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  • Title: Measles in Brazil.
    Journal: EPI Newsl; 1984 Jun; 6(3):1-3. PubMed ID: 12267944.
    Abstract:
    In April 1983, the Federal District of Brasilia, Brazil, registered an unusual increase in the number of reported measles cases. Over 60,000 doses of vaccine were administered, as opposed to only 5000 doses which normally would have been given, but by mid-June the incidence of the disease was even higher than before. The persistence of the measles epidemic despite apparently high levels of vaccination coverage led the Ministry of Health to initiate an epidemiologic investigation of the siuation. Authorities chose Planaltina, 1 of the Federal District's 8 administrative regions, as the site of a random sample survey to determine vaccine efficacy and history of the disease during the outbreak. For the purpose of the study, Planaltina was divided in 244 blocks (clusters) with an average of 37 households per block. 30 clusters were selected for the survey. Health agents used a standard questionnaire to collect information on the outbreak and search for additional cases that might have occurred during the previous 6 months. Questionnaires were completed in 997 households (11% of all households) over a period of 2 weeks, beginning June 25, 1983. The survey measured vaccination coverage on December 31, 1982, considered the beginning of the epidemic, and June 30, 1983. Coverage rates for each of the years between 1978-81 were at least 60% and had reached nearly 70% by the end of 1982. A total of 300 cases occurring between January and June 1983 were recorded during the investigation. 106 cases (40%) of those with known vaccination history occurred in vaccinated individuals; 158 (60%) occurred in unvaccinated individuals. Children under 5 years of age accounted for 212 (70%) cases. Vaccine efficacy was calculated both for children who received vaccination before 9 months of age and for those who were vaccinated at 9 months or later. The data showed that vaccine efficacy was only 43% for children who received the vaccine before 9 months of age; it was 83% for children who were vaccinated later. Of the 300 measles cases investigated, 61 (20%) occurred in children less than 1 year of age. Although the total vaccination coverage of children 9 months to 9 years of age increased from 68.4 to 84% between December 31, 1982 and June 30, 1983, the survey showed that coverage of children who had not previously had measles only increased from 50 to 55.4%. This explains why the increased measles vaccination was not effective in stopping the outbreak. As an immediate measure, the Ministry of Health recommended that measles vaccine be administered simultaneously with polio vaccine during the national poliio immunization day on August 13, 1983. This plan was put into effect for the whole Federal District, and a total of 62,756 children 9 months to 4 years of age were vaccinated at that time.
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