Public Health

The Global Elimination of Measles

A new study1 from the World Health Organization (WHO) and Centers for Disease Control and Prevention (CDC) examined the progress toward regional and global measles elimination from 2000 to 2018.

Among the findings was that measles-containing-vaccine first-dose (MCV1) coverage increased globally from 72% in 2000 to 86% in 2018. However, the number of measles cases increased by 167% globally in 2018 compared with 2016. Despite global action plans and goals set by WHO and other organizations, these findings show that gaps still exist in eliminating measles worldwide.

To better understand these gaps and the study findings, Consultant360 reached out to lead author Minal K. Patel, MD, who is a researcher in the Department of Immunization, Vaccines, and Biologicals at the World Health Organization in Geneva, Switzerland.

Here are her answers to our burning questions.

C360: You and your colleagues examined the trend in regional measles elimination. Which parts of the world were closest to elimination? Why are these areas closer than others?

Minal Patel: While several countries have made progress, the last two years have seen a number of severe, often protracted measles outbreaks across all regions of the world. Because measles is so contagious, it will spread anywhere people are unprotected against the disease. The Region of the Americas had achieved measles elimination in 2016. However, last year Venezuela re-established endemic measles, meaning the same strains of the virus had been circulating within the country for more than a year, and Brazil followed in 2019. In the European Region, 37 of 53 countries have been verified as having eliminated the disease. Four of 11 countries in the South East Asia Region and 17 of 27 countries in the Western Pacific Region have been verified as having achieved measles elimination. In the Eastern Mediterranean Region, it is 3 of 21 countries. The African Region has yet to have verified any country as having achieved elimination. Progress is seen in those countries that have made a serious commitment to stopping transmission—ensuring high rates of vaccination, rapidly detecting cases of measles, and stopping transmission quickly if an outbreak occurs.

C360: In your study, you and your team wrote: “As the period covered by the Global Vaccine Action Plan 2012–2020 approaches its end, a new vision and strategy for accelerated progress on immunization for 2021-2030 is being developed by countries and stakeholders.” In your opinion, what approaches or targets need to be included in this strategy?

MP: Our vision is a world where everyone, everywhere, at every age fully benefits from vaccines for good health and well-being. The way to achieve this is for immunization stakeholders to focus on commitment and demand, coverage and equity, research and innovation, rapid response in outbreak and emergencies, and supply and sustainability. Each country needs to evaluate why it continues to have measles cases. For example, are cases occurring in a certain location? Among a certain age group? Among a certain religious group or community? Why are these populations not being appropriately vaccinated? Then, each country needs to develop strategies to reach those populations.

C360: What are the implications of your findings for public health providers?

MP: First it is important for providers to realize that measles can occur in any community that has not achieved 95% population immunity. Nowhere is safe as long as there is measles anywhere in the world, because the virus travels fast and does not respect borders. Public health providers need to make efforts to ensure that there is high vaccination coverage, and when a case of measles is suspected, that immediate action is taken to stop further transmission. For example, public health providers should be educating/reminding clinical providers (those who see both children and adults) that measles should be in the differential diagnosis for those who present with fever and rash. They should be informing clinicians of the proper methods for testing and how to alert public health of suspected cases. They should work with clinicians to understand the reasons that people are not fully vaccinated and then work to address those reasons. Stopping an outbreak requires public health providers to work with clinicians to identify patients who have not been vaccinated against measles and to identify ways of vaccinating these individuals.

Reference:

  1. Patel MK, Dumolard L, Nedelec Y, et al. Progress toward regional measles elimination—Worldwide, 2000-2018. MMWR Morb Mortal Wkly Rep. 2019;68:1105-111 http://dx.doi.org/10.15585/mmwr.mm6848a1.