GLOBAL CONTROL AND REGIONAL ELIMINATION OF MEASLES, 2000–2012

Tuesday, 11th of February 2014

[source]Weekly Epidemiological Record (WER)[|source]

In 2010, the World Health Assembly established three milestones towards global measles eradication to be reached by 2015. Since that time, elimination goals have been set by member states of all six World Health Organization (WHO) regions, and reaching measles elimination in four WHO regions by 2015 is an objective of the Global Vaccine Action Plan (GVAP).

In this report, updates of the previous report for 2000–2011 are provided. The report describes progress toward global control and regional elimination of measles during 2000–2012. During this period, the report documents increases in routine MCV coverage, plus supplementary immunization activities (SIAs) reaching 145 million children in 2012, leading to a 77% decrease in worldwide estimates of annual measles incidence, from 146 to 33 per million population, and a 78% decline in estimated annual measles deaths, from 562,400 to 122,000. More details are available at:  http://www.who.int/wer/2014/wer8906.pdf?ua=1http://www.who.int/wer/2014/wer8906.pdf?ua=1

 

MMWR Editorial Note

During 2000–2012, increasing routine MCV coverage worldwide and regular SIAs in member states lacking high coverage with 2 doses of MCV contributed to a 77% decrease in reported measles incidence and a 78% reduction in estimated measles mortality, reaching historic lows. During this period, measles vaccination prevented an estimated 13.8 million deaths. Measles elimination continues to be maintained in AMR, and WPR is approaching measles elimination. However, based on current trends and performance, the WHO Strategic Advisory Group of Experts (SAGE) concluded that the 2015 global targets and regional elimination targets in EUR, EMR, and AFR will not be achieved on time.

AFR, EMR, and SEAR, the regions with the largest number of infants not receiving MCV1 through routine immunization services in 2012, had large measles outbreaks during 2012 and had 98% of the estimated global measles mortality burden, highlighting the need to strengthen immunization systems. Globally 2012 might represent a temporary low in the normal cycle of measles incidence. Preventing resurgence will require progress in reaching ≥95% of children with 2 MCV doses through routine immunization services and high-quality SIAs.

The findings in this report are subject to at least three limitations. First, MCV coverage estimates likely included errors resulting from inaccurate estimates of the size of target populations, inaccurate reporting of doses delivered, and inclusion of SIA doses given to children outside the target age group. Second, underestimation in surveillance data can occur because not all patients with measles seek care and not all of those who seek care are reported. These errors in coverage and surveillance data in turn affect the accuracy of the measles mortality model results. Finally, some member states also maintain multiple reporting systems for measles and might, like India, report aggregate, unconfirmed cases rather than case-based data.

To achieve measles elimination, member states should aim to fully implement measles control and elimination strategies described in GVAP and the 2012–2020 Global Measles and Rubella Strategic Plan of the Measles and Rubella Initiative,^††† which include achieving vaccination coverage ≥95% with 2 doses of MCV administered through routine immunization or SIAs and maintaining this coverage uniformly across all districts. For many member states now at <90% coverage nationally, reaching ≥95% coverage will require substantial and sustained additional investments of financial and human resources to strengthen health systems and achieve equitable access to immunization services. Further progress toward achieving the 2015 global measles control targets and regional measles elimination targets will also require member states and partners to increase the visibility of measles elimination activities and make the needed investments.