Immunization

Reducing measles mortality

© UNICEF Liberia/2011/Scott

Wonsen, 5, receives a measles vaccination during a UNICEF-supported immunization campaign in Liberia.

GOALS:
Achieve 95% measles mortality reduction by 2015, as compared to 2000.
Exceed 90% measles vaccination coverage nationally and 80% in every district.
Reduce the incidence of measles to less than 5 cases per million.

Global Programming Context

To achieve these goals, UNICEF and its partners are improving routine measles immunization and conducting vaccination campaigns in the high-risk regions of Africa and Asia every two to four years.

Measles vaccination is an indicator of progress towards achieving Millennium Development Goal 4 (MDG4) which aims at reducing child mortality by two-thirds by 2015 compared with the level in 1990. Progress towards MDG4 must, therefore, include improvement in measles vaccination coverage.

Measles vaccination is also the most critical health intervention under UNICEF’s Core Commitments for Children as measles has been one of the major causes of child deaths among under-nourished children in humanitarian emergencies.

The Disease

Measles is a viral respiratory infection that attacks the immune system. Exceptionally contagious, children who are not immunized will suffer from the disease when exposed. Unvaccinated children under the age of five are most at risk. 

Most people see measles as a disease that causes temporary illness, requiring time off from school or work. But it is deadly: as many as five out of every hundred measles cases among children can cause death. Survivors of measles are often left with life-long disabilities, such as blindness, deafness or brain damage. 

“These children are usually found in the most vulnerable, poorest areas in the world. Immunization can protect millions of children against this deadly disease,” said Edward Hoekstra, Senior Health Specialist for the measles programme at UNICEF.

The Challenge

An estimated 164,000 people – 450 a day – died from this easily preventable disease in 2008. Though that number is a far cry from the 2.6 million global measles deaths in 1980, it is still much too high. More than 95% of measles deaths occur in countries with low per capita incomes and weak health infrastructures.

Measles deaths are clustered primarily in India, which accounts for three-quarters of global measles deaths. The introduction of a second dose of measles-containing vaccine (MCV2) in India in 2010 through campaigns or routine services is an important step in reducing global measles mortality. The first phase of measles campaigns in India have demonstrated substantial challenges in planning and implementing campaigns, such as obtaining strong state-level leadership, having trained staff at all levels, and increasing public demand and confidence in vaccines.

Though important gains have been made during the last decades, the poorest, most marginalized children, especially in hard-to-reach areas, have been left behind. Reaching the 2015 goal requires increasing measles immunization coverage in countries with weak health infrastructures, sustaining quality campaigns to ensure reaching the unreached, and ensuring the full implementation of the measles control strategy in India.

The Solution

Measles deaths are easily prevented through immunization. It costs less than US $1 to vaccinate a child. 

The UNICEF/WHO joint strategy for measles mortality reduction is a two dose measles vaccination and involves:

• 1st dose for infants given around 9 months - indicator for MDG4
• 2nd dose in routine immunization or campaigns (whichever strategy reaches most children)
• Effective surveillance
• Enhanced case management of measles cases (vitamin A, antibiotics etc.)

Delivering these strategies requires:

• Routine immunization programme
• Campaigns in countries with weak health systems, especially for the 2nd dose. Good quality campaigns are more equitable and reach the poorest children, who are most at risk for measles complications and deaths.
• Use of measles vaccination as a platform for delivery of other life saving interventions, such as bed-nets, vitamin A, de-worming tablets, Oral Polio Vaccine, etc.

The Measles Initiative

The Measles Initiative has supported the vaccination of over a billion children against measles since 2001. This initiative, which combines the efforts of UNICEF with American Red Cross, the World Health Organization, the US Centers for Disease Control and Prevention (CDC), the UN Foundation, and UNICEF has proven so successful that the work has expanded from Africa to Asia. The donor investment in measles mortality reduction has resulted in the prevention of an estimated 4.3 million deaths at $184 per death averted.

By working with national ministries of health and other local government agencies, the Initiative partners are increasing routine vaccination services, conducting nationwide immunization days and mobilizing entire communities in order to get each child vaccinated. Good quality campaigns are particularly important for reaching the previously unvaccinated children. In addition to immunizing against measles, the Initiative is providing other health interventions, including Vitamin A, de-worming tablets, vaccination against polio (OPV) and insecticide-treated bed nets for malaria prevention.

For its part, UNICEF uses its logistical and procurement capacity to support the purchase and delivery of syringes, vaccine and other items to vaccination sites. UNICEF further provides cold-chain logistics and maintenance and social mobilization.

Progress

In 2000, 733,000 children died annually from measles. Over 95% of these deaths occurred in 47 countries. All these countries provided only one dose of measles vaccination. UNICEF as a key partner, implemented a 2nd dose through campaigns in 46 of the 47 countries, resulting in a 78% reduction of measles deaths between 2000 and 2008 (from 733,000 to 164,000).

The Millennium Development Goals Report 2011

“This programme has achieved incredible results. In short it’s resulted in about 1,500 less children dying every day from measles worldwide,” said Hoekstra. The expansion of measles vaccination in routine and supplementary campaigns has done its job of protecting vulnerable children. From 1990 to 2008, the programme’s contribution to MDG4 has been 23 percent.

Measles vaccination intervention has been the most successful public health program in the last decade, with Africa leading the way in the achievement of the 92% mortality reduction between 2000 and 2008. In 2010, India endorsed the full measles strategy and introduced a second dose of measles in the country.

Vaccination coverage for measles topped 85% in 2010, up from 72% in 2000. Measles supplemental immunization activities conducted in 2010 reached more than 102 million children.

To sustain the gains and to ensure that no child goes unprotected, measles vaccination campaigns must be offered every two to four years until the routine immunization system is capable of reaching all children with two doses of measles vaccine.