Dramatic Decline in Measles Deaths Worldwide

Measles is a highly contagious illness caused by a virus in the paramyxovirus family, which normally grows in the cells that line the back of the throat and in the cells that line the lungs. Prior to1963, measles was an expected life event. Each year in the United States, there were approximately 3 to 4 million cases and an average of 450 deaths, with epidemic cycles occurring every two to three years. More than half the population had measles by the time they reached the age of six, and 90 percent had the disease by the time they were 15. However, all that changed after the measles vaccine became available. The number of U.S. cases dropped by 99 percent and the epidemic cycles dramatically diminished. Unfortunately, the same did not hold true for developing nations with low income and a weak health care infrastructure, where measles has remained a leading cause of death among young children. However, a campaign aimed at getting children vaccinated globally seems to be changing the dynamics of the disease.

Measles deaths worldwide decreased by 74 percent between 2000 and 2007; from an estimated 750,000 a year to 197,000, according to a report released by the Measles Initiative, a global partnership founded by the American Red Cross, the United States Centers for Disease Control and Prevention (CDC), the United Nations Foundation (UN Foundation), UNICEF and the World Health Organization (WHO). The group’s estimates come from a mathematical model, which factors in vaccination and death rates for unvaccinated children. The biggest improvements were seen in Africa and in eastern Mediterranean countries like Afghanistan, Pakistan and Sudan, where measles deaths dropped by about 90 percent, from 96,000 a year to 10,000. Health officials estimate 11 million deaths overall were avoided in the decline. Julie Gerberding, Director of the Atlanta-based CDC, referred to the drop in measles deaths as “remarkable” but noted that it was unfortunately “not enough for the 554 children who die every day” from the disease. “It’s absolutely wonderful that so many children are off to a healthy start in life thanks to the progress we’ve made in combating measles through immunization,” she said. “Other children’s lives are still at risk, however, so it’s time we refocus our attention on sustaining our immunization efforts in countries where rates are low.”

Many of the children still at risk reside in India, which now accounts for more than two-thirds of the world’s measles deaths, and is the only country that hasn’t taken part in the collaboration. But, according to Edward Hoekstra, coordinator of the measles program at the United Nations Children Fund, it is now working with organizations to begin coverage. “They are in the final stages of planning, and we’re confident they will be on track in the next two to three years,” Hoekstra said in a conference call with reporters. “Four states account for 84 percent of measles in India. Those states are meeting in December.”

The latest figures reinforce what appears to be a successful trend. Last year, the Measles Initiative reported that worldwide measles deaths dropped 60 percent from 1999 to 2005. In 2007, more than twice the number of children were immunized in the Eastern Mediterranean region through vaccination campaigns as in 2006. “There are thousands of health workers and volunteers from our Red Cross and Red Crescent family who deserve much of the credit for this success. They give their time to literally go door-to-door informing, educating and motivating mothers and caregivers about the critical need to vaccinate their children,” said Bonnie McElveen-Hunter, Chairman of the Board of the American Red Cross. “This mobilization helps us to consistently reach more than 90 percent of the vulnerable population and save countless lives.”

In May 2005, the 58th World Health Assembly adopted the WHO/UNICEF Global Immunization Vision and Strategy (GIVS). GIVS calls on countries to reduce global measles deaths by 90 percent by 2010 compared to 2000 estimates. The United Nations Millennium Declaration also set a child survival target: to reduce the under-five child mortality rate by two-thirds by the year 2015 compared with 1990 levels. The world’s success in reaching these goals depend on ensuring that all children receive two doses of measles vaccine, including one dose by their first birthday and another dose from 18 to 24 months, as well as strengthening disease surveillance systems and providing effective treatment for measles. “Progress also depends on addressing the considerable funding gap,” said Kathy Calvin, Executive Vice President and Chief Operating Officer for the UN Foundation. “The shortfall stands at US $176 million for 2009-2010, of which US $35 million is urgently needed for 2009. With continued funding and increasing ownership and commitment of countries, we can sustain our progress and achieve our goal by 2010. We ask our supporters to stay with us and strongly encourage new supporters to join us in our effort to save lives.”

There has been a resurgence of measles in the U.S., where the goal is to increase immunization rates by 2010 to 95 percent, the level needed to stop outbreaks through what is referred to as “herd immunity,” where even unvaccinated people are protected. While this year’s increased case count seems small, only about 130, it is about double the cases reported for the entire year of 2007 and the highest level seen in America for more than a decade. Nearly half of the recent cases involved children whose parents rejected vaccination because of personal or religious exemption. Unvaccinated people not only run the risk of acquiring measles themselves, but can also transmit the disease to others, including children too young to be vaccinated.

While measles is probably best known for the full-body rash it causes, the first symptoms of the infection resemble the flu; hacking cough, high fever, runny nose, and watery eyes. However, while these symptoms are unpleasant, complications can be dangerous. Measles cause ear infections in nearly 1 of every 10 children who get it, as many as 1 out of 20 children with measles get pneumonia, and about 1 in every 1,000 children who get measles will develop encephalitis, an inflammation of the brain that can lead to convulsions and can render a child deaf or mentally retarded. Measles is also the leading cause of blindness among African children.