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WASHINGTON, Friday, May 25, 2012 — The global partnership committed to the elimination of measles, rubella and congenital rubella syndrome applauds today’s global pledge to meet measles and rubella elimination goals. One hundred and ninety-four countries resolved their commitment to achieving these goals in the context of a new Global Vaccines Action Plan (GVAP) endorsed today by the World Health Assembly.
The GVAP aims to prevent more than 20 million deaths over the next decade by increasing access to vaccines for all people. The plan is the result of world-wide collaboration and consultation of more than 1,000 immunization experts from 140 countries. Its goals include reducing measles-related deaths by 95% by 2015 and eliminating measles and rubella in at least five of six World Health Organization (WHO) Regions by 2020.
“Today 194 countries have made a fundamental commitment to bring the benefit of vaccination to every person, no matter who they are or where they live.” said Andrea Gay, Executive Director of Children’s Health at the UN Foundation. “This commitment includes eliminating measles and rubella from most of the world by 2020 using proven, cost effective vaccination strategies. The Measles & Rubella Initiative looks forward to working with priority countries and donors to deliver on this global, life-saving commitment.”
Intensified efforts to vaccinate children against measles have resulted in a 74% drop in global measles-related deaths between 2000 and 2010, from an estimated 535,000 down to 139,000.
Measles and rubella elimination strategies have been effective in the Americas which has not recorded an indigenous measles case since 2002 or an indigenous rubella or congenital rubella syndrome case since 2009. The Western Pacific Region aims to eliminate measles next and has made notable progress reducing measles incidence and introducing a combined measles-rubella vaccine in most countries of the region. The European region has pledged to eliminate measles and rubella by 2015 and is working to raise vaccination coverage and stop the measles outbreaks in several countries of the region.
Priority geographic areas for intensified measles and rubella vaccination now include India and sub-Saharan Africa which respectively account for 47% and 36% of global measles deaths. India has strengthened its measles control efforts and is in the midst of a campaign to reach an additional 134 million children with measles vaccine. Sub-Saharan African countries experienced a resurgence in measles outbreaks after 2008 as funds and political commitment to vaccinate children waned. Many countries of the region are now back on track with renewed efforts to ensure every child receives two doses of measles vaccine. The WHO African region aims to eliminate measles by 2020.
Partners in the Measles & Rubella Initiative have recently launched a new Global Measles & Rubella Strategic Plan 2012-2020, which includes strengthening routine immunization as a core strategy. The Initiative has built a measles surveillance system serving most countries of the world which can provide core support to achieving GVAP targets.
“Where there are measles outbreaks we know that routine immunization coverage is simply not high enough,” said Dr. Rebecca Martin, Director of the Global Immunization Division at the U.S. Centers for Disease Control and Prevention. “Surveillance, including the measles laboratory networks can flag the areas where efforts to reach communities with vaccine must be redoubled. This kind of collaboration will reap the full benefits of vaccination everywhere and help the world reduce child deaths to the levels promised through Millennium Development Goal 4.”
For more information, contact:
Hayatee Hassan, WHO, Geneva, +41 79 500 6532, HasanH@who.int
Christian Moen, UNICEF, New York, +1 212 326 7516, cmoen@unicef.org
Alan Janssen, CDC, Atlanta, (404) 639-8517 axj3@cdc.gov
Eric Porterfield, UN Foundation, Washington, DC, +1 202 352 6087, eporterfield@unfoundation.org
Niki Clark, American Red Cross, Washington, DC +1 202 251 8638, Niki.Clark@redcross.org
Links and social media:
Website: www.MeaslesInitiative.org
The blog: https://stopmeaslesrubella.org
More about measles: www.who.int/topics/measles/en
Twitter: @MeaslesRubella
Subscribe to the e-newsletter: http://bit.ly/ICQGJf
Download the Strategic Plan:
http://bit.ly/IHKuCo or in Ipad format for IBooks: http://bit.ly/meas-rub
Abstract below; full text is at http://www.sciencedirect.com/science/article/pii/S0264410X12005944
Original Text
Walter A Orenstein a , Alan R Hinman b
The Lancet, Volume 379, Issue 9832, Pages 2130 - 2131, 9 June 2012
Measles has been, and remains, a major killer of children around the world. Despite the introduction of the measles vaccine in 1963, measles caused an estimated 2·6 million deaths in a single year as recently as 1980.1 In The Lancet, Emily Simons and colleagues2 estimate that, after more than 45 years of measles vaccine availability, the disease caused nearly 140 000 deaths in 2010.
Even in industrialised countries, complications, including pneumonia, diarrhoea, encephalitis, and subacute sclerosing panencephalitis, lead to substantial morbidity and mortality.3, 4 However, it is in developing countries where measles exacts its greatest health burden. A review of community-based measles studies5 showed a median case-fatality ratio of 3·91% (mean 7·40%, range 0—40·15%).
Through global measles prevention efforts, great progress has been made in measles control. Elimination of indigenous transmission of disease has been achieved in the WHO Americas region.1 Five of the six WHO regions have set goals to eliminate measles by 2020. At present, there is a worldwide goal of a 95% reduction in measles mortality by 2015 compared with 2000 estimates. Measles eradication is biologically feasible and, although no formal eradication goal has yet been set, progress toward the mortality reduction goal will lead to consideration of an eradication goal.1, 6
Measles is one of the most contagious vaccine-preventable diseases,7 and is one of the best indicators for problems in vaccination programmes because of its high communicability and recognisable rash. Outbreaks of measles with complications and deaths can be a greater motivating force for change than immunisation coverage data gaps and the theoretical potential for outbreaks.8 This was the case in the USA, where a resurgence of measles in 1989—91 led to major investments in, and strengthening of, the overall National Immunization Program.
If immunisation programmes fail to immunise new susceptibles added to the population daily through births and migration, enough susceptibles will accumulate to fuel another measles outbreak. For example, since 2008, after substantial reductions in measles mortality, measles has resurged in Africa.9 It is crucial to maintain high immunity levels and immunise all children at recommended ages.
How can we best monitor the progress of global immunisation programmes to guide corrective actions if needed? Measuring measles vaccine coverage provides some information but does not directly translate into effects on health burden. Global disease surveillance systems are at present unable to capture measles case numbers accurately enough to monitor deaths directly. Instead, progress has been assessed through changes in estimated annual measles-attributed deaths. As noted by Simons and colleagues,2 65 countries have adequate vital registration data, which allow the measurement of actual deaths. However, for the remaining 128 countries where most deaths from measles occur, vital registration data are inadequate and necessitate the estimation of those deaths.
The accuracy of estimates depends on the assumptions and data used in modelling exercises. Traditionally, it was assumed that all susceptible people acquired measles, so the number of cases depended on vaccine coverage and effectiveness. Once cases were estimated, age distributions were inferred on the basis of coverage, and age-specific case-fatality ratios for a particular region were estimated and applied to the number of cases to estimate the number of deaths.10 Although this approach has been useful for monitoring the progress of measles mortality reduction efforts, there is a potential bias toward overestimating deaths since it does not account for herd immunity, which is likely to decrease incidence of measles and deaths indirectly. Simons and colleagues2 attempt to take this into account by incorporating a decrease in the rate of infection among susceptibles as population immunity rises, and by using actual surveillance data to modify the estimates of cases and mortality (along with other adjustments).2 In so doing, they estimated that that there were 535 300 deaths from measles in 2000, 27% lower than the previous estimate of 733 000.11 Although substantially lower, this estimate still highlights that far too many children are dying from this readily preventable disease. And, in 2010, they estimate 139 300 deaths (382 deaths per day) despite substantial improvements in immunisation coverage.
Most importantly, perhaps, Simons and colleagues' report highlights crucial gaps in available data to guide prevention programmes—surveillance and vital record registrations are inadequate in much of the world. What is most needed is not more advanced ways to estimate mortality, but the direct measurement of mortality. As measles is considered for eradication, it will be crucial to improve surveillance to the point that deaths and cases will actually be measured, not estimated.
We declare that we have no conflicts of interest.
References
1 Strebel PM, Cochi SL, Hoekstra E, et al. A world without measles. J Infect Dis 2011; 204 (suppl 1): S1-S3. CrossRef | PubMed
2 Simons E, Ferrari M, Fricks J, et al. Assessment of the 2010 global measles mortality reduction goal: results from a model of surveillance data. Lancet 201210.1016/S0140-6736(12)60522-4. published online April 24. PubMed
3 Strebel PM, Papania MJ, Dayan GH, Halsey NA. Measles vaccine. In: Plotkin SA, Orenstein WA, Offit PA, eds. Vaccines. Philadelphia: Saunders Elsevier, 2008: 353-398.
4 Orenstein WA, Papania MJ, Wharton ME. Measles elimination in the United States. J Infect Dis 2004; 189 (suppl 1): S1-S3. CrossRef | PubMed
5 Wolfson LJ, Strebel PM, Gacic-Dobo M, Hoekstra EJ, McFarland JW, Hersh BS. Has the 2005 measles mortality reduction goal been achieved? A natural history modelling study. Lancet 2007; 369: 191-200. Summary | Full Text | PDF(1261KB) | CrossRef | PubMed
6 Bellini WJ, Rota PA. Biological feasibility of measles eradication. Virus Res 2011; 162: 72-79. CrossRef | PubMed
7 Fine PEM, Mulholland K. Community Immunity. In: Plotkin SA, Orenstein WA, Offit PA, eds. Vaccines. Philadelphia: Saunders Elsevier, 2008: 1573-1592.
8 Orenstein WA. The role of measles elimination in development of a national immunization program. Pediatr Infect Dis J 2006; 25: 1093-1101. CrossRef | PubMed
9 Moss WJ, Griffin DE. Measles. Lancet 2011; 379: 153-164. Summary | Full Text | PDF(1370KB) | CrossRef | PubMed
10 Wolfson LJ, Grais RF, Luquero FJ, Birmingham ME, Strebel PM. Estimates of measles case fatality ratios: a comprehensive review of community-based studies. Int J Epidemiol 2009; 38: 192-205. CrossRef | PubMed
11 Centers for Disease Control and Prevention. Global measles mortality, 2000—2008. MMWR Morb Mortal Wkly Rep 2009; 58: 1321-1326. PubMed
a School of Medicine and Emory Vaccine Center, Emory University, Atlanta, GA 30322, USA
b Center for Vaccine Equity, Task Force for Global Health, Decatur, GA, USA
Access this article on SciVerse ScienceDirect
The Lancet, Volume 379, Issue 9832, Pages 2173 - 2178, 9 June 2012
Full text is at http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)60522-4/fulltext
Summary
Background
In 2008 all WHO member states endorsed a target of 90% reduction in measles mortality by 2010 over 2000 levels. We developed a model to estimate progress made towards this goal.
Methods
We constructed a state-space model with population and immunisation coverage estimates and reported surveillance data to estimate annual national measles cases, distributed across age classes. We estimated deaths by applying age-specific and country-specific case-fatality ratios to estimated cases in each age-country class.
Findings
Estimated global measles mortality decreased 74% from 535 300 deaths (95% CI 347 200—976 400) in 2000 to 139 300 (71 200—447 800) in 2010. Measles mortality was reduced by more than three-quarters in all WHO regions except the WHO southeast Asia region. India accounted for 47% of estimated measles mortality in 2010, and the WHO African region accounted for 36%.
Interpretation
Despite rapid progress in measles control from 2000 to 2007, delayed implementation of accelerated disease control in India and continued outbreaks in Africa stalled momentum towards the 2010 global measles mortality reduction goal. Intensified control measures and renewed political and financial commitment are needed to achieve mortality reduction targets and lay the foundation for future global eradication of measles.