Abstract
In 2010, the World Health Assembly (WHA) set the following three milestones for measles control to be achieved by 2015: 1) increase routine coverage with the first dose of measles-containing vaccine (MCV1) among children aged 1 year to ≥90% at the national level and to ≥80% in every district, 2) reduce global annual measles incidence to less than five cases per 1 million population, and 3) reduce global measles mortality by 95% from the 2000 estimate* (1). In 2012, WHA endorsed the Global Vaccine Action Plan,† with the objective of eliminating measles§ in five of the six World Health Organization (WHO) regions by 2020. This report updates a previous report (2) and describes progress toward WHA milestones and regional measles elimination during 2000-2018. During 2000-2018, estimated MCV1 coverage increased globally from 72% to 86%; annual reported measles incidence decreased 66%, from 145 to 49 cases per 1 million population; and annual estimated measles deaths decreased 73%, from 535,600 to 142,300. During 2000-2018, measles vaccination averted an estimated 23.2 million deaths. However, the number of measles cases in 2018 increased 167% globally compared with 2016, and estimated global measles mortality has increased since 2017. To continue progress toward the regional measles elimination targets, resource commitments are needed to strengthen routine immunization systems, close historical immunity gaps, and improve surveillance. To achieve measles elimination, all communities and countries need coordinated efforts aiming to reach ≥95% coverage with 2 doses of measles vaccine (3).
Highlights
The MMWR series of publications is published by the Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention (CDC), U.S Department of Health and Human Services, Atlanta, GA 30329-4027
A previously described model for estimating measles cases and deaths was updated with new measles vaccination coverage data, case data, and United Nations population estimates for all countries during 2000–2018, enabling derivation of a new series of disease and mortality estimates [5]
During 2000–2018, increased coverage with MCV1 and MCV2, widespread SIAs, and other elimination efforts contributed to a 66% decrease in reported measles incidence, a 73% reduction in estimated measles mortality, and a reduction in the number of circulating measles virus genotypes worldwide
Summary
In 2018, all 194 WHO member countries conducted measles surveillance, and 191 (98%) had access to standardized quality-controlled laboratory testing through the WHO Global Measles and Rubella Laboratory Network. Surveillance remains weak in many countries, and only 84 (55%) of 152 countries that reported surveillance indicators achieved the sensitivity indicator target of ≥2 discarded measles and rubella§§ cases per 100,000 population. §§ A discarded case is defined as a suspected case that has been investigated and determined not to be measles or rubella using 1) laboratory testing in a proficient laboratory or 2) epidemiological linkage to a laboratory-confirmed outbreak of a communicable disease that is not measles or rubella. The discarded case rate is used to measure the sensitivity of measles surveillance. The MMWR series of publications is published by the Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention (CDC), U.S Department of Health and Human Services, Atlanta, GA 30329-4027.
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