Morbidity and Mortality Weekly Report (MMWR): Progress Toward Regional Measles Elimination — Worldwide, 2000–2013
Robert T. Perry, MD1, Marta Gacic-Dobo, MSc1, Alya Dabbagh, PhD1, Mick N. Mulders, PhD1, Peter M. Strebel, MBChB1, Jean-Marie Okwo-Bele, MD1, Paul A. Rota, PhD2, James L. Goodson, MPH3 (Author affiliations at end of text)
In 2012, the World Health Assembly endorsed the Global Vaccine Action Plan* with the objective to eliminate measles in four World Health Organization (WHO) regions by 2015. Member states of all six WHO regions have adopted measles elimination goals. In 2010, the World Health Assembly established three milestones for 2015: 1) increase routine coverage with the first dose of measles-containing vaccine (MCV1) for children aged 1 year to ≥90% nationally and ≥80% in every district; 2) reduce global annual measles incidence to <5 cases per million; and 3) reduce global measles mortality by 95% from the 2000 estimate (1).† This report updates the 2000–2012 report (2) and describes progress toward global control and regional measles elimination during 2000–2013. During this period, annual reported measles incidence declined 72% worldwide, from 146 to 40 per million population, and annual estimated measles deaths declined 75%, from 544,200 to 145,700. Four of six WHO regions have established regional verification commissions (RVCs); in the European (EUR) and Western Pacific regions (WPR), 19 member states successfully documented the absence of endemic measles. Resuming progress toward 2015 milestones and elimination goals will require countries and their partners to raise the visibility of measles elimination, address barriers to measles vaccination, and make substantial and sustained additional investments in strengthening health systems.
WHO and the United Nations Children's Fund (UNICEF) use data from administrative records and surveys reported annually by member states to estimate coverage with MCV1 and the second dose of MCV (MCV2) through routine immunization services.§ Since 2003, member states also have reported the number of districts with ≥80% MCV1 coverage. Estimated MCV1 coverage increased globally from 73% to 83% from 2000 to 2009, then remained at 83%–84% through 2013 (Table 1). The number of member states with ≥90% MCV1 coverage increased from 84 (44%) in 2000 to 131 (68%) in 2012, then decreased to 129 (66%) in 2013. Among member states with ≥90% MCV1 coverage nationally, the proportion having ≥80% MCV1 coverage in all districts increased from 17% (18 of 104) in 2003 to 43% (56 of 131) in 2012, then declined to 37% (48 of 129) in 2013. Of the estimated 21.5 million infants not receiving MCV1 through routine immunization services in 2013, approximately 13.2 million (62%) were in six member states: India (6.4 million), Nigeria (2.7 million), Pakistan (1.7 million), Ethiopia (1.1 million), Indonesia (0.7 million), and the Democratic Republic of the Congo (0.7 million).
From 2000 to 2013, the number of member states providing MCV2 through routine immunization services increased from 96 (50%) to 148 (76%), with four member states introducing MCV2 in 2013. Estimated global MCV2 coverage increased from 15% in 2000 to 53% in 2013. During 2013, approximately 205 million children received MCV during supplementary immunization activities (SIAs) conducted in 34 member states.¶ Of these, 16 states (47%) reported ≥95% SIA coverage, and 21 (62%) provided one or more additional child health interventions during the SIA (Table 2).