Measles Deaths Decline but Elimination Progress Stalls in Some Regions

The number of measles deaths globally decreased by 71 percent between 2000 and 2011, from 542 000 to 158 000. Over the same period, new cases dropped 58 percent from 853 500 in 2000 to 355 000 in 2011, according to new data released Thursday by the World Health Organization (WHO), a leading member of the Measles and Rubella Initiative. Although the WHO Region of the Americas has sustained measles elimination since 2002, and the WHO Western Pacific Region is on track to achieve elimination, large outbreaks of measles are jeopardizing progress in the remaining regions that have these goals.

WHO recommends that every child receive two doses of measles vaccine. The new data, published in this weeks edition of the Centers for Disease Control and Prevention (CDC)'s Morbidity and Mortality Weekly Report and then in WHOs Weekly Epidemiological Record, show overall progress in reducing deaths is linked largely to increased vaccination coverage.

Estimated global coverage with a first dose of vaccine increased from 72 percent in 2000 to 84 percent in 2011. The number of countries providing the second dose through routine services increased from 97 in 2000 to 141 in 2011. Since 2000, with support from the Measles & Rubella Initiative, more than 1 billion children have been reached through mass vaccination campaigns about 225 million of them in 2011.

Despite this global progress, some populations remain unprotected. An estimated 20 million children worldwide did not receive the first dose of vaccine in 2011. More than half of these children live in five countries:
- Democratic Republic of the Congo (DRC) (0.8 million)
- Ethiopia (1 million)
- India (6.7 million)
- Nigeria (1.7 million)
- Pakistan (0.9 million)
 
In 2011, large measles outbreaks were reported in all these countries and several others in:
- DRC (134,042 cases)
- Ethiopia (3,255 cases)
- France (14,949 cases)
- India (29,339 cases)
- Italy (5,189 cases)
- Nigeria (18,843 cases)
- Pakistan (4,386 cases)
- Spain (3,802 cases)
 
Most of these countries are in WHO regions which have committed to eliminate measles by 2015 or 2020.

The measles outbreaks pose a serious challenge to the regional elimination efforts and signal where national health systems and routine immunization programmes need strengthening. Resuming progress in reducing measles cases and deaths means strengthening health systems so that they can provide effective immunization services and laboratory-supported surveillance for vaccine-preventable diseases to all children.

The outbreaks also indicate the need to ensure that parents are fully aware of the benefits of immunization and the risks associated with not vaccinating children.

Launched in 2001, the Measles Initiative is a partnership led by the American Red Cross, United Nations Foundation, U.S. Centers for Disease Control and Prevention, UNICEF and WHO committed to reducing measles deaths worldwide.

In April of 2012, the partners of the Measles Initiative introduced a new global plan to jointly tackle measles and rubella using the same strategy and a combined measles-rubella vaccine. This new strategy is represented in its new name, the Measles & Rubella Initiative. The Initiatives goal is now to reduce measles deaths worldwide by 95 percent between by 2015 and to eliminate measles and rubella in at least five of six WHO regions by 2020.

In 2010, the World Health Assembly established three milestones towards the future eradication of measles to be achieved by 2015:
1. Increase routine coverage with the first dose of measles-containing vaccine (MCV1) for children aged 1 year to 90% nationally and 80% in every district or equivalent administrative unit;
2. Reduce and maintain annual measles incidence to <5 cases per million; and
3. Reduce estimated measles mortality by >95% from the 2000 estimate.

Since then, WHO and partners in the Measles and Rubella Initiative have developed a Global Measles & Rubella Strategic Plan 2012-2020. The plan presents a five-pronged strategy to cut global measles deaths by at least 95% by 2015 compared with 2000 levels and to achieve measles and rubella elimination in at least five WHO regions by 2020. The strategies include: high vaccination coverage; monitoring spread of disease using laboratory-backed surveillance; outbreak preparedness and response and case management; communication and community engagement; and research and development.

Other countries reporting large measles outbreaks in 2011:
- Afghanistan (3,013 cases)
- Chad (8,650 cases)
- Ethiopia (3,255 cases)
- France (14,949 cases)
- Indonesia (21,893 cases)
- Italy (5,189 cases)
- Philippines (6,538 cases)
- Romania (4,189 cases)
- Somalia (17,298 cases)
- Spain (3,802 cases)
- Sudan (5,616 cases)
- Uganda (3,312 cases)
- Zambia (13,324 cases)