemiol Rev 1988; 10: 212–41.
8.Cutts FT, Brown DWG. The contribution of field tests to measles surveillance and control: a review of available methods. Rev Med Virol 1995; 5: 3540.
9.Katz SL. Gellin BG. Measles vaccine: do we need new vaccines or new programs? Science 1994; 265: 1391–2.
10.Global Programme for Vaccines of the World Health Organization. Role of mass campaigns in global measles control. Lancet 1994; 344: 174–5.
11.World Bank. World development indicators. In: World Development Report 1993. Investing in Health. Oxford: Oxford University Press. 1993; 231.
12.Malfait P. Jataou IM. Jollet M-C. Margot A. De Benoist A-C. Moron A. Measles epidemic in the urban community of Niamey: transmission patterns, vaccine efficacy and immunization strategies. Niger, 1990 to 1991. Pediatr Infect Dis J 1994; 13: 3845.
13.Ndumbe PM. Do vaccines reach those who most need them? Cameroon. In: Cutts FT. Smit PG. Eds. Vaccination and world health. Chichester: John Wiley. 1994; 225–38.
14.Bernier RH. Orenstein W. Hutchins S. Zell ER. Do vaccines reach those who most need them? United States. In: Cutts FT. Smith PG. Eds. Vaccination and world health. Chichester: John Wiley. 1994; 213–25.
15.Miller E. The new measles campaign. BMJ 1994; 309: 1102–3.
16.Rosenthal G. The economic burden of sustainable EPI: implications for donor policy. Resources for Child Health Project. Feb. 1990. Arlington: John Snow Inc. 1990.
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Epidemiology & Infection
  • ISSN: 0950-2688
  • EISSN: 1469-4409
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