Assessment of the 2010 global measles mortality reduction goal: Results from a model of surveillance data

Expanded Programme on Immunization, Department of Immunization, Vaccines and Biologicals, WHO, Geneva, Switzerland.
The Lancet (Impact Factor: 45.22). 04/2012; 379(9832):2173-8. DOI: 10.1016/S0140-6736(12)60522-4
Source: PubMed


In 2008 all WHO member states endorsed a target of 90% reduction in measles mortality by 2010 over 2000 levels. We developed a model to estimate progress made towards this goal.
We constructed a state-space model with population and immunisation coverage estimates and reported surveillance data to estimate annual national measles cases, distributed across age classes. We estimated deaths by applying age-specific and country-specific case-fatality ratios to estimated cases in each age-country class.
Estimated global measles mortality decreased 74% from 535,300 deaths (95% CI 347,200-976,400) in 2000 to 139,300 (71,200-447,800) in 2010. Measles mortality was reduced by more than three-quarters in all WHO regions except the WHO southeast Asia region. India accounted for 47% of estimated measles mortality in 2010, and the WHO African region accounted for 36%.
Despite rapid progress in measles control from 2000 to 2007, delayed implementation of accelerated disease control in India and continued outbreaks in Africa stalled momentum towards the 2010 global measles mortality reduction goal. Intensified control measures and renewed political and financial commitment are needed to achieve mortality reduction targets and lay the foundation for future global eradication of measles.
US Centers for Disease Control and Prevention (PMS 5U66/IP000161).

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    • "The results in the present study have implications for the global eradication of MV . Tobacco advertising and promotion is common in Africa and South Asia [ Simons et al . , 2012 ; Song et al . , 2013 ] , where measles epidemics are still common [ Simons et al . , 2012 ] ."
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    ABSTRACT: Vaccine modified measles (VMM) affects individuals with attenuated vaccine induced immunity. An outbreak of measles occurred in a junior high school, starting from an unvaccinated eighth-grade student who developed natural measles and affected a majority of students who were immunized with a low potent strain of measles vaccine (TD97). To determine whether environmental tobacco smoke (ETS) exposure was associated with the development of VMM in this population, a questionnaire was used asking whether students had VMM symptoms during the outbreak and the smoking status of family members. VMM was defined in the study population as occurrence of fever and/or erythema, along with documented history of measles vaccination. A total of 513 students (85.9%) responded. Overall, the presence of in-house smokers did not differ between VMM students (49.3%) and non-VMM students (50.2%). However, in the ninth grade, presence of an in-house smoker was significantly higher in the family of VMM students (54.0%) than in non-VMM students (36.6%) (p = 0.044). Urinary cotinine levels were also measured in selected students (n = 37). Among families with at least one smoker, urinary cotinine levels were significantly higher in VMM students than in non-VMM students (p = 0.032). Furthermore, a multivariable logistic regression analysis showed that a high urinary cotinine level (>10 ng/mg creatinine; 13.5 percentile) was associated with the development of VMM. Our findings suggest that a high level of ETS exposure may be associated with an increased risk of VMM in a population with attenuated vaccine induced immunity against measles. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
    Full-text · Article · May 2015 · Journal of Medical Virology
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    • "Despite these global reductions, measles mortality remains substantial and concentrated in a number of high measles-burdened countries [2] [3] [6]. For example, India accounted for almost 50% (about 65,000 deaths) of estimated measles mortality in 2010, and the WHO Africa region for almost 40% (about 50,000 deaths) [6] [11]. Some of these countries have low levels of routine immunization, such as Nigeria with a 42% coverage rate for the first dose of measles vaccine (MCV1) [12]. "
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    ABSTRACT: Background The Measles & Rubella Initiative, a broad consortium of global health agencies, has provided support to measles-burdened countries, focusing on sustaining high coverage of routine immunization of children and supplementing it with a second dose opportunity for measles vaccine through supplemental immunization activities (SIAs). We estimate optimal scheduling of SIAs in countries with the highest measles burden. Methods We develop an age-stratified dynamic compartmental model of measles transmission. We explore the frequency of SIAs in order to achieve measles control in selected countries and two Indian states with high measles burden. Specifically, we compute the maximum allowable time period between two consecutive SIAs to achieve measles control. Results Our analysis indicates that a single SIA will not control measles transmission in any of the countries with high measles burden. However, regular SIAs at high coverage levels are a viable strategy to prevent measles outbreaks. The periodicity of SIAs differs between countries and even within a single country, and is determined by population demographics and existing routine immunization coverage. Conclusions Our analysis can guide country policymakers deciding on the optimal scheduling of SIA campaigns and the best combination of routine and SIA vaccination to control measles.
    Full-text · Article · Dec 2014 · Vaccine
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    • "Hence, mechanistic models are often used to fill the gap. For instance, transmission models have been used to help estimate the global burden of measles (Simons et al., 2012), using our knowledge of how susceptibility drives epidemic dynamics to infer the true number of cases from what was observed. Likewise, models have been used to help translate observed cases of acute flaccid paralysis to polio incidence through our understanding of transmission and the symptomatic attack rate (Eichner and Dietz, 1996). "
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    ABSTRACT: Infectious disease models are both concise statements of hypotheses and powerful techniques for creating tools from hypotheses and theories. As such, they have tremendous potential for guiding data collection in experimental and observational studies, leading to more efficient testing of hypotheses and more robust study designs. In numerous instances, infectious disease models have played a key role in informing data collection, including the Garki project studying malaria, the response to the 2009 pandemic of H1N1 influenza in the United Kingdom and studies of T-cell immunodynamics in mammals. However, such synergies remain the exception rather than the rule; and a close marriage of dynamic modeling and empirical data collection is far from the norm in infectious disease research. Overcoming the challenges to using models to inform data collection has the potential to accelerate innovation and to improve practice in how we deal with infectious disease threats. Copyright © 2014 The Authors. Published by Elsevier B.V. All rights reserved.
    Full-text · Article · Dec 2014 · Epidemics
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