Saturday, 25th of June 2011 Print

Many thanks to the indispensable Jane Wachira, who, on the eve of her holiday, assembled 35 pages of abstracts from the forthcoming supplement to the Journal of Infectious Diseases, with abstracts on all aspects of measles epidemiology, control and eradication, as well as articles on rubella and CRS.

Those with subscriptions can access both the table of contents and full text at

Many firmly held beliefs will not survive the appearance of this supplement. If you think that measles vaccine efficacy is 85 percent, read the piece by Uzicanin and Zimmermann. If you think that measles eradication is poor bang for the buck, read the piece by Levin and colleagues. If you think that outbreak response immunization comes too little and too late, read the piece by Cairns and colleagues. If you think that measles eradication will undermine health systems, try the piece by Griffiths and colleagues.

Subscribers to JID can access the full text of all articles at http://jid.oxfordjournals.org/content/204/suppl_1.toc


Good reading.




The Measles Initiative: Moving Toward Measles Eradication

  1. 1.   Athalia S. Christie1 and
  2. 2.   Andrea Gay2 

- Author Affiliations

  1. 1.    1International Services, American Red Cross
  2. 2.    2United Nations Foundation, Washington, D.C

Correspondence: Ms Athalia S. Christie, MIA, Senior Technical Advisor, American Red Cross–International Services, NW3-117C, 2025 E St NW, Washington, DC 20006 (christieat@usa.redcross.org).


The World Health Assembly should establish a target date for measles eradication based on continued progress toward existing mortality reduction goals. We have a safe, effective, and inexpensive vaccine; a proven elimination strategy; high country demand; and an effective global partnership. Since it was founded in 2001, the Measles Initiative has supported the vaccination of >900 million children in supplementary immunization activities. Largely as a result, global measles deaths decreased by 78% between 2000 and 2008, averting an estimated 4.3 million deaths. The Measles Initiative has exceeded its targets and evolved to address increasingly ambitious goals. The current challenges include a decline in funding and weak routine immunization systems in some countries. Skeptics of measles eradication raise 3 main objections: the yet-to-be-achieved polio eradication goal, the high cost, and the impact on health systems. These are important concerns that can be addressed with judicious program planning. All 6 World Health Organization regions have committed to measles elimination, and 5 have set a target date. The World Health Assembly has endorsed interim targets toward eradication, and an independent global measles advisory group has determined measles can and should be eradicated. A target date for eradication will focus efforts and capitalize on the achievements of the last decade.






Measles Mortality Reduction Contributes Substantially to Reduction of All Cause Mortality Among Children Less Than Five Years of Age, 1990–2008

  1. 1.   Maya M. V. X. van den Ent1,
  2. 2.   David W. Brown1,
  3. 3.   Edward J. Hoekstra1,
  4. 4.   Athalia Christie2 and
  5. 5.   Stephen L. Cochi3 

- Author Affiliations

  1. 1.    1United Nations Children’s Fund (UNICEF), New York, New York
  2. 2.    2International Services, American Red Cross, Washington, DC
  3. 3.    3Global Immunization Division, Centers for Disease Control and Prevention, Department of Health and Human Services, Atlanta, Georgia
  4. Correspondence: Maya van den Ent, PharmD, MPH, UNICEF Headquarters, 3 UN Plaza, New York, NY 10017 (mvandenent@unicef.org).


Background. The Millennium Development Goal  4 (MDG4) to reduce mortality in children aged <5 years by two-thirds from 1990 to 2015 has made substantial progress. We describe the contribution of measles mortality reduction efforts, including those spearheaded by the Measles Initiative (launched in 2001, the Measles Initiative is an international partnership committed to reducing measles deaths worldwide and is led by the American Red Cross, the Centers for Disease Control and Prevention, UNICEF, the United Nations Foundation, and the World Health Organization).

Methods. We used published data to assess  the effect of measles mortality reduction on overall and disease-specific global mortality rates among children aged <5 years by reviewing the results from studies with the best estimates on causes of deaths in children aged 0–59 months.

Results. The estimated measles-related  mortality among children aged <5 years worldwide decreased from 872,000 deaths in 1990 to 556,000 in 2001 (36% reduction) and to 118,000 in 2008 (86% reduction). All-cause mortality in this age group decreased from >12 million in 1990 to 10.6 million in 2001 (13% reduction) and to 8.8 million in 2008 (28% reduction). Measles accounted for about 7% of deaths in this age group in 1990 and 1% in 2008, equal to 23% of the global reduction in all-cause mortality in this age group from 1990 to 2008.

Conclusions. Aggressive efforts to prevent  measles have led to this remarkable reduction in measles deaths. The current funding gap and insufficient political commitment for measles control jeopardizes these achievements and presents a substantial risk to achieving MDG4.






Strategic Planning for Measles Control: Using Data to Inform Optimal Vaccination Strategies

  1. 1.   Emily Simons1,
  2. 2.   Molly Mort2,
  3. 3.   Alya Dabbagh1,
  4. 4.   Peter Strebel1 and
  5. 5.   Lara Wolfson3 

- Author Affiliations

  1. 1.    1Expanded Programme on Immunization, Department of Immunization, Vaccines and Biologicals
  2. 2.    2Consultant to Program for Appropriate Technology in Health
  3. 3.    3Global Influenza Programme, Department of Health, Security, and Environment, World Health Organization, Switzerland
  4. Correspondence: Emily Simons, MHS, 20 Ave Appia, 1211 Geneva 27, Switzerland (simonse@who.int).


Background. In response to repeated requests  for assistance in evaluating the health benefit and cost implications of adjustments to national measles immunization strategies, the World Health Organization (WHO) has developed the Measles Strategic Planning (MSP) tool to harness routinely available data to estimate effectiveness and cost effectiveness of vaccination strategies.

Method. The MSP tool estimates measles  incidence and mortality through a country-specific cohort model, using a probability of infection dependent on population immunity levels. This method approximates measles transmission dynamics without requiring detailed data that would prohibit use in low- and middle-income countries. Coupled with cost data, the tool estimates incremental costs and cost effectiveness of user-defined vaccination strategies over 5–10 year planning periods.

Results. The MSP tool produces valid  estimates of measles incidence in settings with low to moderate vaccination coverage. Early adopters report that the tool facilitates decision making by minimizing the amount of time required to assess the impact of vaccination strategies on population immunity.

Conclusions. By clearly illustrating what  vaccination strategies can effectively protect against measles at the least cost to immunization programs, the MSP tool supports evidence-based decision making for effective and comprehensive measles control.




Should Outbreak Response Immunization Be Recommended for Measles Outbreaks in Middle- and Low-Income Countries? An Update

  1. 1.   K. Lisa Cairns1,
  2. 2.   Robert T. Perry1,
  3. 3.   Tove K. Ryman1,
  4. 4.   Robin K. Nandy2 and
  5. 5.   Rebecca F. Grais3 

- Author Affiliations

  1. 1.    1Global Immunization Division, US Centers for Disease Control and Prevention, Atlanta, Georgia
  2. 2.    2UNICEF, New York, New York
  3. 3.    3Epicentre, Paris, France

Correspondence: K. Lisa Cairns, MD, MPH, MS E-05, 1600 Clifton Rd, Atlanta, GA 30306 (kfc4@cdc.gov).


Background  Measles caused mortality in . >164,000 children in 2008, with most deaths occurring during outbreaks. Nonetheless, the impact and desirability of conducting measles outbreak response immunization (ORI) in middle- and low-income countries has been controversial. World Health Organization guidelines published in 1999 recommended against ORI in such settings, although recently these guidelines have been reversed for countries with measles mortality reduction goals.

Methods  We searched literature published . during 1995–2009 for papers reporting on measles outbreaks. Papers identified were reviewed by 2 reviewers to select those that mentioned ORI. World Bank classification of country income was used to identify reports of outbreaks in middle- and low-income countries.

Results  We identified a total of 485 . articles, of which 461 (95%) were available. Thirty-eight of these papers reported on a total of 38 outbreaks in which ORI was used. ORI had a clear impact in 16 (42%) of these outbreaks. In the remaining outbreaks, we were unable to independently assess the impact of ORI.

Conclusions These findings generally . support ORI in middle- and low-income countries. However, the decision to conduct ORI and the nature and extent of the vaccination response need to be made on a case-by-case basis.




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