Measles in Africa: Burden of Disease

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ARCHI 2010

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Measles in Africa

Burden of Disease

Measles remains a major childhood killer throughout most of Africa, responsible for an estimated 435,000 deaths or approximately 50% of global measles deaths in 1995. Of those approximately 80% are occurring in West and Central Africa.*

Estimated number of measles cases and deaths in 1995 in WHO/AFRO Region:
Surviving Infants    22,024,000
Cases                          9,200,000
Deaths                           435,000

The West African subregion reported the highest measles morbidity between 1992-1997 (121 measles cases per 100,000 inhabitants). During the same period, the reported measles incidence in the different subregions is as follows: Central Africa - 81/100,000 inhabitants; Southern Africa - 58/100,000 inhabitants; Eastern Africa - 78/100,000 inhabitants; and countries in special circumstances (i.e. Angola, DR Congo, Ethiopia and Nigeria) - 33/100,000 inhabitants.

In contrast, significant reduction in reported measles incidence and mortality has been observed recently in countries in the Southern African subregion which have achieved and sustained high (i.e. >75%) routine measles vaccination coverage for several years. In some cases, measles incidence has shifted to older age groups. Recent outbreaks in Cape Verde (1997) and Seychelles (1998) involved mainly individuals older than 15 years of age. The case fatality rate was low during both outbreaks.

Countries in the Eastern African subregion present an intermediate situation, with moderate to high vaccine coverage and relatively low measles related mortality.

Immunization Coverage

In 1998, eighteen countries in the African region failed to reach 50% measles immunization coverage. (Burkina Faso, Burundi, Cameroon, CAR, Chad, Congo, DR Congo, Dijbouti, Ethiopia, Gabon, Lesotho, Liberia, Mauritania, Niger, Nigeria, Somalia, Togo, and Uganda)

UNICEF priority countries for 1998-2000 include: Angola, Burkina Faso, Cameroon, Côte d'Ivoire, DR Congo, Ethiopia, Ghana, Guinea, Kenya, Madagascar, Mali, Nigeria, Somalia, Senegal, Tanzania, Uganda

In recent years measles coverage has increased steadily and in an effort to reduce disease burden a number of countries have started to implement supplemental measles immunization activities even in low-income countries such as Benin, Chad, Mauritania, Mozambique and Niger. For example, Mauritania implemented a campaign of children under 5 years of age in 1995 and a follow-up campaign in 1997 which has reduced measles mortality and morbidity to very low levels.*

*from "Acceleration of Measles Mortality Reduction and Measles Elimination in the African Region, Five-year Plan of Action, Version 2.0, Nov. 1998", CDC draft.

Southern African Countries

<50%	Coverage	51-70%	Coverage	71-80%	Coverage	81%+	Coverage
Lesotho	43%	Swaziland	62%	S. Africa	76%	Mozambique	87%
		Namibia	63%	Botswana	80%	Malawi	90%
		Angola	65%
		Zimbabwe	65%
		Zambia	69%

East African Countries

<50%	Coverage	51-70%	Coverage	71-80%	Coverage	81%+	Coverage
Djibouti	21%	Eritrea	52%	Kenya	71%	Mauritius	85%
Uganda	30%	Sudan	63%	Tanzania	72%	Seychelles	93%
Burundi	44%	Madagascar	65%
Ethiopia	46%	Rwanda	66%
Somalia	47%	Comoros	67%

Central African Countries

<50%	Coverage	51-70%	Coverage	71-80%	Coverage	81%+	Coverage
DR Congo	10%	Sao Tome/P	59%	None		Eq. Guinea	82%
Congo	18%
Chad	30%
Gabon	32%
CAR	39%
Cameroon	44%

West African Countries

<50%	Coverage	51-70%	Coverage	71-80%	Coverage	81%+	Coverage
Mauritania	20%	Guinea-B	51%		None	Benin	82%
Nigeria	26%	Mali	57%			Gambia	91%
Niger	27%	Guinea	58%
Liberia	31%	Ghana	62%
Togo	32%	Senegal	65%
Burkina-F.	46%	C.d'Ivoire	66%
		Cape V.	66%
		Sierra L.	68%

North African Countries

<50%	Coverage	51-70%	Coverage	71-80%	Coverage	81%+	Coverage
	None		None	Algeria	75%	Morocco	91%
						Libya	92%
						Tunisia	94%
						Egypt	98%

Possible Role for RC/RCs

Advocacy

RC community volunteers can obtain the latest coverage data (baseline data) on BCG, DPT, polio and measles for their respective communities from their local health facilities or staff.

Through social mobilisation and follow-up with families of new-borns and infants, RC community volunteers can play a vital role in increasing a community's immunization coverage. Volunteers can also measure the impact of their activities by monitoring (with health authorities) progress (increases) in coverage rates in their specific areas.

To be effective in EPI social mobilisation, village/community health volunteers need to know their community's population including the new-borns who are the target group for EPI.

For more information on EPI vaccines and diseases, access WHO Immunization Profiles
or through email at: EPI@WHO.CH

ALL INFORMATION, DATA, AND MATERIAL CONTAINED, PRESENTED, OR PROVIDED HERE IS FOR GENERAL INFORMATION PURPOSES ONLY AND IS NOT TO BE CONSTRUED AS REFLECTING THE KNOWLEDGE OR OPINIONS OF THE PUBLISHER, AND IS NOT TO BE CONSTRUED OR INTENDED AS PROVIDING MEDICAL OR LEGAL ADVICE. THE DECISION WHETHER OR NOT TO VACCINATE IS AN IMPORTANT AND COMPLEX ISSUE AND SHOULD BE MADE BY YOU, AND YOU ALONE, IN CONSULTATION WITH YOUR HEALTH CARE PROVIDER.