Chao Ma1, Fangjun Li2, Xiang Zheng3, Hong Zhang4, Mengjuan Duan5, Yanhua Yang6, Lixin Hao7, Qiru Su8, Lance Rodewald9, Bosong Guo10, Shanliang Xiao11, Huaqing Wang12, Li Li13, Junhua Li14, Huiming Luo15, Lidong Gao16. 1. National Immunization Programme, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Xicheng District, Beijing, China. maachao@163.com. 2. Hunan Province Center for Disease Control and Prevention, Changsha, Hu Nan province, China. fangjunliself678@sina.com. 3. Taizhou Prefecture Center for Disease Control and Prevention, Taizhou, Zhe Jiang province, China. xiaoyucool88@163.com. 4. Hunan Province Center for Disease Control and Prevention, Changsha, Hu Nan province, China. 6184778524@qq.com. 5. National Immunization Programme, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Xicheng District, Beijing, China. duan123mengjuan@163.com. 6. Hunan Province Center for Disease Control and Prevention, Changsha, Hu Nan province, China. hncdcyyh@163.com. 7. National Immunization Programme, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Xicheng District, Beijing, China. lixinh2010@163.com. 8. National Immunization Programme, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Xicheng District, Beijing, China. shine_firefly@126.com. 9. World Health Organization Office in China, Beijing, China. rodewaldl@wpro.who.int. 10. Longhui County Center for Disease Control and Prevention, Shaoyang, Hu Nan province, China. 361778524@qq.com. 11. Shaoyang Prefecture Center for Disease Control and Prevention, Shaoyang, Hu Nan province, China. 1178273088@qq.com. 12. National Immunization Programme, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Xicheng District, Beijing, China. hqwang@vip.sina.com. 13. National Immunization Programme, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Xicheng District, Beijing, China. llsdjn@163.com. 14. Hunan Province Center for Disease Control and Prevention, Changsha, Hu Nan province, China. 867663530@qq.com. 15. National Immunization Programme, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Xicheng District, Beijing, China. Luohm@Chinacdc.cn. 16. Hunan Province Center for Disease Control and Prevention, Changsha, Hu Nan province, China. gldlj@hotmail.com.
Abstract
BACKGROUND: China is approaching measles elimination, but indigenous measles still circulates. County L in China has reported measles-containing vaccine (MCV) coverage rates >95% since 2000. Despite high reported coverage, a large measles outbreak occurred among young children in L County. We measured MCV coverage using 5 different methods during an investigation on this outbreak and compared our estimates with reported rates. METHODS: Reported coverage rates are determined by aggregating clinic-based data across the county: doses administered in each clinic divided by the number of children registered in each clinic. Our methods estimated coverage for the 2010-2012 birth cohort, and were (1) administrative method: doses administered in clinics divided by the birth cohort recorded in the Statistical Year Book, (2) house-to-house convenience-sample survey of children living near cases, (3) vaccination clinic records review, (4) determination of a convenience sample of measles outbreak cases' vaccination statuses and using the field vaccine efficacy outbreak equation to estimate population coverage, and (5) a seroprevalence survey using a convenience sample of residual blood samples from hospitals. RESULTS: The measles outbreak totaled 215 cases, representing an incidence of 195.8 per million population. Our estimated MCV coverage rates were: (1) administrative method: 84.1%-87.0% for MCV1 and 80.3%-90.0% for MCV2, (2) in-house survey: 83.3% of 9-17 month children received MCV1, and 74.5% of 24-47 month children received MCV2, (3) clinic record review: 85.5% of 9-17 month children received MCV1, and 73.2% of 24-59 month children received MCV2, (4) field VE method: 83.6% of 9-47 month children received one or more MCV doses, and (5) serology: seropositive rates were <80% in the 12-17 and 18-23 month age cohorts. CONCLUSIONS: Compared with reported coverage >95%, our 5 coverage assessments all showed substantially lower coverage. China should evaluate guidelines for reporting vaccination coverage and identify feasible improvements to the assessment methods.
BACKGROUND: China is approaching measles elimination, but indigenous measles still circulates. County L in China has reported measles-containing vaccine (MCV) coverage rates >95% since 2000. Despite high reported coverage, a large measles outbreak occurred among young children in L County. We measured MCV coverage using 5 different methods during an investigation on this outbreak and compared our estimates with reported rates. METHODS: Reported coverage rates are determined by aggregating clinic-based data across the county: doses administered in each clinic divided by the number of children registered in each clinic. Our methods estimated coverage for the 2010-2012 birth cohort, and were (1) administrative method: doses administered in clinics divided by the birth cohort recorded in the Statistical Year Book, (2) house-to-house convenience-sample survey of children living near cases, (3) vaccination clinic records review, (4) determination of a convenience sample of measles outbreak cases' vaccination statuses and using the field vaccine efficacy outbreak equation to estimate population coverage, and (5) a seroprevalence survey using a convenience sample of residual blood samples from hospitals. RESULTS: The measles outbreak totaled 215 cases, representing an incidence of 195.8 per million population. Our estimated MCV coverage rates were: (1) administrative method: 84.1%-87.0% for MCV1 and 80.3%-90.0% for MCV2, (2) in-house survey: 83.3% of 9-17 month children received MCV1, and 74.5% of 24-47 month children received MCV2, (3) clinic record review: 85.5% of 9-17 month children received MCV1, and 73.2% of 24-59 month children received MCV2, (4) field VE method: 83.6% of 9-47 month children received one or more MCV doses, and (5) serology: seropositive rates were <80% in the 12-17 and 18-23 month age cohorts. CONCLUSIONS: Compared with reported coverage >95%, our 5 coverage assessments all showed substantially lower coverage. China should evaluate guidelines for reporting vaccination coverage and identify feasible improvements to the assessment methods.
Authors: Amy Parker Fiebelkorn; Susan B Redd; Kathleen Gallagher; Paul A Rota; Jennifer Rota; William Bellini; Jane Seward Journal: J Infect Dis Date: 2010-10-07 Impact factor: 5.226
Authors: Carlos Castillo-Solorzano C; Cuauhtémoc Ruiz Matus; Brendan Flannery; Christina Marsigli; Gina Tambini; Jon Kim Andrus Journal: J Infect Dis Date: 2011-07 Impact factor: 5.226
Authors: Fred Nsubuga; Lilian Bulage; Immaculate Ampeire; Joseph K B Matovu; Simon Kasasa; Patricia Tanifum; Alex Ario Riolexus; Bao-Ping Zhu Journal: BMC Infect Dis Date: 2018-01-08 Impact factor: 3.090
Authors: Marc Choisy; Son Tung Trinh; Thi Ngoc Diep Nguyen; Tran Hien Nguyen; Quynh Le Mai; Quang Thai Pham; Nhu Duong Tran; Duc Anh Dang; Peter W Horby; Maciej F Boni; Juliet Bryant; Sonia O Lewycka; Behzad Nadjm; H Rogier Van Doorn; Heiman F L Wertheim Journal: Open Forum Infect Dis Date: 2019-01-24 Impact factor: 3.835