Global Measles Mortality, 2000–2008

A Dabbagh, PhD; M Gacic-Dobo; E Simons, MHS; D Featherstone, PhD; P Strebel, MBChB; JM Okwo-Bele, MD; E Hoekstra, MD; M Chopra, MBChB; A Uzicanin, MD; S Cochi, MD

Disclosures

Morbidity and Mortality Weekly Report. 2009;58(47):1321-1326. 

In This Article

Editorial Note

After a period of rapid progress in reducing global measles mortality during 2000–2006, the reduction in measles mortality has begun to level off, raising the possibility that the 2010 goal might not be reached. Approximately 77% of the estimated global measles mortality in 2008 was concentrated in one region (SEAR). Further progress toward the 90% mortality reduction goal is impeded by two factors: 1) India has not fully implemented the measles mortality strategies recommended by WHO and UNICEF in 2001,[3,4] and 2) political and financial commitment to sustaining measles control in many of the other 46 priority countries has declined.

Efforts to reduce measles-related mortality since 2000 have contributed substantially to the reduction in overall child mortality. During 2000–2008, child mortality decreased by 1.6 million, from an estimated 10.4 million to 8.8 million deaths***; during the same period, estimated measles deaths declined by 569,000, suggesting that the decline in measles-related deaths played a major role in the overall decline in child mortality. Because measles deaths play a large role in global child mortality, reductions in efforts to further decrease measles deaths (e.g., reductions in regular measles SIAs and laboratory-supported surveillance) could slow progress toward reaching MDG4.

Several related factors influence the measles mortality burden estimates and projections presented in this report. The natural history model used by WHO uses the published age-specific measles case-fatality ratios (CFRs) and keeps them constant; hence, current mortality estimates are primarily determined by changes in the size of the birth cohort and measles vaccination coverage over time.[6] However, measles CFRs are known to differ within populations over time.[9] Most notably, increased measles vaccination coverage is thought to be the major factor contributing to declines in overall measles CFRs. As measles vaccination coverage increases, the average age of infection rises, and a larger proportion of measles cases occur among previously vaccinated children.[10] Because CFRs are one of the key parameters in estimating the global measles mortality burden, additional field studies should be conducted to gather additional CFR data, especially in post-SIA settings. Multiple factors have been associated with increased measles CFRs, including low socioeconomic status, malnutrition, vitamin A deficiency, HIV-infection, young age at infection, and lack of measles immunization. Although an age-appropriate dose of vitamin A is recommended for measles case management,[3] access to vitamin A treatment often is limited.

The results achieved in 46 of the 47 priority countries suggest that a 90% reduction in global measles mortality can be achieved and sustained if the recommended strategy is implemented fully. Key factors related to a possible delay in achieving the 90% reduction in global measles mortality beyond 2010 and the risk for a measles mortality resurgence include delayed implementation of catch-up SIAs in India and suboptimal routine MCV and SIA coverage in AFR. Routine vaccination is a cornerstone of the WHO/UNICEF recommended strategy,[3] and increasing MCV coverage must be given high priority to achieve and sustain the global goal.

*** Regional data available at http://www.childinfo.org/mortality_underfive.php.

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