Commentary: Accelerated measles control/measles elimination in southern Africa.

has developed a global plan for accelerated measles control which calls for implementation of a strategy based on that used to successfully control measles in the Americas—a 'catch-up' campaign providing measles vaccine to all children (usually 9 months [or 1 year] to 14 years of age) regardless of prior history of immunization or disease, followed by high levels of routine coverage with measles immunization ('keep-up'), and periodic 'follow-up' campaigns targeting all children 1–4 years of age. 1 The article by Uzicanin et al. is an exciting and impressive preliminary report on the short-term impact of adoption of this strategy, starting with a 'catch-up' measles immunization campaign in South Africa. 2 The dramatic results seen in the short-term are to be expected, particularly since routine measles coverage before the 'catch-up' campaign was sufficiently high to have prolonged the inter-epidemic cycle of measles in South Africa. As the authors point out, the real test of long-term control/elimin-ation will be the ability of the country to maintain high levels of routine coverage with measles vaccine along with periodic 'follow-up' campaigns to provide a second opportunity for measles vaccine for all young children. Nonetheless, the striking reduction in average annual morbidity and mortality gives cause for optimism about the longer-term impact of the programme. In addition to the obvious short-term impact of the campaign, two other aspects are notable—the concurrence of two different systems of surveillance and the ability of the campaign to reach children who had not previously been vaccinated (the 'hard to reach'). In the absence of a case-based reporting system backed up by laboratory confirmation, there are always questions about the accuracy/representativeness of passive reporting systems such as existed in South Africa until recently. The fact that hospital admission data closely paralleled reported morbidity increases confidence that the morbidity reporting system at least reflected trends in incidence. Given the fact that not all cases of measles seek medical attention and that, even for those who do seek attention, medical care providers do not always report cases as they should, the number of cases reported almost certainly underestimates reality unless there are major confounders from other illnesses such as rubella. It is clear that case reporting includes many non-measles illnesses, as manifested by the fact that, after the campaign, only approximately 10% of reported 'measles' cases were positive for hospital-based nurses for the surveillance of potential disease outbreaks. clinical diagnosis of measles: …