MEASLES EPIDEMICS IN TURKEY AND DEVELOPING COUNTRIES: REVIEW OF THE LITERATURE

During the research of measles outbreak occured in the region of Güzelbahçe village clinic of Izmir Province, Turkey in 1993, Ellidokuz et al. (17) determined that 68.6% of the measles cases aged 0 to 14 years had been vaccinated before. Mutlu et al. (18) searched the vaccination status of measles cases in Izmir and revealed their vaccination ratios by the years; according to these datas, in 1988, 49%, in 1989, 42%, in 1990, 41%, in 1991, 49%, in 1992, 48%, and in 1993, 57% of the cases had been vaccinated before. In recent outbreak, the vaccination status of the cases were 42.1% in Cizre and 13.5% in Idil (15). These are meaningful because of bringing up the insufficiency of the vaccine and the necessity for an argument about measles vaccination schedule. A high proportion of vaccine preventable cases in an outbreak would suggest that a failure to vaccinate children was a significant factor (11,12).

Aylward et al. (19) reported that the literature searches and record reviews identified 301 reports of measles outbreaks that occurred between 1963 and 1995. Sixty-six reports described outbreaks in a total of 35 middle or low income countries. Seventeen measles outbreak reports described 13 separate immunization responses in 12 middle or low income countries (four outbreaks were reported in two articles or reports).

We searched the reports of measles outbreaks that occurred between 1993 and 2002 in English published medline. Thirty-five reports described outbreaks in a total of 19 middle or low income countries (Table 2) (20-37).

In 2001, the number of confirmed measles cases in the Region of the Americas reached a record low of 537 cases, a 99% decrease since 1990 (31,34). During 2001, the Dominican Republic and Haiti interrupted indigenous measles transmission successfully (34,35), ending known indigenous transmission of the D6 measles virus genotype. This genotype, which had circulated widely in the Region of the Americas since 1995, caused nationwide outbreaks in Argentina, Bolivia, Brazil, the Dominican Republic, and Haiti during 1997-2001 (34-37). In August 2001, a measles outbreak introduced by a traveler returning from Europe occurred in Venezuela and was exported to Colombia in 2002 (31).