In the Journals

WHO: Progress towards measles elimination stalling

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November 14, 2014

Based on current trends of measles vaccination and incidence, 2015 global targets to eliminate measles in four WHO regions will not be achieved on time, according to study findings in MMWR.

The World Health Assembly endorsed the Global Vaccine Action Plan in 2010 to eliminate measles in four WHO regions by 2015. Three milestones were set for 2015:

  • Increase routine coverage with the first dose of measles-containing vaccine (MCV1) among children aged 1 year to ≥90% nationally and ≥80% in every district;
  • Reduce global annual measles incidence to <5 cases per million;
  • Reduce global measles deaths by 95% compared with the 2000 estimate.

WHO and UNICEF used data from administrative records and surveys reported by member states to evaluate progress made toward global and regional control and elimination of measles from 2000 to 2013.

During the study period, annual reported measles incidence decreased from 146 cases to 40 cases per million population overall, indicating a 72% decrease. Annual estimated deaths from measles decreased 75%, from 544,200 to 145,700. However, this decline is not enough, as it is significantly below the target of a 95% reduction in measles deaths between 2000 and 2015, according to a WHO press release.

Overall reported cases and measles incidence increased from 2012 to 2013, even though fewer member states reported data in 2013 compared with 2012. There were 227,739 reported measles cases in 2012 vs. 279,776 in 2013. The incidence rate for measles was 33 cases per million population in 2012 vs. 40 cases per million population in 2013.

From 2000 to 2009, MCV1 coverage increased from 73% to 83% and remained between 83% and 84% through 2013.

Approximately 21.5 million infants did not receive MCV1 via routine immunization services in 2013. Of these, 62% (13.2 million) were from six member states including India, Nigeria, Pakistan, Ethiopia, Indonesia, and the Democratic Republic of the Congo.

“Poor progress in increasing measles vaccination coverage has resulted in large outbreaks of this highly contagious disease, throwing the 2015 elimination targets off track,” Peter Strebel, MBChB, of the WHO department of immunization, vaccines and biologicals, said in a press release.

Outbreaks reported in the Democratic Republic of the Congo, Nigeria, China, Pakistan, Angola, Indonesia, and Turkey increased measles incidence in 2013, according to Robert T. Perry, MD, of the WHO department of immunization, vaccines and biologicals, and colleagues, who wrote the MMWR report.

In addition to these outbreaks, progress stalled in the WHO Eastern Mediterranean region as a result of weak health care systems, conflict and population displacement, according to the release. Further, measles has reemerged in the European region with outbreaks in Georgia, Turkey and Ukraine.

“The net effect of reduced global funding by governments and partners has caused postponed and suboptimal immunization campaigns, resulting in large outbreaks that threaten our hard earned gains,” Robert Kezaala, of UNICEF, said in the release.

To achieve the 2015 target, awareness about measles elimination and risks associated with not vaccinating children needs to increase, according to the American Red Cross, United Nations Foundation, CDC, UNICEF and WHO, who partnered on the Measles and Rubella Initiative.

Benin, Burkina Faso, Cote d’Ivoire, Lao PDR, Mali, Mauritania and Yemen are scheduled to implement mass vaccination campaigns in November 2014. The Democratic Republic of the Congo started a one-year rolling campaign in 2013 that ended in August 2014.

Disclosure: The researchers report no relevant financial disclosures.

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