Elsevier

The Lancet

Volume 376, Issue 9754, 20–26 November 2010, Pages 1719-1720
The Lancet

Comment
Measles eradication: past is prologue

https://doi.org/10.1016/S0140-6736(10)61934-4Get rights and content

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    For example, there remains the potential for challenges to the health system if measles SIAs are relied upon as a replacement for weak routine vaccination programs rather than as a supplementary improvement to routine vaccination services. Some have recommended that SIAs must have “reached, and sustained, a predetermined level” in order to counteract the potential for these efforts to supplant or mask weak routine vaccination programs [41]. Furthermore, others have proposed that continued efforts towards measles control should focus specifically on strengthening the routine vaccination program, integrating vaccination with other health services, and encouraging donor support of primary health care [42].

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    At present such children can only be protected by raising herd protection by supplemental measles vaccinations. Others have argued that if measles is to be eliminated and ultimately eradicated it would be better to strengthen routine services to achieve high coverage before deploying mass immunization [32,33]. An early two dose schedule would fit well into this scheme: it protects the very young [5] and the HIV infected [34], increases coverage [4] and enhances child survival [6].

  • Measles control in Sub-Saharan Africa: South Africa as a case study

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    This situation prevents effective disease control, which in turn affects potential for disease elimination. In the case of measles, SIAs can reduce some of this heterogeneity while raising overall coverage in all districts, and addressing the promise of equity in targeting those not reached by health care systems [53,54]. Yet, SIAs can also create perverse effects such as lowering levels of routine coverage and, moreover, affecting performance of the health system as a whole.

  • Surveillance in eradication and elimination of infectious diseases: A progression through the years

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    Other eradication and elimination programmes underway include leprosy, lymphatic filiariasis, and onchocerciasis [26]. Discussion regarding measles elimination continues as well [27], and in addition to surveillance for clinical disease, monitoring of the vaccination status of children may also be required [27]. Recent experience with handheld communication technologies and the development of point of care diagnostic tests would be important additions to all existing or future elimination programmes, reducing time from identification to laboratory confirmation if required; and facilitating a more rapid and effective response.

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