Development of a District-Level Programmatic Assessment Tool for Risk of Measles Virus Transmission.

All six World Health Organization (WHO) regions have now set goals for measles elimination by or before 2020. To prioritize measles elimination efforts and use available resources efficiently, there is a need to identify at-risk areas that are offtrack from meeting performance targets and require strengthening of programmatic efforts. This article describes the development of a WHO measles programmatic risk assessment tool to be used for monitoring, guiding, and sustaining measles elimination efforts at the subnational level. We outline the tool development process; the tool specifications and requirements for data inputs; the framework of risk categories, indicators, and scoring; and the risk category assignment. Overall risk was assessed as a function of indicator scores that fall into four main categories: population immunity, surveillance quality, program performance, and threat assessment. On the basis of the overall score, the tool assigns each district a risk of either low, medium, high, or very high. The cut-off criteria for the risk assignment categories were based on the distribution of scores from all possible combinations of individual indicator cutoffs. The results may be used for advocacy to communicate risk to policymakers, mobilize resources for corrective actions, manage population immunity, and prioritize programmatic activities. Ongoing evaluation of indicators will be needed to evaluate programmatic performance and plan risk mitigation activities effectively. The availability of a comprehensive tool that can identify at-risk districts will enhance efforts to prioritize resources and implement strategies for achieving the Global Vaccine Action Plan goals for measles elimination.

Baseline burden of rotavirus disease in Sudan to monitor the impact of vaccination.

BACKGROUND: In 2011, Sudan became the first low-income country in Africa to introduce a rotavirus vaccine. Prevaccine baseline data on rotavirus disease burden are crucial for monitoring the impact of this new vaccine program. METHODS: We conducted active, hospital-based surveillance for rotavirus disease at 8 regional public hospitals in Sudan using a standard protocol recommended by the World Health Organization for 2 full years immediately preceding vaccine introduction. Cases were children <5 years hospitalized with gastroenteritis, defined as acute onset of 3 or more loose stools or 2 or more episodes of vomiting in a 24-hour period. Stool specimens from cases were tested for rotavirus using a commercially available assay. RESULTS: From June 2009 to May 2011, rotavirus was detected in 3985 (36%) of 10,953 children hospitalized for gastroenteritis, with detection rates ranging from 25% to 48% at the 8 hospitals. Approximately 61% of the rotavirus hospitalizations occurred before 1 year of age and most (91%) occurred before 2 years of age. Rotavirus was detected year-round in Sudan with peaks during March to May and November to December. Applying rotavirus prevalence to national estimates of diarrhea events, we calculated 9800 deaths, 22,800 hospitalizations and 55,400 outpatient visits related to rotavirus per year among children <5 years of age in Sudan. CONCLUSIONS: The high burden of rotavirus disease in Sudan indicates that the recently implemented vaccination program should substantially improve child health in Sudan. This nationwide rotavirus surveillance system will be an important platform for assessing the benefits and value of rotavirus vaccine in a developing country setting.