Measles vaccination in humanitarian emergencies: a review of recent practice.
Measles vaccination in humanitarian emergencies: a review of recent practice.
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DOI：
10.1186/1752-1505-5-21
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发表时间：
2011-09-26
影响因子：
3.6
通讯作者：
Gayer, Michelle
中科院分区：
文献类型：
--
作者：
Grais, Rebecca F;Strebel, Peter;Gayer, Michelle
背景技术背景：人道主义紧急情况下儿童和青少年的健康需要对救济工作的成功和降低死亡率至关重要。麻疹一直是人道主义紧急情况下儿童死亡的主要原因之一，并通过加剧营养不良和维生素A缺乏症而进一步增加死亡率。在此，我们回顾了已发表文献中记载的人道主义紧急情况下的麻疹疫苗接种活动。我们的主要兴趣是审查现有的证据，重点是针对人道主义紧急情况或人道主义背景下麻疹爆发的大规模疫苗接种运动的目标年龄范围，以确定当前指南是否需要根据最近的经验进行修订。方法：我们检索了1998年1月1日至2010年1月1日期间发表的关于紧急情况下麻疹的文献。由于紧急情况的定义和概念各不相同，并随着时间的推移而发生变化，我们选择考虑在审查期间向联合国中央应急循环基金提出联合呼吁程序或紧急呼吁的任何情况。我们包括出版物的国家，无论他们在麻疹控制的人道主义紧急情况可能会发生在任何这些情况下，因此，指导适用于无论麻疹控制的目标。结果：少数有据可查的流行病描述在人道主义紧急情况下，病例的年龄范围不限于5奥尔兹以下的儿童。综合来自预防和疫情应对干预措施的所有数据，在本文审查的有足够数据的报告中，约59%的病例仍为5岁以下儿童，18%为5-15岁儿童，2%为15岁以上儿童。在干预措施针对减少年龄范围的情况下，几份报告得出结论认为，年龄范围应扩大到15岁，因为很大一部分病例发生在5岁以上。结论：由于先前存在的人群免疫力水平低，麻疹疫情继续发生在人道主义紧急情况下。根据现有的公开资料，病例继续发生在5岁以上的儿童中。在老年群体中预防病例可能会防止年幼儿童受到感染，并降低年幼和老年群体的死亡率。
BACKGROUND: The health needs of children and adolescents in humanitarian emergencies are critical to the success of relief efforts and reduction in mortality. Measles has been one of the major causes of child deaths in humanitarian emergencies and further contributes to mortality by exacerbating malnutrition and vitamin A deficiency. Here, we review measles vaccination activities in humanitarian emergencies as documented in published literature. Our main interest was to review the available evidence focusing on the target age range for mass vaccination campaigns either in response to a humanitarian emergency or in response to an outbreak of measles in a humanitarian context to determine whether the current guidance required revision based on recent experience.METHODS: We searched the published literature for articles published from January 1, 1998 to January 1, 2010 reporting on measles in emergencies. As definitions and concepts of emergencies vary and have changed over time, we chose to consider any context where an application for either a Consolidated Appeals Process or a Flash Appeal to the UN Central Emergency Revolving Fund (CERF) occurred during the period examined. We included publications from countries irrespective of their progress in measles control as humanitarian emergencies may occur in any of these contexts and as such, guidance applies irrespective of measles control goals.RESULTS: Of the few well-documented epidemic descriptions in humanitarian emergencies, the age range of cases is not limited to under 5 year olds. Combining all data, both from preventive and outbreak response interventions, about 59% of cases in reports with sufficient data reviewed here remain in children under 5, 18% in 5-15 and 2% above 15 years. In instances where interventions targeted a reduced age range, several reports concluded that the age range should have been extended to 15 years, given that a significant proportion of cases occurred beyond 5 years of age.CONCLUSIONS: Measles outbreaks continue to occur in humanitarian emergencies due to low levels of pre-existing population immunity. According to available published information, cases continue to occur in children over age 5. Preventing cases in older age groups may prevent younger children from becoming infected and reduce mortality in both younger and older age groups.