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Decrease in the coverage of measles-containing vaccines and the risk of reestablishing endemic transmission of measles in Brazil

2019; Elsevier BV; Volume: 82; Linguagem: Inglês

10.1016/j.ijid.2019.03.014

1878-3511

Flávia Caselli Pacheco, Giovanny Vinícius Araújo de França, Guilherme Almeida Elidio, César de Oliveira, Dirce Guilhem,

Immune responses and vaccinations

In September 2016, the Pan-American Health Organization (PAHO) declared the Region of the Americas free of measles (Pan American Health Organization/World Health Organization, 2016Pan American Health Organization/World Health Organization Washington, D.C., USA55th directing council. 68th session of the regional committee of who for the Americas — plan of action for maintaining measles, rubella, and congenital rubella syndrome elimination in the region of the Americas: final report2016.55th directing council. 68th session of the regional committee of who for the Americas — plan of action for maintaining measles, rubella, and congenital rubella syndrome elimination in the region of the Americas: final report. 2016; Google Scholar). In August 2018, PAHO announced that endemic transmission of measles was re-established in Venezuela, likely due to ongoing civil strife in the country. In 2018, 12/35 countries of the Americas confirmed measles cases (Pan American Health Organization/World Health Organization, 2018Pan American Health Organization/World Health Organization Epidemiological update: measles. PAHO/WHO, Washington, D.C2018Google Scholar). In February 2018, a measles outbreak was reported in the Roraima state, northern Brazil, bordering Venezuela. On 10 December 2018, the measles outbreak had reached 11/27 states in Brazil and 10,262 cases were confirmed by laboratory and epidemiological criteria (Elidio et al., 2019Elidio G.A. França G.V.A. Pacheco F.C. Ferreira M.M. Pinheiro J.d.S. Campos E.N. et al.Measles outbreak: preliminary report on a case series of the first 8,070 suspected cases, Manaus, Amazonas state, Brazil, February to November 2018.Euro Surveill. 2019; 24 (pii=1800663)Crossref PubMed Scopus (13) Google Scholar). Most cases were registered in the North region (99.2%), with higher incidence among children under 5 years of age (Ministry of Health, 2019Ministry of Health Brazil. Report n° 36/2019 – epidemiological update measles in Brazil, 2018 [in Portuguese].2019Google Scholar). The D8 genotype was identified in the confirmed cases, which was the same found in Venezuela (Pan American Health Organization/World Health Organization, 2018Pan American Health Organization/World Health Organization Epidemiological update: measles. PAHO/WHO, Washington, D.C2018Google Scholar). Vaccination is the main public health strategy to prevent the spread of the measles virus and, consequently, prevent deaths and complications (Moss, 2017Moss W. Measles.Lancet. 2017; 390: 2490-2502Abstract Full Text Full Text PDF PubMed Scopus (249) Google Scholar). Measles-containing vaccines (MCV) have been available free of charge in Brazil since 1977 (Ministry of Health. Brazil, 2013Ministry of Health. Brazil National Immunization Program (NIP): 40 years. Ministry of Health, Brasília2013Google Scholar). The national routine vaccination schedule recommends at least two doses of MCV, the first at 12 months and the second at 15 months of age. The coverage target adopted by the Brazilian Ministry of Health for the first and second routine doses of measles vaccine is 95% at state and national levels, as recommended by the World Health Organization, 2012World Health Organization Global measles and rubella strategic plan: 2012–2020. WHO Press, Geneva2012Google Scholar. More information on the Brazilian vaccination schedule can be found elsewhere (Brazilian Ministry of Health, 2018Brazilian Ministry of Health National immunization schedule.2018http://portalarquivos2.saude.gov.br/images/pdf/2018/julho/11/Calendario-de-Vacinacao-2018.pdfGoogle Scholar). We analyzed official national data on the MCV coverage obtained through an administrative method, based on the number of doses and the target population (Domingues and Teixeira, 2013Domingues C.M.A.S. Teixeira A.M.d.S. Vaccination coverage and impact on vaccine-preventable diseases in Brazil between 1982 and 2012: National Immunization Program progress and challenges.Epidemiol Serv Saúde. 2013; 22: 9-27Crossref Google Scholar). At national level, the coverage of the first dose of MCV decreased since 2014, not reaching the target in 2017 (90.4%) (Figure 1). Similarly, the target for the second dose of MCV had not been reached since 2013 and decreased since 2015. At regional level, decreases were also found, and the worst scenario was observed in the North region for both first and second doses. Although the reintroduction of measles in Brazil seems to be related to the outbreak in Venezuela, the spread of the virus was favored by the seemingly low MCV coverages. It is urgent to investigate the determinants of the decrease in MCV coverage in Brazil and to implement effective strategies to reach the 95% target of both first and second doses of MCV, aiming to stop further spread of the virus and to avoid the reestablishment of the endemic transmission of measles in the country. FCP and GVAF analysed the data, wrote the manuscript and coordinated the preparation of the manuscript. GAE supported data collection and reviewed the final manuscript. CMO and DBG contributed to the outline of the manuscript and reviewed the final manuscript. All authors approved the manuscript. The authors declare no conflict of interest. DBG receives funding from the National Council for Scientific and Technological Development – CNPq and Research Productivity Grant 1-D (2016–2020). The other authors do not receive funding from any source.