Low Measles Seroprevalence Among Children in a High Vaccination Coverage Area - Atebubu-Amantin District, Ghana-2020

Vaccine preventable diseases

Atebubu-Amantin District in Bono East region of Ghana had recorded measles vaccination coverages above 95% since 2015. However, the district experienced measles outbreak in 2018. We therefore assessed measles vaccination coverages and seroprevalence in the district after the outbreak.
We conducted community-based cross-sectional survey using two-stage cluster sampling in Atebubu-Amantin District from December 2019 to August 2020. We interviewed 400 caregivers of children aged 24 to 59 months
using semi-structured questionnaire to collect data on a child’s measles vaccination status. We drew 5ml venous blood from fully vaccinated children to determine measles IgG antibody seroprevalence using measles IgG
enzyme-linked immunosorbent assay (ELISA) test kit, according to the manufacturer’s (Microimmune Measles IgG capture EIA) instructions.
We assessed health workers’ knowledge on cold chain management and cold chain management practices in facilities using a checklist. We performed summary descriptive statistics on quantitative data collected.
The median age (interquartile range) of caregivers was 30(26-35) years while mean age (standard deviation) of children was 39.0 (10.2) months. Measles vaccination coverage for the first dose of measles-containing-vaccine (MCV-1) was 91.0% (364/400), and second dose (MCV-2) was 80.0% (320/400). Of 136 blood samples of fully vaccinated children tested, the measles IgG antibody seroprevalence was 31.6% (43/136). Only 33.3% (3/9) facilities had an alternative power supply during power outage. About 42% (11/26) of health workers did not know the measles vaccine was heat sensitive and 65.4% (17/26) thought vaccines could be used shortly after discardable endpoint.
Measles vaccination coverage was high, but seroprevalence after full vaccination was low. The district experienced irregular power outage without alternate power supply in most facilities. Staff knowledge on cold chain management was inadequate. We recommend training of health workers on cold chain management and provision of alternative power supply for cold chain equipment.

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