Immunization Strategy Reduces Worldwide Measles Mortality By More Than Half

The goal to halve worldwide measles mortality during the past six years has been met with a 60% decrease, according to an Article published in the Lancet.

Despite the availability of a safe, effective, and relatively inexpensive measles vaccine for over forty years, at the beginning of the millennium, measles remained a leading cause of childhood mortality, especially for children in developing countries. To address this problem, WHO and UNICEF began to target 45 countries with the highest burden of measles deaths with a comprehensive strategy for measles mortality reduction. The strategy has four components: achieving and maintaining high coverage for routine measles immunisation in every district, ensuring that all children receive a second opportunity for immunisation, effective surveillance for measles cases, and appropriate clinical management of patients with measles. In 2002, the UN General Assembly Special Session on Children adopted a goal to halve measles mortality (based on 1999 estimates) by 2005.

Lara Wolfson (Initiative for Vaccine Research, WHO, Geneva) and colleagues describe the progress made to eliminate measles in developing countries during the past six years and the achievement of the UN's ambitious goal. According to estimates based on the natural history model and corroborated by surveillance data, global measles mortality decreased by 60%, from 873 000 deaths in 1999, to 345 000 deaths in 2005. The largest percentage reduction in estimated measles mortality was in the western Pacific region (81%), followed by Africa (75%). During this period nearly 7.5 million deaths from measles were prevented through immunisation*. The success of these efforts has led to a further goal: to reduce mortality due to measles by 90% between 2000 and 2010.

The authors conclude: "If political will and financial commitments to achieving this goal are maintained, and innovative strategies for linking delivery of measles vaccine with other child survival interventions are used (eg, insecticide treated bednets), there is good reason to believe that this new target can be met, accelerating progress towards achieving one of the targets of the Millennium Development Goal 4, to reduce child mortality by two-thirds."

In an accompanying Comment, David Elliman and Helen Bedford from Great Ormond Street Hospital, London, UK, state: "For the greatest effect on children's health, immunisation should be delivered as part of a strategy of Integrated Management of Childhood Illness**...this more holistic approach helps to address the five conditions that make up 70% of the deaths in children younger than 5 years-ie, respiratory infections, diarrhoea, measles, malaria, and malnutrition."

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