Elimination Phase of Measles: an Epidemiological Survey in Gonabad (Iran) during 2006-2010

Hamed Ramezani A., MSc1; Alireza Atarodi B., MSc2; Mahdi Moshki, PhD3 1. Control Disease Unit of Health Deputy, Gonabad University of Medical Sciences, Gonabad, Iran 2. School of Paramedical Sciences, Gonabad University of Medical Sciences, Gonabad, Iran 3. School of Health, Social Development & Health Promotion Research Center, Gonabad University of Medical Sciences, Gonabad, Iran Received: Nov 27, 2010; Accepted: Sep 26, 2011 Mortality rate of measles disease has dramatically decreased because of vaccination programs, since the mortality rate of measles has decreased from 104000 in 1999 to 10000 in 2007 in the Eastern Mediterranean Region (EMR) and has decreased to 15869 cases based on reports in 2009[1,2]. In October 1997, the EMR member countries adopted a resolution for elimination of measles from the region by the year 2010. This resolution endorsed the following four strategies to reach the goal: To achieve and maintain routine measles vaccine coverage more than 95% among children under 1 year of age; conducting a onetime, nationwide, mass immunization campaign or catch-up campaign targeting all children (usually those aged from 9 months – 15 years) regardless of the history of measles disease or vaccination; follow-up campaigns every 3-5 years, targeting all children born since the last campaign (usually those aged from 9 months to 4 years), or achieving 95% routine coverage with a second routine dose of measles vaccine; and to strengthen detection of suspected cases through measles surveillance and laboratory confirmation systems[3]. Today the reports from measles surveillance system information show a dramatic decrease of disease incidence in Iran, so that the incidence of the disease has decreased from 12 in 100000 to 1.6% cases per 100000 population in 2009[4]. During the elimination of measles program in Gonabad city in 5 years (from April 2006 to December 2010) 23 cases of suspected measles based on WHO definition such as having fever and rash plus one of the following 3 symptoms: cough, runny nose, and/or conjunctivitis, were detected. The elimination of measles disease is based on quality assessment indices of surveillance system such as: detection of 2 cases in a population of more than 100000 members; reporting of suspected cases detected within 24 hours after the appearance of cutaneous rashes; history of vaccination for suspected cases, reporting rate of public and private health care centers and sending laboratory samples within 7 days to laboratory. From 23 suspected cases of measles in Gonabad city 56.2% were females and 43.2% males. 2 to 3 cases have been detected each year from 2006, but 13 cases were detected in the first 9 months of the year 2010 by more expert activity of surveillance system measures. Reporting index of suspected cases from Gonabad health centers from appearing of rashes within 48 hours was 82.1% or higher than the national index of the country (80%). However, more effort is needed to train all the parents to refer willingly to physicians of local health and treatment centers within 48 hours after the incidence of cutaneous rashes. The third index is complete sampling percentage (urine, throat swab, blood samples). Twentythree cases in general were detected. From 78.2% of suspected cases 3 samples and from 13% only 1 sample of blood serum had been collected and the rest of cases were not sampled because their parents refused the sampling. The national defined index of blood serum for sampling must be obtained from at least 80% of the detected cases, in this research it was over the national index. All the samples sent to laboratory were received by the laboratory and diagnostic tests were negative in terms of Letter to Editor Iran J Pediatr Jun 2012; Vol 22 (No 2), Pp: 277-278