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This article describes the arc of global measles and rubella elimination since 2000 from the perspective of the founding partners of the Measles Initiative. The Measles Initiative was formed in 2001 as a partnership among the American Red Cross, the Centers for Disease Control and Prevention, UNICEF, the United Nations Foundation, and the World Health Organization with the aim to reduce measles deaths in low-income countries. Recognizing rubella as the leading infectious disease cause of congenital abnormalities globally and achievement of measles and rubella elimination in the region of the Americas, the partnership was renamed the Measles and Rubella Initiative (MRI) in 2012. The goals of the MRI were at least a 95% reduction in global measles mortality and elimination of measles and rubella in at least five of the six WHO regions. In January 2023, the membership of the partnership was expanded to include the Bill and Melinda Gates Foundation (BMGF) and Gavi the Vaccine Alliance, and its name changed to the IA2030 Measles and Rubella Partnership. We describe the role the partnership has had in measles partner effectiveness and its impact on measles and rubella disease burden, including how the partnership has strategically adapted to the evolving immunization landscape. We conclude with lessons learned regarding the role global partnerships can play in furthering the impact of disease control programs within the current global immunization environment. [ABSTRACT FROM AUTHOR]

Objective To achieve high and equitable coverage of insecticide-treated bednets by integrating their distribution into a measles vaccination campaign. Methods In December 2002 in the Lawra district in Ghana, a measles vaccination campaign lasting 1 week targeted all children aged 9 months-15 years. Families with one or more children less than five years old were targeted to receive a free insecticide-treated bednet. The Ghana Health Service, with support from the Ghana Red Cross and UNICEF, provided logistical support, volunteer workers and social mobilization during the campaign. Volunteers visited homes to inform caregivers about the campaign and encourage them to participate. We assessed pre-campaign coverage of bednets by interviewing caregivers leaving vaccination and distribution sites. Five months after distribution, a two-stage cluster survey using population-proportional sampling assessed bednet coverage, retention and use. Both the pre-campaign and post-campaign survey assessed household wealth using an asset inventory. Findings At the campaign exit interview 636/776 (82.0%) caregivers reported that they had received a home visit by a Red Cross volunteer before the campaign and that 32/776 (4.1%) of the youngest children in each household who were less than 5 years of age slept under an insecticide-treated bednet. Five months after distribution caregivers reported that 204/219 (93.2%) of children aged 9 months to 5 years had been vaccinated during the campaign; 234/248 (94.4%) of households were observed to have an insecticide-treated bednet; and 170/249 (68.3%) were observed to have a net hung over a bed. Altogether 222/248 (89.5%) caregivers reported receiving at least one insecticide-treated bednet during the campaign, and 153/254 (60.2%) said that on the previous night their youngest child had slept under a bednet received during the campaign. For households in the poorest quintile, post-campaign coverage of insecticide-treated bednets was 10 times higher than pre-campaign coverage of households in the wealthiest quintile (46/51 (90.2%) versus 14/156 (9.0%)). The marginal operational cost was US$ 0.32 per insecticide-treated bednet delivered. Conclusion These findings suggest that linking bednet distribution to measles vaccination campaigns may provide an important opportunity for achieving high and equitable coverage of bednets. Keywords Bedding and linens/supply and distribution; Immunization programs/organization and administration; Delivery of health care, Integrated/economics; Malaria/prevention and control; Mosquito control/organization and administration; Measles vaccine/supply and distribution; Costs and cost analysis; Ghana (source: MESH, NLM). Mots cles Literie et linge/ressources et distribution; Programmes de vaccination/organisation et administration; Distribution integree soins/economie; Paludisme/prevention et controle; Lutte contre moustique/organisation et administration; Vaccin antimorbilleux/ ressources et distribution; Cout et analyse cout; Ghana (source: MESH, INSERM). Palabras clave Ropa de cama y ropa blanca/provision y distribucion; Programas de inmunizacion/organizacion y administracion; Entrega integrada de atencion de salud/economia; Paludismo/prevencion y control; Control de mosquitos/organizacion y administracion; Vacuna antisarampion/provision y distribucion; Costos y analisis de costo; Ghana (fuente: DeCS, BIREME). [TEXT NOT REPRODUCIBLE IN ASCII.], Resume Distribution de moustiquaires impregnees d'insecticide pendant la vaccination antirougeoleuse un moyen peu couteux d'assurer une couverture etendue et equitable. Resume Objectif Afin d'obtenir une couverture etendue et equitable en [...]

Case management to increase childhood immunization rates in inner-city black families may be modestly effective and very expensive. Poor and minority children are less likely to be fully immunized. Researchers randomly assigned 419 infants and their families to receive home visits and support by case managers, or just printed information on vaccination (the control group). About 64% of children receiving case management completed first-year immunizations, compared to 50.6% of children in the control group. Case management cost $12,022 for each additional child who became fully-immunized., Context. -- Immunization rates in the inner city remain lower than in the general US population, but efforts to raise immunization levels in inner-city areas have been largely untested. Objective. -- To assess the effectiveness of case management in raising immunization levels among infants of inner-city, African American families. Design. -- Randomized controlled trial with follow-up through 1 year of life. Setting. -- Low-income areas of inner-city Los Angles Calif. Patients -- A representative sample of 419 African American infants and their families. Interventions. -- In-depth assessment by case managers before infants were 6 weeks of age, with home visit 2 weeks prior to when immunizations were scheduled and additional follow-up visits as needed. Main Outcome Measures. -- Percentage of children with up-to-date immunizations at age 1 year, characteristics associated with improved immunization rates, and cost-effectiveness of case management intervention. Results. -- A total of 365 newborns were followed up to age 1 year. Overall, the immunization completion for the case management group was 13.2 percentage points higher than the control group (63.8% vs 50.6%; P=.01). In a logistic model, the case management effect was limited to the 25% of the sample who reported 3 or fewer well-child visits (odds ratio, 3.43; 95% confidence interval, 1.26-9.35); for them, immunization levels increased by 28 percentage points. Although for the case management group intervention was not cost-effective ($12 022 per additional child immunized), it was better ($4546) for the 25% of the sample identified retrospectively to have inadequate utilization of preventive health visits. Conclusions. -- A case management intervention in the first year of life was effective but not cost-effective at raising immunization levels in inner-city, African American infants. The intervention was demonstrated to be particularly effective for subpopulations that do not access well-child care; however, currently there are no means to identify these groups prospectively. For case management to be a useful tool to raise immunizations levels among high-risk populations, better methods of tracking and targeting, such as immunization registries, need to be developed.

Only a small number of poor inner-city Latino and African American toddlers may be fully immunized against preventable disease. Researchers determined the degree of full childhood immunization among 301 African American and 724 Latino families. At three months of age, 70 percent of Latinos and 53% of African Americans were fully immunized against the combination of diphtheria-tetanus-pertussis and polio. Full protection at age two consisted of four diphtheria-tetanus-pertussis vaccines, three polio vaccines, and one measles-mumps-rubella vaccine. Only 42% of Latinos and 26% African Americans had all vaccinations by age two. Children were more likely to receive full immunization as three-month-olds if they had been in pre-natal care and were born to small families. Public health coverage, such as Medicaid, seemed to be a factor in the full immunization of 24-month-olds., Objective. To identify factors associated with undervaccination at 3 months and 24 months among low-income, inner-city Latino and African-American preschool children. Design. Interviews with a representative sample of inner-city families using a cross-sectional, multi-stage, cluster-sample design combined with a replicated quota sampling approach. Setting. South Central and East Los Angeles areas in inner-city Los Angeles. Population. Eight hundred seventeen Latino and 387 African-American families with children between 12 and 36 months of age. Main Outcome Variables. Being fully immunized or up-to-date (UTD) at 3 months (1 diphtheria-tetanus-pertussis vaccine and 1 oral pokio vaccine) and 24 months of age (4 diphtheria-tetanus-pertussis vaccines, 3 oral polio vaccines, and 1 measles-mumps-rubella vaccine). Methods. Logistic regressions of UTD immunization status at 3 and 24 months by population and health care system factors. Results. Seventy percent of Latino children and 53% of African-American children were UTD at 3 months of age. At 24 months of age, 42% of Latino children and 26% of African-American children were UTD on their immunizations. Receipt of the first immunizations by 3 months was associated with smaller family size, and evidence of connection to prenatal care. Latino children were less likely to be UTD at 24 months if they obtained well child care from private providers versus public clinics (odds ratio [OR] = 0.45, 95% confidence interval [CI] = 0.26, 0.79). There was also a trend for Latino children to be less well immunized if they were in health maintenance organizations versus public clinics (0.31, .0.05 < P < .1). African-American children were more likely to be UTD at 24 months if they were UTD at 3 months (OR = 5.56, 95% CI = 1.43, 21.6), had more health visits (OR = 1.13, 95% CI = 1.01, 1.27), and were less likely to be UTD at 24 months if they were on Medicaid versus private insurance (OR = 0.26, 95% CI = 0.08, 0.90). Implications. Both African-American and Latino children in inner-city Los Angeles have low immunization rates at 3 and 24 months. Prenatal care and family size are strongly associated with being UTD by 3 months; however, family and child characteristics are relatively unimportant predictors of being UTD at 24 months of age. Important risk factors for underimmunization at 2 years of age in the inner-city, low-income communities studied include type of health insurance and source of well child care, with the public sector having higher rates than private doctors&apos; offices or health maintenance organization/managed care plans. Pediatrics 1995; 96:295-301; immunization status, inner-city, Latino, African-American, health insurance., ABBREVIATIONS: DTP, diphtheria, tetanus, and pertussis vaccine; OPV, oral polio vaccine; MMR, measles, mumps, and rubella vaccine; UTD, up-to-date; OR, odds ratio; CI, confidence interval; HMO, health maintenance organization. After [...]

We abstracted 752 randomly selected records of 2-year-old children at 5 public health centers in Los Angeles. Only 27% of the children were up-to-date in their vaccinations by 2 years of age. Being up-to-date was strongly associated with the number of missed opportunities to vaccinate and number of well child visits. Missed opportunities to vaccinate occurred during 52% of all visits and were associated with minor illness diagnoses and inaccurate immunization status assessment by nurses. Frequent missed opportunities to vaccinate and inadequate numbers of well child visits may result in low immunization levels among children attending public health clinics. (Am J Public Health. 1995;85:850--853), The immunization status among small children may be incomplete in five Los Angeles public health centers. Researchers analyzed the medical records of 752 two-year-olds with respect to vaccination levels. Only 202 children had received all age-appropriate vaccinations and these had come to the clinic more often overall. Further analysis revealed low vaccination levels because of too few well-child clinic visits and missed opportunities to vaccinate at the time of a visit. Specifically, nurses made errors in identifying times when immunization should take place. Very minor cases of illness interfered with vaccination at the time of the clinic visit.

Abstract Background An increasing number of malaria-endemic African countries are rapidly scaling up malaria prevention and treatment. To have an initial estimate of the impact of these efforts, time trends in health facility records were evaluated in selected districts in Ethiopia and Rwanda, where long-lasting insecticidal nets (LLIN) and artemisinin-based combination therapy (ACT) had been distributed nationwide by 2007. Methods In Ethiopia, a stratified convenience sample covered four major regions where (moderately) endemic malaria occurs. In Rwanda, two districts were sampled in all five provinces, with one rural health centre and one rural hospital selected in each district. The main impact indicator was percentage change in number of in-patient malaria cases and deaths in children < 5 years old prior to (2001–2005/6) and after (2007) nationwide implementation of LLIN and ACT. Results In-patient malaria cases and deaths in children < 5 years old in Rwanda fell by 55% and 67%, respectively, and in Ethiopia by 73% and 62%. Over this same time period, non-malaria cases and deaths generally remained stable or increased. Conclusion Initial evidence indicated that the combination of mass distribution of LLIN to all children < 5 years or all households and nationwide distribution of ACT in the public sector was associated with substantial declines of in-patient malaria cases and deaths in Rwanda and Ethiopia. Clinic-based data was a useful tool for local monitoring of the impact of malaria programmes.

Background Bovine colostrum with egg powder (BC/egg) is rich in essential amino acids and immunoactive compounds. Objectives This trial tested the hypothesis that a daily supplement of BC/egg would reduce linear growth faltering and environmental enteric dysfunction (EED) in Malawian infants when compared with an isoenergetic ration of corn/soy flour used as a control. EED was defined by a lactulose permeability test. Methods This was a prospective, randomized, blinded, placebo-controlled clinical trial in which 9-mo-old infants received BC/egg or a control for 3 mo. The primary outcomes were change in length-for-age z -score (ΔLAZ) and urinary lactulose excretion (%L) at 12-mo-old. Secondary outcomes included episodes of diarrhea, stunting, EED, and the 16S configuration of the fecal microbiota. Results Of the 277 children enrolled, 267 completed the intervention phase of the study. LAZ decreased in all children from 9 to 17 mo, although ΔLAZ was less in children receiving BC/egg from 9 to 12 mo (difference = 0.12 z -scores; P  = 0.0011). This difference persisted after feeding was completed, with less ΔLAZ (difference = 0.09 z -scores). A lower prevalence of stunting was seen in the intervention group (n  = 47/137) than the control group (n  = 62/127) at 17 mo (RR = 0.70; 95% CI: 0.52, 0.94).The median %L at 12 mo of age in the children receiving BC/egg was 0.14%, compared with 0.17% in the control group (P  = 0.74). In children with %L >0.45% at enrollment (severe EED), the BC/egg group had more children with normal %L at 12 mo of age (10/20, 50%) than was seen in controls (2/15, 13%; P  = 0.024). Episodes of diarrhea and β-diversity of the 16S configuration of fecal microbiota did not differ between the 2 groups. Conclusions Addition of BC/egg to complementary feeding in Malawian infants resulted in less linear growth faltering. This trial was registered at clinicaltrials.gov as NCT03801317. [ABSTRACT FROM AUTHOR]

Pediatricians contribute to the lack of complete immunization in children. Studies show that pediatricians may fail to immunize children at well-child visits. This is especially a problem in inner-city clinics. Pediatricians may also fail to follow recommended immunization schedules. They may fail to take advantage of sick-child visits for bringing immunizations up to date, although immunization is rarely contraindicated by illness. Reminder and recall systems have been shown to improve immunization status, yet studies show that few pediatricians use them. Pediatricians tend to think immunization coverage is higher in their practices than it is, which would tend to make them ignore recommendations for how to improve coverage. Pediatricians often rely on parental assurance alone that the child has received all appropriate immunizations, but parents, too, tend to overestimate their child's coverage. All of these problems are readily amenable to improvement, which could potentially greatly increase the percentage of completely immunized children., The most recent national survey of vaccination coverage among children in the United States reports that 75% have received the primary vaccination series--the highest level ever recorded.1 However, this survey [...]

Several years ago, I was explaining the value of a measles-vaccination campaign to a doctor at a paediatric hospital in northern Uganda, where, at that time, measles was endemic. The [...]

Background: Efficiently delivered interventions to reduce HIV, malaria, and diarrhea are essential to accelerating global health efforts. A 2008 community integrated prevention campaign in Western Province, Kenya, reached 47,000 individuals over 7 days, providing HIV testing and counseling, water filters, insecticide-treated bed nets, condoms, and for HIV-infected individuals cotrimoxazole prophylaxis and referral for ongoing care. We modeled the potential cost-effectiveness of a scaled-up integrated prevention campaign. Methods: We estimated averted deaths and disability-adjusted life years (DALYs) based on published data on baseline mortality and morbidity and on the protective effect of interventions, including antiretroviral therapy. We incorporate a previously estimated scaled-up campaign cost. We used published costs of medical care to estimate savings from averted illness (for all three diseases) and the added costs of initiating treatment earlier in the course of HIV disease. Results: Per 1000 participants, projected reductions in cases of diarrhea, malaria, and HIV infection avert an estimated 16.3 deaths, 359 DALYs and $85,113 in medical care costs. Earlier care for HIV-infected persons adds an estimated 82 DALYs averted (to a total of 442), at a cost of $37,097 (reducing total averted costs to $48,015). Accounting for the estimated campaign cost of $32,000, the campaign saves an estimated $16,015 per 1000 participants. In multivariate sensitivity analyses, 83% of simulations result in net savings, and 93% in a cost per DALY averted of less than $20. Discussion: A mass, rapidly implemented campaign for HIV testing, safe water, and malaria control appears economically attractive. [ABSTRACT FROM AUTHOR]

Background: Integrated disease prevention in low resource settings can increase coverage, equity and efficiency in controlling high burden infectious diseases. A public-private partnership with the Ministry of Health, CDC, Vestergaard Frandsen and CHF International implemented a one-week integrated multi-disease prevention campaign. Method: Residents of Lurambi, Western Kenya were eligible for participation. The aim was to offer services to at least 80% of those aged 15-49. 31 temporary sites in strategically dispersed locations offered: HIV counseling and testing, 60 male condoms, an insecticide-treated bednet, a household water filter for women or an individual filter for men, and for those testing positive, a 3-month supply of cotrimoxazole and referral for follow-up care and treatment. Findings: Over 7 days, 47,311 people attended the campaign with a 96% uptake of the multi-disease preventive package. Of these, 99.7% were tested for HIV (87% in the target 15-49 age group); 80% had previously never tested. 4% of those tested were positive, 61% were women (5% of women and 3% of men), 6% had median CD4 counts of 541 cell/μL (IQR; 356, 754). 386 certified counselors attended to an average 17 participants per day, consistent with recommended national figures for mass campaigns. Among women, HIV infection varied by age, and was more likely with an ended marriage (e.g. widowed vs. never married, OR.3.91; 95% CI. 2.87-5.34), and lack of occupation. In men, quantitatively stronger relationships were found (e.g. widowed vs. never married, OR.7.0; 95% CI. 3.5-13.9). Always using condoms with a non-steady partner was more common among HIV-infected women participants who knew their status compared to those who did not (OR.5.4 95% CI. 2.3-12.8). Conclusion: Through integrated campaigns it is feasible to efficiently cover large proportions of eligible adults in rural underserved communities with multiple disease preventive services simultaneously achieving various national and international health development goals [ABSTRACT FROM AUTHOR]

Background: An increasing number of malaria-endemic African countries are rapidly scaling up malaria prevention and treatment. To have an initial estimate of the impact of these efforts, time trends in health facility records were evaluated in selected districts in Ethiopia and Rwanda, where long-lasting insecticidal nets (LLIN) and artemisinin-based combination therapy (ACT) had been distributed nationwide by 2007. Methods: In Ethiopia, a stratified convenience sample covered four major regions where (moderately) endemic malaria occurs. In Rwanda, two districts were sampled in all five provinces, with one rural health centre and one rural hospital selected in each district. The main impact indicator was percentage change in number of in-patient malaria cases and deaths in children < 5 years old prior to (2001-2005/6) and after (2007) nationwide implementation of LLIN and ACT. Results: In-patient malaria cases and deaths in children < 5 years old in Rwanda fell by 55% and 67%, respectively, and in Ethiopia by 73% and 62%. Over this same time period, non-malaria cases and deaths generally remained stable or increased. Conclusion: Initial evidence indicated that the combination of mass distribution of LLIN to all children < 5 years or all households and nationwide distribution of ACT in the public sector was associated with substantial declines of in-patient malaria cases and deaths in Rwanda and Ethiopia. Clinic-based data was a useful tool for local monitoring of the impact of malaria programmes. [ABSTRACT FROM AUTHOR]