Measles in Rwanda: Evaluation of decade (2006-2015) surveillance and immunization coverage towards measles elimination goal by 2020.

Abstract

The introduction of vaccines against measles has drastically reduced the incidence of measles in World Health Organization (WHO) Member States in the African Region, and substantial progress has been made towards measles mortality reduction and elimination goals. However, many countries are at risk for not meeting elimination goals by 2020 due to challenges in measles surveillance and inadequate immunization coverage that has resulted in a resurgence of measles in some countries. A cross-sectional study was conducted to investigate national measles case-based surveillance and immunization data maintained by the Vaccine Preventable Disease Program , Rwanda Biomedical Center from 2006 to December 2015. The objective of the study was to identify characteristics of reported measles cases, geographic trends in measles and immunization rates, and to evaluate the achievement of performance indicators for surveillance and elimination targets. Measles was confirmed in 301 of the 3,787 suspected cases reported, with the majority of cases occurring in 2010 (40.5%) alone. Children of under 5 age were the most affected (46.%). Measles cases were most frequently reported from the Western province (40%), and in districts that shared a border with neighboring countries. From 2006 to 2015, national immunization rates were estimated at 95% for routine and (≥ 100%) for supplementary immunizations. During the 10-year study period, Rwanda achieved 8 of the 11 WHO target indicators used in this study to evaluate performance towards measles elimination. Despite progress from 2006 to 2015, inadequate immunization coverage and challenges with measles surveillance in Rwanda have delayed progress towards Rwanda’s measles elimination goals. Improved measles surveillance, strengthened immunization strategies,and a renewed political and financial commitment are necessary to achieve elimination targets for Rwanda by the year 2020.