Journal of Infectious Diseases
Volume 210 Issue 12 December 15, 2014
http://jid.oxfordjournals.org/content/current

Emergency Settings: Be Prepared to Vaccinate Persons Aged 15 and Over Against Measles
Reinhard Kaiser
Author Affiliations
Immunization, Vaccines, and Emergencies, WHO Regional Office for Africa, Inter-country Support Team, East and Southern Africa, Harare, Zimbabwe
[Initial text]
In their landmark article on measles prevention in emergency settings, Toole and colleagues recommended in 1989 that all children aged 6 months to 5 years should be immunized with measles vaccine at the time they enter an organized camp or settlement [1]. In 2000, Salama and colleagues documented substantial mortality during a famine emergency in Ethiopia, with measles and malnutrition as major contributing factors. In a retrospective study of mortality, measles alone, or in combination with wasting, accounted for 35 (22.0%) of 159 deaths among children younger than 5 years and for 12 (16.7%) of 72 deaths among children aged 5–14 years. The setting was a rural population without routine childhood immunization and exposure to natural measles virus infection [2]. The authors concluded that measles vaccination, in combination with vitamin A distribution, should be implemented in all types of complex emergencies. Vaccination coverage should be 90% and extended to children up to age 12–15 years [2]. A vaccination age range up to 14 years was included in the World Health Organization (WHO)/United Nations Children’s Fund (UNICEF) statement to reduce measles mortality in emergencies [3], and the revised SPHERE project guidelines [4]. However, since then, the discussion about target age groups has increasingly included the potential need to vaccinate adults. As early as 2000–2001, Kamugisha and colleagues documented 21% of measles cases that were 16 years and older in a major outbreak in Tanzanian camps with refugees from Burundi [5]. The authors concluded that in some emergency settings, achieving population immunity adequate to prevent virus transmission may require vaccinating persons older than 15 years, and the selection of …

Measles Outbreak Response Among Adolescent and Adult Somali Refugees Displaced by Famine in Kenya and Ethiopia, 2011
Carlos Navarro-Colorado1, Abdirahman Mahamud1,a, Ann Burton2,a, Christopher Haskew3, Gidraf K. Maina4, John B. Wagacha2, Jamal A. Ahmed5,a, Sharmila Shetty1,a, Susan Cookson1,
James L. Goodson1, Marian Schilperoord3 and Paul Spiegel3
Author Affiliations
1Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
2United Nations High Commissioner for Refugees (UNHCR), Nairobi, Kenya
3UNHCR, Geneva, Switzerland
4UNHCR, Addis Ababa, Ethiopia
5CDC, Nairobi, Kenya
Abstract
Background
The refugee complexes of Dadaab, Kenya, and Dollo-Ado, Ethiopia, experienced measles outbreaks during June–November 2011, following a large influx of refugees from Somalia.
Methods
Line-lists from health facilities were used to describe the outbreak in terms of age, sex, vaccination status, arrival date, attack rates (ARs), and case fatality ratios (CFRs) for each camp. Vaccination data and coverage surveys were reviewed.
Results
In Dadaab, 1370 measles cases and 32 deaths (CFR, 2.3%) were reported. A total of 821 cases (60.1%) were aged ≥15 years, 906 (82.1%) arrived to the camps in 2011, and 1027 (79.6%) were unvaccinated. Camp-specific ARs ranged from 212 to 506 cases per 100 000 people. In Dollo-Ado, 407 cases and 23 deaths (CFR, 5.7%) were reported. Adults aged ≥15 years represented 178 cases (43.7%) and 6 deaths (26.0%). Camp-specific ARs ranged from 21 to 1100 cases per 100 000 people. Immunization activities that were part of the outbreak responses initially targeted children aged 6 months to 14 years and were later expanded to include individuals up to 30 years of age.
Conclusions
The target age group for outbreak response–associated immunization activities at the start of the outbreaks was inconsistent with the numbers of cases among unvaccinated adolescents and adults in the new population. In displacement of populations from areas affected by measles outbreaks, health authorities should consider vaccinating adults in routine and outbreak response activities.