A World Without Measles

Abstract

Measles is one of the most highly transmissible contagious human diseases. In the prevaccine era, .90% of children had measles by their 15th birthday. In 1980, before the use of measles vaccine was widespread, an estimated 2.6 million deaths due to measles occurred worldwide. The aim of Millennium Development Goal 4 (MDG4) is to reduce the overall number of deaths among children by two-thirds by 2015, compared with the level in 1990.[1] Recognizing the potential of measles vaccination to reduce mortality among children and that measles vaccination coverage may be considered a marker of access to children’s health services, routine measles vaccination coverage was selected as an indicator of progress towards this goal. At the 63rd World Health Assembly (WHA) in 2010, Member States endorsed the following accelerated measles control targets to be achieved by 2015 [2]: exceed 90% coverage with the first dose of measlescontaining vaccine nationally and exceed 80% vaccination coverage in every district; reduce annual measles incidence to ,5 cases per million and maintain that level; and reduce measles mortality by $95%, compared with 2000 estimates. These ambitious targets are aligned with MDG4 and represent milestones towards the global eradication of measles. Global mortality attributed to measles has decreased by an impressive 78% from an estimated 733,000 deaths in 2000 to 164,000 in 2008 [3]. The decrease in measles mortality has accounted for 23% of the overall decrease in childhood mortality since 1990 and for 24% since 2000.[4] All countries, with the exception of India, achieved the 2010 global goal of reducing measles mortality by 90% two years ahead of the target date [3]. This progress has been made possible through accelerated measles control activities implemented by high-burden countries with the financial and technical support of the Measles Initiative. (Launched in 2001, the Measles Initiative is an international partnership committed to reducing measles deaths worldwide, founded and led by the American Red Cross, the Centers for Disease Control and Prevention, UNICEF, United Nations Foundation, and the World Health Organization (WHO) and joined subsequently by a number of other organizations. Additional information available at http://www.measlesinitiative.org). Moreover, measles elimination has been sustained in the WHO Region of the Americas since 2002, and important steps are being taken to achieve the goal of measles elimination in 3 other WHO regions (Europe, Eastern Mediterranean, and Western Pacific) by 2015 or before. In 2009, the African Region adopted the goal of eliminating measles by 2020, and the South East Asian Region passed a resolution urging countries to mobilize resources to support elimination of measles with discussions continuing about establishing a target date. In May 2008, encouraged by the progress being made in reducing measles deaths worldwide, Member States requested that the WHO evaluate the feasibility of the global eradication of measles [5]. A comprehensive program of work was performed that explored the biological, programmatic, economic, social, and political aspects of the feasibility of measles eradication. In July 2010, at a Global Consultation on the Feasibility of Measles Eradication, the results of these studies were presented to an ad hoc advisory panel [6]. The panel concluded that measles can and should be eradicated and that global eradication by 2020 is feasible given evidence of measurable progress towards the 2015 targets (see the advisory group report in this issue). Furthermore, the ad hoc advisory panel stressed that measles eradication activities should be carried out in the context of strengthening Potential conflicts of interest: none reported. Supplement sponsorship: This article is part of a supplement entitled ''Global Progress Toward Measles Eradication and Prevention of Rubella and Congenital Rubella Syndrome'', which was sponsoredby theCenters forDiseaseControl andPrevention. Two of the authors are staff members of the World Health Organization. The authors alone are responsible for the views expressed in this publication, and they do not necessarily represent the decisions, policy, or views of the World Health Organization. Correspondence: Peter Strebel, MBChB, MPH, Accelerated Disease Control, Expanded Programme on Immunization, Dept of Immunization, Vaccines and Biologicals, World Health Organization, Avenue Appia, CH-1211, Geneva 27, Switzerland (strebelp@who.int). The Journal of Infectious Diseases 2011;204:S1–S3 The Author 2011. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals. permissions@oup.com 0022-1899 (print)/1537-6613 (online)/2011/204S1-0001$14.00 DOI: 10.1093/infdis/jir111