Reviewed case report studies for various countries in Africa

Type, Study, Region, Sample Size & Purpose/ & Quantitative Results Qualitative Results Caveats Year(s) of Objective Population Size Study Guyer and Case Reports Describe the Yearly attack rates per 1000 children 6-35mo: -SEP (1968) interrupted epidemic -1968: cases seen at PMI McBean -national epidemiology of Year Attack Rate pattern seen previously but Centrale were reported so + surveillance measles in transmission still occurred at a much only those cases treated at 1981 [46] 1969 11 -endemic Yaoundé during 1970 15 lower rate; PMI were reported; NA* the period prior to 1971 87 -surveillance improved in 1973- -1974: surveillance Yaoundé, 1968-1975 EPI (1968-1975) 1975 but still a decrease in included all dispensaries 1972 316 Cameroon incidence; and child health care 1973 194 -% cases has shifted slightly but centres, improved number 166,000 (1968) 1974 101 significantly to older children in reported cases 1975 97 1975 (herd immunity effect);  accuracy before this will 260,000 (1975) 1971 attack rates per 1000 children in age group: -theoretically enough vaccinations be less accurate Age (mo) Attack rate were given to children 6-35mo to  still only reports treated 0-5 8.9 provide adequate coverage of cases 6-11 200.1 children in and entering susceptible -incomplete records for 12-23 95.6 population 1969, 1970, last 6 months 24-35 26.6 of 1972 1975 attack rates per 1000 children in age group: Age (mo) Attack rate 0-5 4.7 6-11 135.0 12-23 73.0 24-35 27.0 Heymann, Case Reports Describe the Incidence per 1000 population**: -number of weekly reporting sites -sample survey could have Maybean, -community impact of the Year Incidence increased from 6 to 13 in 1977 but contained children from Murphy surveillance changes in the 1974 10.45 overall incidence still decreased other age groups to et al 1983 [47] -endemic immunization 1975 9.49 over 1974-1979, except for a peak determine possible second 40,349 (1975) policy in Yaoundé 1976 6.44 in 1978 dose coverage Yaoundé, 45,519 (1976) (1975-1979). This -from 1975-1979 incidence -surveillance system will 1977 5.97 Cameroon 49,615 (1977) paper continues on decreased by 64% (0-8mo), 30.4% miss cases not treated at 1978 7.59 255,116 (1974) 54,081 (1978) from where Guyer (9-23mo), 20.5% (24-47mo) health facilities 58,948 (1979) et al (1981) leave 1979 5.87 -constant vaccination coverage of 278,076 (1975) -sample survey off. Incidence per 1000 children in age group (age in 39-40% (12-23mo) from 1976-1979 -endemic months): 313,706 (1976) 187 (1976) Age (mo) 206 (1977) Year 0-8 9- 24- Total 342,939 (1977) 209 (1979) 23 47 1975 88. 92. 34.6 65.4 372,714 (1978) 2 7 1976 36. 78. 23.3 44.4 406,258 (1979) 9 8 1977 31. 71. 24.7 41.2 1 3 1978 37. 82. 37.9 52.3 6 5 1979 31. 64. 27.5 40.5 8 5 Taylor, Case Reports Describe Community survey: -proportion of children 9-11mo -community survey only Ruti-Kalisa, -community epidemiology of Incidence rate per 1000 children in age group vaccinated increased 1977-1984 done in 3 months prior to Ma-Disu survey measles to (over 3 months)†: even though same number vaccines the survey et al 1987 [48] (3 months prior measure the effects Age (mo) Incidence were given -children only assumed to survey) of the vaccination 0-5 0 -vaccine coverage increased from vaccinated if they have a Kinshasa, 3092 program 6-8 61.9 37±6% (1977) to 62±4% (1983) in vaccination card Zaire 1983 9-11 67.0 children 12-23mo -62% children in community survey 12-23 45.2 3,000,000 vaccinated 24-35 11.8 -vaccination varied from 16-73% in 36-47 10.3 different clusters non-uniform 48-59 3.7 vaccine coverage within Kinshasa Total 21.7 leaves pockets of susceptibles -18% cases <9mo -27% cases <9mo  might be a -37% cases <1yr reservoir for measles transmission because they are too young to be Reported Cases: vaccinated but have the highest -27% cases <9mo incidence rate -45% cases <1yr -45% cases <1yr -herd immunity was not evident with 50-60% coverage in Kinshasa Dollimore, Case Reports Report on a Incidence per 1000 child-years of follow up: -median age at onset: 41mo -visits were only every 4 Cutts, -field survey community-based Age (mo) Incidence -lower vaccination  higher months Binka -endemic study in northern 0-5 9.9 incidence possibility for inaccurate et al 1997 [49] 25,443 Ghana that studied 6-8 46.2 -no vitamin A supplements  reporting 1989-1991 CFRs, incidence, 9-11 31.4 higher incidence (not stat. sig) -exact date of measles Kassena- and effects of -vaccine coverage was ~50% for onset not recorded 12-23 22.1 Nankana, vitamin A entire study period possibility that cases 24-35 23.7 Ghana supplementation -median age of vaccination was 11.7 were recorded in wrong 36-47 23.3 months age group but it was over 180,000 48-59 24.6 2yrs 60-71 25.3 ≥72 23.1 Total 24.3 -incidence was 35.5 per 1000 child-years among unvaccinated children and 10.7 per 1000 child- years among vaccinated children Weeks, Barenzi, Case Reports Assess the issue of All cases were within 5mo to 12 yrs: -vaccine efficacy varies depending -zones were chosen that and Wayira -household the large -4% cases <9mo on zone: had the highest number of 1992 [42] survey proportion -75% cases <5yr 75% in zone 1, 55% in zone 2 reported cases -outbreak of cases that -25% cases >4yr -no major problems with the cold -case detection may have Kampala, 301 occurred in Attack rates per 1000 children in age group‡: chain were found but improved been influenced by Uganda 1990 children that have Age (mo) Attack maintenance and stock control need mother’s recall or by been vaccinated rate to be improved incorrect diagnosis 800,00 <9 55.6 -two communities did not 9-11 50.0 describe the extent of the 12-23 320.5 outbreak or immunization coverage 24-35 140.4 -small sample size 36-47 150.0 considering the size of the 48-59 153.8 city Total 169.4 -40% children aged 12-23mo in zone 1 and 58% in zone 2 were vaccinated Age (mo) % vaccinated 9-11 45 12-23 47 24-35 58 36-47 38 48-59 48 Total 48 Malfait, Jataou, Case Reports Describe the Incidence rates per 1000 children in age group -vaccine coverage in Niamey was -bias in control group for Jollet et al 1994 -national epidemiological for epidemic (7 months)§: estimated to be 73% in children 12- calculating VE since they [43] surveillance characteristics, risk Age (mo) Incidence 23mo and 63% in children 9-11mo could be more likely to -outbreak factors for illness, 0-5 46.4 in 1990 attend health facilities often Niamey, 435,606 recommendations 6-8 279.1 -highest IR in age group 6-8mo then -controls also had no Niger 1990-1991 developed during 9-11 244.5 9-11mo  need vaccine with higher history of measles infection the outbreak, and efficacy at 6mo, however, sufficient 12-59 105.1 445,715 (1988) calculate vaccine vaccine coverage levels in older 5-14 18.2 efficacy children would have reduced risk in ≥15 4.8 younger children (herd immunity) Total 31.2 -low vaccine efficacy seems not to be the cause of the epidemic Grais, Dubray, Case Reports Estimate measles Boukoki attack rates per 1000 children in age -Dong District in Nigeria had -poor age breakdown for Gerstl et al 2007 -household ARs, CFRs, group: highest AR of all 3 districts ARs [44] -retrospective frequency of Age (yrs) Attack -Nigeria also had the lowest vaccine -study during epidemic survey measles (and rate¶ coverage -survey was conducted Boukoki, -outbreak related <5 170.6 -few cases below 9mo in all 3 6mo after epidemic started Niamey, 26,795 complications), 5-14 23.3 districts so cases at beginning may Niger, (Niger) and access to ≥15 2.3 -18mo median age of case fatality not have been reported 21,812 health care during -visitiation of health centre lowest in -site selection biased Total 38.2 NA (Chad) these epidemics in Nigeria towards more accessible Moursal: 16,249 order to provide a -money was a factor in all 3 places areas Moursal, (Nigeria) picture of measles Age (yrs) Attack -treatment was not free -ages are imprecise N'Djamena, 2003-2005 morbidity and rate¶ -geographical limitations Chad, mortality in high <5 171.7 burden settings 5-14 37.1 NA ≥15 2.4 Total 34.2 Dong District, Dong District: Adamawa State, Nigeria Age (yrs) Attack rate¶ NA <5 243.3 5-14 115.3 ≥15 10.6 Total 87.9 Vaccine coverage: Boukoki: 37.3% Moural: 70% Dong District: 1.0%

+ Reference numbers in brackets refer to reference list in main manuscript text.

*NA = Not Available

**values were changed from incidence per 100000 to incidence per 1000

†values recalculated to be incidence per 1000 rather than per 100

‡ values recalculated to be incidence per 1000 rather than per 100

§ original IR values were per 1000 person months; number of people per age group was found by dividing by length of epidemic (7

months)

¶ values recalculated to be incidence per 1000 rather than per 100