Epidemiology of confirmed measles virus cases, surveillance, incidence, and associated factors in Eritrea: 18-year retrospective analysis

Frontiers in Public Health

Public Health

Asmerom Tesfagiorgis Tewelde¹  Wintana Yebio Werke²  Samuel Tekle Mengistu³  Issaias Michae⁴  Luwam Gilazghi Woldu⁴  Freweini Tekle⁴  Mensura Said⁴  Haimanot Abai⁴  Tsigehana Tsegai⁴  Dawit Fsahatsion⁴  Rahel Mulugeta⁴  Oliver Okoth Achila⁵  Mohammed Elfatih Hamida⁶ 

[1] IDSR, CDC, Ministry of Health, Asmara, Eritrea;Keren Hospital, Ministry of Health in Anseba Branch, Keren, Eritrea;Nakfa Hospital, Ministry of Health Northern Red Sea Branch, Nakfa, Eritrea;Serology Department, National Health Laboratory, Asmara, Eritrea;Unit of Clinical Laboratory Sciences, Orotta College of Medicine and Health Sciences, Asmara, Eritrea;Unit of Microbiology, Orotta College of Medicine and Health Sciences, Asmara, Eritrea;

关键词: measles;    surveillance;    vaccination;    epidemiology;    spatial inequality;   

DOI  :  10.3389/fpubh.2023.1218317

 received in 2023-05-06, accepted in 2023-08-29,  发布年份 2023

来源: Frontiers

【 摘 要 】

BackgroundDespite the outstanding measles vaccine coverage (MVC) in Eritrea, sporadic outbreaks are not uncommon. Therefore, understanding the incidence of laboratory-confirmed measles virus cases, related factors, and spatial inequalities in testing and surveillance remains crucial. In this analysis, we evaluated the incidence and spatiotemporal distribution of measles in Eritrea. An evaluation of the factors associated with measles vaccination and IgM positive (+) febrile rash was also undertaken.MethodsA retrospective (period: 2002–2020) study was carried out by abstracting data from the integrated disease surveillance and response database (IDSR). Data was analyzed using descriptive statistics and binary logistic regression. Spatial variability and distribution of confirmed cases was evaluated using ArcGIS Pro version 3.0.1.ResultsIn total, 9,111 suspected cases, 2,767 [1,431 (51.7%) females] were serologically tested. The median (IQR) age, minimum-maximum age were 7 years (IQR: 4–14 years) and 1 month-97 years, respectively. Among the 608(21.9%) laboratory-confirmed cases, 534 (87.8%) were unvaccinated and 53 (9.92%) were < 1 year old. The crude incidence rate for MV was 14/100,000 persons. The age-specific positivity rate per 100,000 suspected cases tested was 21.5 with individuals >30 years presenting with the highest rates (69.9/100,000). Higher odds (OR) of MV test positivity was associated with age at onset – higher in the following age-bands [10–14 years: OR = 1.6 (95%CI, 1.1–2.2, value of p = 0.005); 15–29 years: OR = 7.0 (95%CI, 5.3–9.2, value of p = 0.005); and > =30 years: OR = 16.7 (95%CI, 11.7–24) p < 0.001]. Other associations included: Address – higher in Anseba (OR = 2.3, 95%CI: 1.7–3.1, value of p<0.001); Debub (OR = 2.7, 95%CI: 1.9–3.9, value of p < 0.001); Gash-Barka (OR = 15.4, 95%CI: 10.9–21.7, value of p < 0.001); Northern Red Sea (OR = 11.8, 95%CI: 8.5–16.2, value of p < 0.001); and Southern Red Sea (OR = 14.4, 95%CI: 8.2–25.2, value of p < 0.001). Further, test positivity was higher in health centers (OR = 2.5, 95%CI: 1.9–3.4, value of p < 0.001) and hospitals (OR = 6.8, 95%CI: 5.1–9.1, value of p < 0.001). Additional factors included vaccination status - higher in the unvaccinated (OR = 14.7, 95%CI: 11.4–19.1, value of p < 0.001); and year of onset of rash – (higher >2015: OR = 1.4, 95%CI: 1.1–1.7, value of p<0.001). Uptake of measles vaccine associated with a similar complement of factors.ConclusionIn large part, efforts to eliminate measles in Eritrea are hindered by disparities in vaccine coverage, under-surveillance, and low vaccination rates in neighboring countries. Enhanced surveillance and regional micro planning targeting hard-to-reach areas can be an effective strategy to improve measles elimination efforts in Eritrea.

【 授权许可】

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Copyright © 2023 Mengistu, Achila, Tewelde, Hamida, Tekle, Michae, Said, Fsahatsion, Abai, Mulugeta, Tsegai, Woldu and Werke.