Measles can cause epidemics that cause many deaths, especially among malnourished young children. In countries where measles has been virtually eliminated, imported cases remain a major source of infection.
Unvaccinated young children are most at risk for the disease and its complications, including death. Unvaccinated pregnant women are also an important risk group. However, anyone who is not immunized (who has not been vaccinated or has not had the disease) can become infected.
In 1980, before the vaccine became widespread, measles caused about 2.6 million deaths a year. However, in the world, it remains one of the leading causes of death in young children, despite the existence of a safe and effective vaccine.
The intensification of vaccination activities has had a decisive influence on the reduction of deaths from measles. Between 2000 and 2013, the measles vaccine prevented approximately 15.6 million deaths. Worldwide, measles deaths have fallen by 75%, from 544,000 in 2000 to 145,700 in 2013 and 89,780 in 2016, most of them in children under 5 years of age.
In 2016, approximately 85% of the world’s child population received, through the usual health services, a dose of measles vaccine before reaching 1 year of age. In 2000, that percentage was just 73%. To guarantee immunity and prevent possible outbreaks, two doses of the vaccine are recommended, since approximately 15% of children do not acquire immunity with the first dose.
Measles is still common in many developing countries, especially in parts of Africa and Asia, but also in countries on the European continent (Table 1). Most deaths occur in countries with low per capita income and poor health infrastructure.
Number of Measles Cases Reported in 2017 by World Health Organization (WHO) Region Source: WHO
South East Asia
WHO response and positioning
The fourth Millennium Development Goal was to reduce the under-5 mortality rate by two-thirds between 1990 and 2015. In 2015, the global effort to improve vaccination coverage resulted in a 79% reduction in deaths. Between 2000 and 2015, with the support of the Measles and Rubella Initiative (ISR) and the Gavi Alliance for Vaccines, vaccination against measles prevented an estimated 20.3 million deaths. In 2015, approximately 183 million children were vaccinated against measles in mass vaccination campaigns carried out in 41 countries. Currently, all WHO regions have set targets to end this preventable deadly disease by 2020.
The Initiative to Fight Measles, so that countries can achieve the goals of control of measles and rubella, is the result of the collaboration of the WHO, the United Nations Children’s Fund (UNICEF), the American Red Cross, the Centers for Disease Control and Prevention and the United Nations Foundation.
In 2012, the Initiative presented a new Global Strategic Plan against Measles and Rubella for the period 2012-2020, which sets new global targets for 2015 and 2020:
By the end of 2015:
- Reduce global measles mortality by at least 95%, compared to 2000 values.
- Achieve regional elimination goals for measles, rubella, and congenital rubella syndrome.
By the end of 2020:
The risk of measles outbreaks is determined by the accumulation of susceptible people in the population. For this reason, WHO recommends vaccination of all susceptible children and adults.
In countries where health systems are weak and children do not have access to essential services, the regular implementation of accelerated vaccination campaigns and actions can be an effective strategy for the interruption of transmission. It is recommended to all countries the establishment
of guidelines for routine vaccination of all children as early as possible during the second year of life or as soon as the vaccine can provide guarantees of immunization in countries at risk (no earlier than 6 months of age).
Incidence in Europe
According to data published by the European Center for Disease Prevention and Control (ECDC), countries belonging to the European Union have reported 14,451 cases of measles in 2017, most of them in Romania (5,560), Italy (5004 ), Greece (967) and Germany (929). In Europe, outside the European Union, cases continue to occur, as in Ukraine (4,767), Tajikistan (649), Russian Federation (408) and Switzerland (105). During the same period, 30 measles deaths were reported: 19 in Romania, four in Italy, two in Greece, and one in Bulgaria, France, Germany, Portugal, and United States.
Measles continues to spread throughout Europe, as vaccination is suboptimal and only 50% of the 30 countries that make up the European Union achieved vaccination coverage of 95% in 2016 with one dose (Fig. 4).
Vaccination coverage with a MMR vaccine in the EU / EEA Source: ECDC (www.ecdc.eu)
Incidence in United States
Before the introduction of the vaccine, there were about 150,000 cases a year in United States.
The measles vaccine was introduced in 1978, but the incidence of the disease did not decrease until 1988, when coverage close to 80% was achieved. Currently, coverage is approximately 95% (Table 2).
Thus, it has gone from 159,562 cases (rate of 42 cases per million inhabitants) in 1982 to 159 declared cases (rate of 3.45 cases per million inhabitants) in 2017. In Figure 5 you can see the number of cases declared in United States from 1996 to 2017. It is worth highlighting the increase in cases in 2011, with 3,641 cases declared, of which 58.0% were reported in Andalusia, 16.5% in the Community of Madrid and 8.4% in Catalonia; the majority of cases were in cohorts that should be correctly vaccinated.
The European Regional Veri ﬁ cation Commission for Measles and Rubella Elimination, in its June 2017 meeting declared the elimination of endemic measles in United States. It should be borne in mind that in countries where measles has been eliminated, cases imported from other countries remain a major source of infection.
Measles cases reported per year in United States in 1996-2017
Source: Weekly Epidemiological Bulletin, Carlos III Health Institute, Ministry of Health, Social Services and Equality