Global measles elimination

Key Points

• Measles remains a leading vaccine-preventable cause of child mortality in Africa and Asia, and continues to cause outbreaks in industrialized countries.

• Remarkable progress in reducing measles incidence and mortality has been made in resource-poor countries, particularly in sub-Saharan Africa, as a consequence of increasing measles vaccine coverage and provision of a second opportunity for measles vaccination through supplementary immunization activities.

• Measles virus (MV) is highly infectious, requiring a high level of population immunity to interrupt transmission, and might be more difficult to eliminate in regions of high population density and high prevalence of human immunodeficiency virus type 1 (HIV-1) infection.

• The global elimination of measles has been debated since the 1960's, shortly after measles vaccines were first licensed.

• Criteria necessary for disease eradication include: first, humans must be required for virus transmission; second, sensitive and specific diagnostic tools must exist; and finally an effective intervention must be available. Measles is thought by many experts to meet all of these criteria

• Measles vaccines are safe, effective and have interrupted MV transmission in large geographic areas, providing a suitable tool for global measles elimination.

• The ideal measles vaccine would be inexpensive, safe, heat-stable, immunogenic in neonates or very young infants, administered as a single dose without needle or syringe, and would not prime individuals for atypical measles or be associated with prolonged immunosuppression. Several vaccine candidates with some of these characteristics are undergoing development.

• A significant challenge to global measles elimination efforts will be to maintain the resources, political will and public confidence to implement measles vaccination and surveillance programmes.

Abstract

Safe and effective vaccines are available that could be used to eradicate measles, which is a primary cause of childhood vaccine-preventable deaths worldwide. This article reviews the pathogenesis of this deadly disease and the prospects for its elimination.

Abstract

Measles remains a leading vaccine-preventable cause of child mortality worldwide, particularly in sub-Saharan Africa where almost half of the estimated 454,000 measles deaths in 2004 occurred. However, great progress in measles control has been made in resource-poor countries through accelerated measles-control efforts. The global elimination of measles has been debated since measles vaccines were first licensed in the 1960's, and this debate is likely to be renewed if polio virus is eradicated. This review discusses the pathogenesis of measles and the likelihood of the worldwide elimination of this disease.