First 5 years of measles elimination in southern Africa: 1996-2000.

BACKGROUND Measles is the leading cause of vaccine-preventable death in Africa. Regional measles elimination is considered feasible using current vaccines and a series of WHO-recommended strategies. We aimed to interrupt transmission of measles, and to use case-based surveillance to show the effect of such interruption. METHODS In southern Africa from 1996, seven countries with a total population of approximately 70 million and with relatively high routine vaccination coverage implemented measles elimination strategies. In addition to routine measles immunisation at 9 months of age, these included nationwide catch-up campaigns among children aged 9 months to 14 years, then follow-up campaigns every 3-4 years among children aged 9-59 months, and the establishment of case-based measles surveillance with serological diagnostic confirmation. RESULTS Nearly 24 million children aged 9 months to 14 years were vaccinated, with overall vaccination coverage of 91%. Reported clinical measles cases declined from 60000 in 1996 to 117 laboratory-confirmed measles cases in 2000. Reported measles deaths declined from 166 in 1996 to zero in 2000. No increase in adverse events was noted after the measles vaccination campaign. CONCLUSION A reduction in measles mortality and morbidity can be achieved in very low-income countries, in countries that split their vaccination campaigns by geographical area or by age-group of the target population, and where initial routine measles vaccination coverage among infants was <90%, even when prevalence of HIV/AIDS was extremely high. Continued high-level national commitment will be crucial to implementation and maintenance of proven strategies in southern Africa.