Measles Remains a Threat Despite Global Vaccination Efforts

Megan Brooks

November 10, 2016

Despite a significant 79% decrease globally in measles deaths between 2000 and 2015, nearly 400 children still die from the disease every day, according to a report released today.

"Making measles history is not mission impossible," Robin Nandy, UNICEF immunization chief, said in a statement. "We have the tools and the knowledge to do it; what we lack is the political will to reach every single child, no matter how far. Without this commitment, children will continue to die from a disease that is easy and cheap to prevent."

The latest measles mortality figures were published online November 10 in Morbidity and Mortality Weekly Report.

Missed Shots Unacceptable

According to the data, between 2000 and 2015, an estimated 20.3 million deaths due to measles were prevented by mass vaccination campaigns and a global increase in routine measles vaccination coverage. During this time, the incidence of measles decreased 75%, from 146 to 36 cases per 1 million population.

The report also notes that the number of countries providing the second dose of measles-containing vaccine (MCV2) nationally through routine immunization services increased to 160 (82%) in 2015, and global MCV2 coverage was 61%. In 2015, a total of 184 million persons were vaccinated against measles through supplementary immunization activities.

Despite progress since 2000, the 2015 global measles control milestones and regional measles elimination goals were not achieved, the report says.

In 2015, about 20 million infants did not receive measles vaccine, and an estimated 134,000 children died from measles. The Democratic Republic of the Congo, Ethiopia, India, Indonesia, Nigeria, and Pakistan account for half of the unvaccinated infants and 75% of the measles deaths, according to the report.

"It is not acceptable that millions of children miss their vaccines every year. We have a safe and highly effective vaccine to stop the spread of measles and save lives," Jean-Marie Okwo-Bele, MD, director of the World Health Organization's Department of Immunization, Vaccines and Biologicals, said in the release. "This year, the region of the Americas was declared free of measles – proof that elimination is possible. Now, we must stop measles in the rest of the world. It starts with vaccination."

Outbreaks Continue

Gaps in routine immunization and in mass vaccination campaigns have led to measles outbreaks in several countries. In 2015, large measles outbreaks were reported in Egypt, Ethiopia, Germany, Kyrgyzstan, and Mongolia. The outbreaks in Germany and Mongolia affected older people, highlighting the need to vaccinate adolescents and young adults who have no protection against measles, the report notes.

Measles also tends to flare up in countries in conflict or during humanitarian emergencies, owing to the challenges of vaccinating every child. Last year, outbreaks were reported in Nigeria, Somalia, and South Sudan.

The United States also remains vulnerable. As reported previously by Medscape Medical News, there were four measles outbreaks in the United States from January 4 through April 2, 2015. One outbreak linked to Disney's California theme parks accounted for 70% of all measles cases. A total of 159 people, including 155 US residents and four foreign visitors, were affected.

Most of the measles cases reported in the United States in the first 3 months of 2015 were traced to people who either were not vaccinated against the highly contagious virus or whose vaccination status was unknown.

"Reaching measles control and elimination goals will require addressing policy and practice gaps that prevent reaching larger numbers of children with measles vaccination, increasing visibility of measles elimination efforts, ensuring funding as polio funding decreases, and ensuring adequate resources for strengthening health systems," write the authors of the report.

"Measles is a key indicator of the strength of a country's immunization systems, and all too often, it ends up being the canary in the coal mine, with outbreaks acting as the first warning of deeper problems," Seth Berkley, CEO of Gavi, the Vaccine Alliance, said in the release. "To address one of the world's most deadly vaccine-preventable childhood killers, we need strong commitments from countries and partners to boost routine immunization coverage and to strengthen surveillance systems."

MMWR Morb Mortal Wkly Rep. Published online November 10, 2016. Full text

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