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Measles-control effort falls short due to problems in India, Africa

April 24, 2012|By Thomas H. Maugh II / For the Booster Shots blog

World Health Organization officials had hoped to achieve a 90% reduction in measles deaths between 2000 and 2010, but fell short of their goal, achieving just a 74% reduction, researchers said Tuesday. The number of deaths worldwide fell from 535,300 in 2000 to 139,300 in 2010, according to a report in The Lancet. That represented a significant accomplishment, but was not as great a gain as officials had hoped for. The major impediments to the planned reduction were India, which accounted for 47% of measles deaths in 2010, and WHO's African region, which accounted for 36%.

There were 222 measles cases in the United States last year, most of them imported, but no deaths.

The primary reason for the high death rate in India is believed to be the low vaccine coverage there, only 74% -- the lowest rate worldwide. Even Africa, with it relatively poor health infrastructure, has a higher vaccination rate at 76%. Around the world, the average is 85%, while the average in the Americas is 93%, and 95% in Western Europe and 97% in the Western Pacific. More than 1 billion supplementary doses of the measles vaccine were delivered in the last decade in addition to normal vaccinations.

Health agencies began gearing up for the measles campaign in the mid-1990s, and by 2005 had achieved their initial goal of a 50% reduction in deaths by 2005, leading to the more ambitious goal of a 90% drop by 2010. But the global economic crisis beginning in 2008 reduced political commitment and the funds available for the program and immunization rates fell. In 2010, according to the WHO, an estimated 19 million infants did not receive measles vaccine, primarily in sub-Saharan Africa and India.

Despite the economic downturn, WHO officials are confident they can reverse course and reduce measles deaths by 95%, compared with 2000, by 2015 and eliminate measles transmissions from five WHO regions by 2020. Officials estimate the program will require $112 million from donors over the next five years to achieve the goal -- a relative pittance compared with the billions being sought for HIV control and treatment.

Meanwhile, officials are also changing emphasis somewhat, changing the name of the program from the Measles Initiative to the Measles & Rubella Initiative. Fighting the two simultaneously seems like a logical progression because vaccines against the two are typically combined in many countries, including the measles-mumps-rubella (MMR) vaccine used in the United States. Rubella, commonly known as German measles, is generally a mild illness, but can cause severe birth defects when transmitted to a pregnant woman. The defects of congenital rubella syndrome include lifelong heart problems, deafness or blindness. An estimated 112,000 cases of the syndrome occur each year, all preventable by vaccination.

Twitter: @LATMaugh

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