Measles surveillance = Surveillance de la rugeole

Wldy Epidem, Rte. : No. 4 - 27 Jlll1uty 1984 Recommendations Because the nature and extent of the problem are not completely delineated, certain precautions appear to be indicated. If intra- dermal pre-exPosure rabies prophylaxis is given, routine serologi- cal testing should be done 2-3 weeks after immwmation. Any individual with a post-immwmation titre lower than 1:16 (approximately 0.16 IU/ml) should receive an additional doscrot vaccine and have serum retested 2-3weeks later. Persons whose only experience with rabies vaccine has been intradermal pre- exposure prophylaxis and whose antibody response is unknown should, if immunized within the past 12 months., have serum tested for rabies antibody; if immunized more than 12 months previously, such persons should receive a single booster dose of vaccine and have serum ~tested 2-3 weeks later. Serological testing.i:toes not appear to be necessary for persons receiving intra- muscular rabies pre-expQsure prophylaxis. For post-exposure prophylaxis., persons who have had 3 X 1.0 ml intramuscular doses of HDCV or who have received intradermal vaccine and have a documented rabies titre of 1 : 16 or higher continue to receive 2 X 1.0 ml intramuscular doses of HDCV - 1 dose each on days O and 3, as currently recommended. Any person who has received intradermal vaccine and who has not had a documented rabies antibody titre of 1 : 16 or higher should be treated with a single 20 IU/kg dose of human rabies immune, globulin and 5 X l ml intramuscular doses of HDCV -1 each Qli' days 0, 3, 7, 14, and 28. · It should be re-emphasized that all pe1"$0nS who have received adequate pre-expQsure prophylaxis with HDCV 5'0uld, following a rabies exposure, receive 2 X 1.0 ml IM post-exposure booster doses of vaccine to ensure protection. - 25 - ·. R~as: >· · La_natureetl'~pleurduprb'qj~~e.~•,e~\P.ali :,:: 'fu~elH<:id¥,fu certatnes precautions sembfent mdiquees. St la v tradenmque · est retenue Pour la prophylaxie antirabique avant exposition, des examens serologiques de routine seront pratiques 2-3 semaines apres la vaccina- tion. Les sujets presentant un titre postvaccinal inferieur a l : 16 (approxi- mativementO, 18 Ultml) teoc1vront une dose supplementaire de vaccin et ••seront:soumis,,aun·nollVel'examen•serologique 2-3 semaines plus tard. Les personnes. qui n'ont subi qu'µne va,.c.clµation antirabique par voie intradermique a titre prophylactique et ctonna reponse immunitaire est inconnue seront, si elles ont ete va(tjnees dans les 12 demiers mois, soumises a un examen serologique a larecherche des anticorps antirabi- ques; si leur vaccinaijon remonte a plus de .12 mois, ces personnes rece- vront une dose de raf1>el unique et l'onlmrom#iencera l'examen serolo- gique 2-3 semaines plµs tard. Le controle sen>logique ne s'impose pas pour I~~ personne~ ataAt fait l'obj~t d'uhe prop~ylaxie antirabique avant exposition par vo1e:1nttamusculaire. · Pour la prophylatie ajm:s exposition,Je& pefibnnes ayant rei;u 3 doses intramusculaires de l,it ml de vaccin produh sur cellules diploi'des humaines ou vaccijiees p4r voie intradermique ~ dont le titre d'anticorps est de l: 16 ou plutrece~nt 2 doses supplemeiitaires de 1,0 ml chacune de vaccif par voi! intramusculaire, ch~Me dose etant administree aux jours O et~3, conpne on le\recommand'e·'act'ue(lement. Toute personne vaccinee per voic;'intrademdque et dont le titre d'anticorps atteste n'etait pas d'aji 11\0ins 1 :16 recevra·.µne dose.unique de 20 Ul/kg d'immuno- glob~e r$biqi,e h~t) et.A{doses intnunu~ulaires de 1 ml chacune de vaccin avx jp~,o; :3;.,1,)4:Ct 28. • .·:,. •, .. · . 11 ct>nvient ~e so~ a n:9uveau que toiites les personnes ayant · chen~cie d'll\le t?oµne -e avant exposiiion au moyen du vaccin prtpare sur ~tiles di' . huiµaines recevront, si elles ont ete expo- ~es a la rage,~2 ~.!fe,tappel de; l,~t~cune administrees par voie mtramusculaire pour asa\.lf'Cr leur ,rotection. (Based on/D'apres: Morbidity and Mortality, 1983, 32, No. 46; US Centers for Disease Control.) EDITORIAL NOTE: WHO recommends that governments and institutions using human diploid cell culture rabies vaccine should have samples tested for potency. This can now be arranged, free of charge, through the Organization. For further information, those' · interested should contact the Unit of Veterinary Public Health, Division of Communicable Diseases, World Health Organization, 1211 Geneva 27, Switzerland. MEASLES SURVEILLANCE· UNITED KINGDOM. - Measles immunization was introduced in the United Kingdom in 1968. Ten years after, in 1977, 8 625 cases of measles were notified to the Scottish Health Service by Health Boards in Scotland An account of an outbreak which occurred that year in the Shetland Islands, showed how measles'could spread widely in a relatively isolated and poorly immunized com- munity, with all age groups of the population affected.1 Examination of the record of annual notifications for the period 1967-1982 (Fig. 1) shows an overall decrease in the incidence,of measles cases since the introduction of measles immwmati<;m. However, the distribution of notifications for the s.year period 1977-1982 clearly indicates thaHneasles. continues to cause signifi- cant morbidity in the community, with 1982 accounting for the highest number (10 589) of notificati,;,ns in fl:Cent yeart,. . . A similar pattern of failure to control measles has been 4educed . also from examination. of the notification figures for the United Kingdom as a whole, where each year some 100 000 children suffer from measles and. 20 die;.a.situation which con.tras~ miu,-~y with that exist,ingin the Un:itedStates of Ameri~ w'here measles immunization was introduced in 1963. In that country-unlike the United Kingdom-vigorous efforts have been made to promote vaccine uptake. Early success with the Childhood Immunization Initiative, introduced in 1977, encouraged the establishment in 1978 of the Measles Elimination Programme with the specific aim of eliminating indigenous measles from the United States of America by 1982. By 1981, reported cases of measles (3 124) had reached their lowest level since 1925, showing that considerable progress towards achievement of this goal has been made.2 While in the 1970s acceptance rates for measles immwmation in Scotland were SS%, the most recent figures for 1982-0fonly 57% highlight the fact that a significant improvement in the uptake of vaccine has not occurred in the last S years. By contrast, in the United States of America an uptake rate of 96% for measles • See No. 33. 1978, p. 245. 'See No. IO, 1983, pp, 72.73 and No. 33, 1983,.pp. 253-255. NOTE DE LA REDACTION: L'OMS recommande aux gouvernements et il,lstitutions utilisant, le vaccin antirabique prepare sur cellules diploi'des bumaines de faire prelever des echant8ns pour controler l'efficacite. Ce colitrole peut desormais se faire gratuitement par l'intermediaire de l'Organisation. Pour de plus amples renseignements, les gouvemements ou institutions interesses sont pries &I ll'adreuer au &r:vu;e di: ,Sante , publique vtte~ ,Division~.Maladiestmnsmissibles, Oqianisation; mondialedela,Sant.e,12H:Geneve27,'Sui8$!.\ , ·· : ., : ·sURVEILLANCE DE'LA'ROUGEOU£i ;<,,_., ,. ,,,,. ROY AUME-UNI. - La vaccination contre la rougeole a ete instautie ii:u Royaume-Uni.en 1.968. Dix;1ms1tPres., en 1977, 8 625 cas de rougeole ont ete notifies au Scottish Health Service par les Health Boards en Ecosse. Le compte rendu.1~une epi}ie~ie ,qui s'~t.J:lrod,llite c~t~ allll,~~la ~s les iles Shetland a· montre ·commeat'fa rougeol~ ~·,•etendm dafti une communaute relativemeriHsolee ei,JRdi'ocrement>immunisee, touchant tous les.grou~d•~e.!,. :, ,_ ., ,L'exammfdu,nonibM des cu signales annuellement:pom,1a,pmodp '1967-1982 (Fig. J) fait apparaitre une diminution generale.dl,·Jtindidehee de la rougei>le apres l'~~UllltiOB. d.e h\: YP.'i'lCin.a!WJl antirg,qge~. Cependant, leis chitfrescwurl3 ,petiode.quinq,u~e.19.H,J98i.moe~, trent clairem,e.-t;que la fougeale continue<l~etre mu~imuse imwrtantf!~; morbidite dans la communaute, le nombre le plus eleve de cas au co:im,4e ces dern;_~ ~et:S {10 S~?) llY~t~ ~ale,,~n 19tl2,,. . ·. t ,: : La meme $ituatiOJHSt mise:en evjdence,par:~!eX!!,Jn~ <le& cliifbs .. ooncernant l'e~nl;ble du .Roya'IUlle,Uni ou ,chaque ~ qqeJque 100 000 enfants sont atteints de rougeole et 20 en meurent; elle contraste . de f~Qn .. ~ .....Pllll·.··.te .•. p.v.<:<;, ill- ,s. it. ua ..... tiQn.. (i. W. . . ·.E ... ta..· ~. r:U~·~,n•Am. e.riq~11 ou la '\iaCClll.iuqn mtifqiigt\ol~µse :· ere:ii,i@duitf ~i\ \§ . t>liis ce ~ys - a la · "'diffetenee·lfea, qui's'est ~atrRoyffilm'e~uru·::!. s efforts ~hergiques ont ete deployes pour promouvoif. la vaccination. Les premiers succes enregistres par la Childhood Immunization Initiative, Iancee en 1977, ont pous~l1:;slµl"f,Orites a entt:ep~i:i\1.re en 1978 un programme d'elimination de la rougeole dans le but precis d'eliminer la rougeole indigene des Etats-Unis d'Amerique avant 1982. En 1981, le nombre de cas de rou- geole notifies (3 124) avait atteint son plus bas niveau depuis 1925, ce qui montre que des progres considerables ont ete accomplis vers la realisation de cet otijectif. 2 I Alors que dans les annees 70 le taux d'acceptation de la vaccination antirougeoleuse en Ecosse etait de SS%, en 1982 il n'etait que de 57%, ce qui montre bien qu'au cours des S demieres annees, il n'y a pas eu de grande amelioration sur ce plan. Par contre, aux Etats-Unis d' Amerique, on est parvenu a un taux d'acceptation de 96%, grace a l'adoption de • Voir N°-33, 1978, p. 245, 2 Voir N". JO, 1983, pp. 72-73 et N° 33, 1983, pp, 253-255. 'Wldy Epi/lml. Rite.: No. 4 - 27 Juuuy 1984 - 26 - Reim epidem. Mbd.: No 4 - 27 janvicr 1984 volves a lepl requirement that school entry be conditional upon dont l'immunite antirougeoleuse a ete verifiee. vaccine has been achieved as a conseq~ of a Policy which in-1 dispositions stipulant que seuls seraient Mimis dans les ecoles les enfants children having proof of immunity to measles. Fig. 1 Annual Netifk:adons of Measles Cues, Scetland, 1966-1982 Nomhre de cas de n,qeole ldpales annnellement, Ecosse, 1966-1982 30000,----------------------------, I O._.,_....__.__._ _ _.__._..__.._...._~_._~~-~-~~~i 1968 1970 1975 1980 1985 YEAR-AMEE Measles immunizati6n has been shown to have not only an absenceofmajotsideeftects but also an efficacy of at least 90-95%. Additionally, immunity induced by vaccination seems to be long lasting. Thus, the health authorities in Scotland, as elsewhere, are in a unique Position to be able to provide to the childhood popu- lation at risk an effective preventive service such as immunization against measles. There appears now to be little excuse: for failure to control measles. Ila ete demontre non seulement que la vaccination antirougeoleuse est exempte d'effets secondaires iml)Onants mais encore qu'elle est efficace a au moins 90-95%. De plus, l'immunite qu'elle contere semble durable. Ainsi, les autorites sanitaires en Ecosse, comme ailleurs, sont parfaite- ment en mesure d'assurer a la population enfantine a risque un service preventif efficace tel que la vaccination antirougeoleuse. II semble done desormais peu excusable de ne pas parvenir a vaincre Ja rougeole. (Based on/D'apres: Communicable Diseases Scotland, 83/30.) EXPANDED PROGB.AMME ON IMMUNIZATION Outbreak of Wheopma Couah INDONESIA. - On 21 April 1983, 2 girls of Sand 13 months of age, ~m Noongan village, North Sulawcsi, died after an illness with whooping couah-:-lilcc symptoms. The village of Noongan had 2 S68 inhabitants (1980 census) with 965 children under the age of l 5 years; 297 children were . under 5, and 337 were 5 to 9 years old. The village consisted of7 wards. The district health staff had performed a preliminary investiga- tion in May 1983. Disease histories were obtained from 788 children, and 153_ of them (19%) had a history consistent with PROGRAMME ELAR.GI DE VACCINATION Flambee de coqueluche INDONESIB. - Le 21 avril 1983, 2 fillettes de 5 et 13 rnois habitant le village de Noongan, Sulawesi-Nord, sont mortes a l'issue d'une maladie comportant des symptomes evoquant la coqueluche. Le village de Noongan comptait 2 568 habitants au recensement de 1980, dont 965 enfants de moins de 15 ans; 297 enfants avaient moins de 5 ans et 337 de 5 a 9 ans. Le village se compose de 7 quartiers . En mai 1983, le personnel de sante du district a fait une enquete pre- liminaire. Ila enregi.stre les antecedents pathologiques de 788 enfants, 153 d'entre eUJC (19%) ayant eu la coqueluche depuis la tin de mars 1983. Table 1. Ap Distribution of 153 Children with Wtioopina Coup from End of March to May 1983, North Sulawesi, Indonesia Tableau I. Distribution par Age de 153 eofants atteints de coqaeluche de la fin mars a mai 1983, Sulawesi-Nord, lndonesie Cumulative ~(in Years) No. of Cales Perceniage Percenlajp: . CanneesJ Nombredtcu Poun;eniage Poun:cnlaie cumule <l 2) 15 15 1 12 8 23 2 14 9 32 3 12 8 40 4 ll 14 54 s 12 ., 8 62 6 17 11 73 7 16 10 83 8 7 5 88 9 5 3 91 ;..10 14 9 100 Total 153 100 -