S U P P L E M E N T A R T I C L E
Innovative Use of Surveillance Data to Harness
Political Will to Accelerate Measles Elimination:
Experience From Guangxi, China
Jiatong Zhuo,1Edward J. Hoekstra,2Ge Zhong,1Wei Liu,1Zhigang Zheng,1and Jian Zhang3
1Division of Immunization Service, Guangxi Zhuang Autonomous Region Center for Disease Control and Prevention, Nanning, Guangxi, China;
2Health Section, Programme Division, Global Measles Program and Health Emergencies, United Nations Children's Fund, New York, and
3Division of Epidemiology, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro
The major challenge for measles elimination is to harness sufficient political will to provide the necessary
financial and human resources. This is particularly relevant for local governments (at county and township
levels in China) and communities that generally have not accepted measles as a serious health burden and thus
have not made its prevention a high priority. An effort has been made to use surveillance data to harness
political will and overcome or mitigate the shortage of resources in the impoverished province of Guangxi, one
of China’s 31 administrative divisions. A comprehensive information system collecting data pertaining to
Expanded Program on Immunization (EPI-info) was refined to align with China’s political system and translate
international and national commitments into sustainable local actions. The EPI-info has proved an effective
tool in identifying high-risk areas, strengthening routine immunization services, conducting mass measles
immunization campaigns, and catalyzing capacity building at both county and local community levels. We
outline the principles and operational features of the EPI-info and the rationale and steps taken to refine it.
In 2003 the World Health Organization Regional Com-
mittee of the Western Pacific Region formally established
a target date of 2012 for measles elimination . Tre-
mendous progress has been made in the region, but the
program is now at a critical stage, with just over 2 years
remaining before the end of the target year. As seen with
the polio immunization program, the final stages of dis-
ease elimination are often the most difficult and resource
intensive: the target year goals can onlybe met if adequate
and timely commitments of the necessary resources are
made. Although leadership and continued support from
national governments and international organizations are
crucial, in most measles-endemic countries the vast ma-
local (ie, county and township) governments and com-
munities [2, 3]. As with polio, the major challenge for the
elimination initiative is in harnessing the political will to
provide the necessary financial and human resources .
communities do not consider measles to be a serious
health burden and thus have not made prevention a high
priority. Mobilizing resources, both financial and human,
from local governments is essential if the elimination
program is to be completed on schedule. This article
presents our experience with using surveillance data in an
innovative way to harness political will and overcome or
mitigate the shortage of resources in Guangxi, an im-
poverished province of China (ranked 20 out of 31 ad-
domestic product per capita ). Much effort went into
refining the existing information system to collect data
pertaining to Expanded Program on Immunization
Potential conflicts of interest: Jian Zhang is partially supported by the Research
Awards Program of Georgia Southern University. The study received no external
funding. All other authors: no conflicts.
Supplement sponsorship: This article is part of a supplement entitled ''Global
Syndrome,'' which was sponsored by the Centers for Disease Control and Prevention.
Correspondence: Jian Zhang, MD, DrPH, Jiann-Ping Hsu College of Public
Health, Georgia Southern University, PO Box 8015, Statesboro, GA (jianzhang@
The Journal of Infectious Diseases
? The Author 2011. Published by Oxford University Press on behalf of the Infectious
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EPI Surveillance in Guangxi
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by guest on January 11, 2016
case for increased resources. This is indeed the only avenue
leading to measles elimination by means of sustainable disease
control and prevention.
We thank the workers of the county public health departments, town-
ship health centers, and village health clinics who comprise the immuni-
zation service system and are responsible for vaccination achievements in
Guangxi. Thanks are also due to the immunization management team at
Guangxi Center for Diseases Control and Prevention who design, deliver,
and administer the Guangxi EPI-info. We acknowledge editorial assistance
from Rose Riddell and graduate assistants at Jiann-Ping Hsu College of
Public Health, Georgia Southern University, in the preparation of this
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Table 3.Annual Incidence of Measles, Vaccine Coverage, and Birth Rates in Guangxi, China, 2001–2006
Total population, millionsa
Birth rate from census bureau, &
Birth rate calculated from EPIbregistration, &
Estimated measles vaccine coverage among childrenc
47.9147.7948.42 48.9649.25 49.61
Measles incidence, cases/1,000,000 133.1879.6252.4429.1132.3218.66
NOTE.aThe Guangxi Census Bureau produces estimates of the resident population annually basis by updating data from the last nationwide census in 2000. The
basic procedure used to estimate population is base population (the year of 2000) 1 births to resident women 2 deaths to residents 1 net floating population.
bEPI, Expanded Program on Immunization
cCoverage was estimated for children 1–6 years old and referred to vaccination with 1 dose of measles-containing vaccine. The denominator was the number of
children with valid birth certificates, and the numerator the number with documents proving immunization with R1 dose of measles-containing vaccine.
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