Journal of immunological sciences最新文献

Background: Ethiopia endorsed the African Regional measles elimination goal and has been implementing the recommended strategies. Measles immunization coverage has been increasing but is still below the target, and measles incidence has remained high.

Objective: To describe the measles epidemiology in Ethiopia, identify predictors of high measles incidence in Ethiopia and recommend strategies to achieve the elimination goal.

Methods: Measles surveillance 2006-2016 data, routine immunization and post measles campaign coverage data was analyzed. We analysed the epidemiology and incidence of measles cases by age, vaccination status, year of occurrence, and geographic area.

Result: There were 66,719 confirmed cases, out of the 94,104 suspected measles cases reported between January 2006 and December 2016. Measles incidence increased from 20 cases per million total population in 2006 to 194 cases per million in 2015 and declined to 49 per million in 2016. On multiple logistic regression analysis, the median age of measles cases, the 2013 measles Supplemental Immunisation Activity (SIAs) coverage, the 2012 routine immunization coverage, and the proportion of reported under-five measles cases were predictors of very high measles incidence (>240 cases per million in the under-five years age population) in the three-year period following the 2013 measles SIAs implementation (p<0.01).

Conclusion: Ethiopia is not on track to achieve the measles elimination goal of less than 1 case per million population by 2020 with the current pace of elimination efforts. Accumulation of susceptible children due to suboptimal routine measles immunization combined with suboptimal and narrow age-group (9-59 months) measles SIAs resulted in continued measles outbreaks.

Recommendation: Ethiopia should scale up the quality and implementation of all the measles elimination strategies, including the introduction of measles second dose and conducting high quality measles SIAs targeting the appropriate age groups as per the measles epidemiology in various parts of the country to accelerate and achieve the 2020 measles elimination goal.

In emergency situations, clinical trials of new vaccines and therapies in resource-constrained settings place an additional burden on the limited resources of low and middle-income countries. The clinical trials of vaccines against Ebola Virus Disease (EVD) in Africa presented challenges on how to ensure there was enough capacity for ethics and regulatory reviews and oversight while still allowing for accelerating the clinical evaluations. Using the African Vaccine Regulatory Forum (AVAREF) platform WHO supported African countries to provide ethics and regulatory reviews and oversight, ensuring that these trials were completed in unprecedented shorter timelines than normal, that is, months instead of years. Pathways were defined, external expertise provided and appropriate review models implemented in the countries which hosted these critical studies. This paper discusses the work around the clinical trials, the models of reviews and timelines for clinical trials and highlights the important lessons revealed. More investments are required to monitor safety during clinical trials, strengthen systems for licensure of new products and implement robust post-marketing surveillance, among other components for effective clinical trials before the next pandemic surfaces.