Global groups renew measles push as drop in deaths slows

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Apr 24, 2012 (CIDRAP News) – Global health officials are making headway with driving down the number of measles deaths, but there are signs that progress is stalling, a pattern that has kept nations from meeting a global mortality benchmark, researchers reported today.

The new profile of measles deaths, which appeared in The Lancet yesterday, comes as world health partners launch a new strategy to prevent the disease, one that involves pairing the vaccine with immunization against rubella.

In 2008, the World Health Assembly set a goal of reducing by 2010 the number of measles deaths by 90% of 2000 numbers. However, according to the new Lancet estimate, the number of measles deaths fell 74% during that period.

The international research team, funded by the US Centers for Disease Control and Prevention (CDC), used a new type of modeling that incorporated surveillance data to estimate the incidence and age distribution of cases, factor in herd immunity, and use robust statistical methods to estimate uncertainty.

Measles deaths declined steadily, due to increased vaccine coverage and the delivery of more than a billion doses, but progress stalled starting in 2008 due to large outbreaks in southern Africa that resulted in a small mortality increase for that World Health Organization (WHO) region. In India, delayed implementation of measles vaccination activities have hampered vaccine coverage there, the researchers said.

The team found that measles mortality dropped by more than three quarters in all WHO regions except for Southeast Asia. India accounted for 47% of estimated measles deaths in 2010, and the WHO's African region accounted for 36%.

Researchers noted that their estimate of measles mortality is lower than earlier estimates, though they lie within 95% confidence interval of the new estimate, they wrote.

In a related editorial, two vaccine experts from Emory University, Walter Orenstein, MD, and Alan Hinman, MD, MPH, wrote that although the estimate of deaths from measles in 2000 was substantially lower in the new report, "this estimate still highlights that far too many children are dying from this readily preventable disease." The group's estimate of deaths in 2000 was 27% lower than an earlier estimate.

Orenstein and Hinman wrote that the group's study highlights crucial gaps in data to guide prevention programs. The study noted that only 65 countries have vital registration data that measures actual deaths, and that the data are inadequate in 128 countries where most measles deaths occur.

"As measles is considered for eradication, it will be crucial to improve surveillance to the point that deaths and cases will actually be measured, not estimated," they wrote.

The WHO said that its Measles Initiative, in keeping with global strategy to battle both measles and rubella, is now called the Measles and Rubella Initiative. Margaret Chan, MD, the WHO's director-general, said in the statement that the 75% drop in deaths shows how effective well-run vaccination programs can be. "Now we need to take the next logical step and vaccinate children against rubella, too," she said.

For measles, the strategy's goal is to cut deaths by 95% of 2000 levels by 2015, the WHO said. Goals also include eliminating measles and rubella in at least five WHO regions by 2020. Strategies also include high vaccination coverage, monitoring measles spread with lab-based surveillance, outbreak and case management, communication initiatives, and research and development.

The 62 countries that aren't vaccinating against rubella are being encouraged to do so within their measles vaccine delivery system.

CDC Director Tom Frieden, MD, said in the statement that rubella is the leading cause of congenital malformations in newborns. "This new plan outlines strategies we know work. It is time to partner with key countries to implement the plan in order to save our children from these terrible diseases," he said.

The WHO said starting this year, developing countries can apply to the Global Alliance for Vaccines and Immunizations (GAVI) for financial support to obtain combined measles-rubella (MR) vaccine. Seth Berkley, MD, chief executive officer of GAVI, said in the statement, "With GAVI's $605 million [USD] investment for both the combined MR and measles second dose vaccines in developing countries, this is an historic moment for the reduction and hopefully eventual elimination of both diseases."

Kathy Calvin, chief executive officer with the United Nations Foundation, said in the statement that $112 million more is needed to achieve measles and rubella goals for 2015. "We need significant commitments from governments and the private sector if we are going to stop measles and rubella, as well as the support of individuals worldwide, because a small donation from the public can go a long way and help save many lives," she said.

See also:

Apr 24 WHO press release

Apr 23 Lancet abstract

Apr 23 Lancet editorial extract

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