Hospital-based surveillance for rotavirus gastroenteritis in children younger than 5 years of age in Ethiopia: 2007-2012.

BACKGROUND: Rotavirus surveillance was initiated in Ethiopia to estimate the burden of rotavirus gastroenteritis in children <5 years of age, to generate data to assist the policy-making process for new vaccine introduction and to monitor impact of vaccination on disease burden after introduction. METHODS: Sentinel surveillance was conducted at 3 hospitals in Addis Ababa, Ethiopia using a standardized WHO surveillance protocol from August 2007 to March 2012. Children <5 years of age, hospitalized for the primary reason of treatment for acute gastroenteritis, were enrolled, stool samples were collected and tested for group A rotavirus using an enzyme immunoassay. Confirmed positive specimens were further characterized by rotavirus genotyping. RESULTS: A total of 1841 children were enrolled and 21% were rotavirus positive. Children 6-12 months of age had the highest proportion of rotavirus (36%) followed by children <6 months of age (23%). There was no significant difference between sexes. Significant differences in clinical characteristics, such as vomiting, vomiting episodes, cases with vomiting and diarrhea among rotavirus positive cases, were observed. Rotavirus circulated year round with peak prevalence from October through January. The most prevalent detected genotypes were G1P[8] (20%), G12P[8] (17%) and G3P[6] (15%), respectively. CONCLUSIONS: Rotavirus infection is common in Ethiopian children. A safe and effective intervention against the infection is needed to prevent severity of the disease. Rotavirus vaccine introduction is planned before the end of 2013. The established surveillance system and the data generated can be used to monitor the impact of rotavirus vaccination program on severe disease.

Progress in measles mortality reduction in Ethiopia, 2002-2009.

BACKGROUND: In 2002, Ethiopia adopted the African regional accelerated measles control strategies to reduce measles mortality. Routine measles vaccination is provided for infants at 9 months of age. A second opportunity for measles vaccination through supplementary immunization activities (SIAs) started in 2002, targeting children aged 6 months-14 years; periodic follow-up SIAs were conducted, targeting children aged 6-59 months from 2005 through 2009. METHODS: The administrative coverage data for routine measles vaccination and the respective World Health Organization-United Nations Children's Fund vaccination coverage estimates, as well as administrative coverage during measles SIAs and the measles case-based surveillance data from 2004 through 2009, were reviewed and analyzed. RESULTS: The administrative coverage with routine measles vaccination increased from 37% in 2000 to 76% in 2009. The SIAs coverage was 92% for the catch-up SIAs, 88% for the first follow-up SIAs, and 92% for the second follow-up SIAs. Measles case-based surveillance met the targets set for the 2 main performance indicators during 2005-2009. CONCLUSIONS: Following the adoption of the measles control strategies, a reduction in the number of reported measles cases and measles outbreaks was documented. However, measles outbreaks continued to occur in Ethiopia, mainly because of suboptimal measles vaccination coverage.

The epidemiology of rubella disease in Ethiopia: data from the measles case-based surveillance system.

BACKGROUND: Rubella is usually a mild rash illness. However, when a woman contracts rubella early in pregnancy, serious consequences may occur, including birth defects known as congenital rubella syndrome (CRS). Information is limited on the epidemiology of rubella and CRS in Ethiopia. METHOD: Rubella cases reported through the measles case-based surveillance system during 2004-2009 were analyzed. RESULTS: A total of 8212 samples were tested for rubella immunoglobulin (Ig) M, and 992 (12.1%) of these specimens had test results that were positive for rubella IgM. The age distribution of patients with rubella-positive cases ranged from 3 months to 44 years. The majority (94.7%) of the cases were in individuals <15 years of age. The proportion of positive specimens from urban areas (19.4%) was higher than that from rural areas (11.6%). CONCLUSIONS: Rubella is endemic in Ethiopia and mainly occurs among children and young adolescents. To better understand the burden of rubella and CRS, and to develop a national strategy for rubella control in Ethiopia, CRS surveillance will need to be established, and appropriate studies need to be conducted.

Analysis and reporting of meningococcal meningitis epidemic in north Gondar 2001-2002.

Severe epidemic meningococcal meningitis occurs in countries of the meningitis belt of Sub-Saharan Africa, including Ethiopia. Many epidemics occurred in this country in the past decade, the recent being in 2000 in Addis Ababa unusually during the wet and rainy season. The study was a cross-sectional design. Data were collected with prepared questionnaires and the line listing. CSF (Cerebro Spinal Fluid) culture and antibiotic sensitivities were done for a limited number of patients. The objective of the study was to assess the progress and management outcome of the epidemic. During the out breaks of epidemic meningitis in north Gondar zone of the Amhara regional state in 2001 and 2002 children and young adults were most affected. There were 384 cases and 26 deaths in 2001 and 1235 cases and 128 deaths, in 2002, making a total of 1619 cases and 154 deaths with a case fatality rate of 9.5%. The etiologic agent was sero-group A. The most affected age group was 15-30 years. About 80% of the cases were in the age 30 years and below. Surveillance, epidemic preparedness, interventions and response were found to be inadequate. Selective vaccination was not effective in handling the epidemic. Efficient surveillance, local processing and use of data, regional laboratory support, multisectoral approach and mass vaccination were recommended to appropriately and timely handle such epidemics.