Unveiling the perilous nature of measles, a highly contagious airborne disease with the potential to cause severe complications and even death. Despite the existence of a safe and cost-effective vaccine, the battle against measles continues. Astonishingly, the measles vaccination campaign has averted a staggering 56 million deaths between 2000 and 2021. However, setbacks caused by the COVID-19 pandemic have left vulnerable populations at risk, necessitating a renewed focus on immunization efforts.
Perplexing Global Figures: In 2021 alone, an estimated 128,000 measles-related deaths occurred globally, predominantly affecting unvaccinated or under-vaccinated children under the age of 5. Furthermore, a worrisome decline was observed in measles vaccination rates, with only 81% of children worldwide receiving a single dose of the measles vaccine by their first birthday – the lowest coverage since 2008.
Historical Context: Before the introduction of the measles vaccine in 1963, the world witnessed devastating measles epidemics every few years, claiming approximately 2.6 million lives annually. The availability of a safe and cost-effective vaccine transformed the landscape and reduced measles deaths from a staggering 761,000 in 2000 to 128,000 in 2021.
Unveiling the Measles Virus: Caused by a virus from the paramyxovirus family, measles spreads through direct contact and the air. After infecting the respiratory tract, the virus disseminates throughout the body, triggering severe disease, complications, and potential fatality. The highly contagious nature of the virus means that one infected individual can transmit it to nine out of ten unvaccinated close contacts.
COVID-19’s Impact: The COVID-19 pandemic dealt a significant blow to measles surveillance and immunization efforts. Suspension of immunization services and declining vaccination rates worldwide left millions of children susceptible to preventable diseases, including measles. The circulation of measles in areas with low immunization coverage amplifies the risk of outbreaks, necessitating urgent action.
Signs, Symptoms, and Complications: Manifesting initially as high fever, measles progresses to include symptoms such as runny nose, cough, red and watery eyes, and characteristic white spots inside the cheeks. A distinct rash emerges after several days, gradually spreading across the body. Measles-related deaths are often the result of severe complications such as blindness, encephalitis, severe diarrhea, ear infections, and respiratory infections like pneumonia. Malnourished children and those with weakened immune systems face a higher risk of developing severe measles complications.
Vulnerable Populations and Global Reach: Measles does not discriminate and affects any non-immune individual, especially unvaccinated young children and pregnant individuals. It remains prevalent, particularly in parts of Africa and Asia, with the majority of measles deaths concentrated in countries with low per capita incomes or weak health infrastructures. Fragile health systems due to natural disasters or conflicts further exacerbate the risk of measles outbreaks.
Transmission and Contagion: Renowned for its extraordinary contagiousness, measles spreads through close contact with infected nasal or throat secretions, primarily via coughing or sneezing. The virus remains active and infectious in the air or on contaminated surfaces for up to two hours, heightening the risk of transmission. Importantly, measles outbreaks are not confined to specific regions and can occur when cases are imported from countries with ongoing transmission, posing a continuous threat to global health.
Treatment and Prevention Efforts: Currently, no specific antiviral treatment exists for measles. However, the severity of complications can be mitigated through supportive care, including proper nutrition, adequate fluid intake, and the administration of WHO-recommended oral rehydration solution to combat dehydration. Antibiotics may be prescribed to treat secondary infections such as eye and ear infections or pneumonia. Additionally, all children diagnosed with measles should receive two doses of vitamin A supplements to prevent eye damage and reduce the risk of measles-related deaths.
The key to combating measles lies in prevention through routine measles vaccination. The measles vaccine, which has been in use for over six decades, is not only safe and effective but also highly affordable, costing just about one US dollar per child. Mass immunization campaigns, combined with routine vaccination, have proven to be crucial in reducing global measles deaths. It is recommended that children receive two doses of the vaccine to ensure full immunity and prevent outbreaks, as not all children develop sufficient immunity after the first dose.
The Impact of WHO and Global Partners: In recognition of the urgency to combat measles and other vaccine-preventable diseases, WHO and global stakeholders endorsed the Immunization Agenda 2021-2030. This agenda sets regional elimination targets and positions measles as an indicator of a health system’s ability to deliver essential childhood vaccines. WHO has also published the Measles and Rubella Strategic Framework, outlining seven strategic priorities to achieve and sustain regional elimination goals.
Thanks to the efforts of the Measles & Rubella Partnership (formerly the Measles & Rubella Initiative) and organizations such as Gavi, the Vaccines Alliance, and UNICEF, remarkable progress has been made. From 2000 to 2021, measles vaccination prevented an estimated 56 million deaths, primarily in the WHO African Region and Gavi-supported countries. However, these gains remain fragile, as several countries that were on the verge of eliminating measles experienced resurgences.
The Urgency of Action: To safeguard the progress achieved thus far, it is imperative to address the challenges posed by the COVID-19 pandemic. Strengthening immunization programs within primary healthcare systems and accelerating efforts to reach all children with two doses of the measles vaccine are essential. Furthermore, robust surveillance systems must be implemented to identify immunity gaps and facilitate targeted interventions. The World Health Organization continues to enhance the Global Measles and Rubella Laboratory Network to ensure timely diagnosis and support countries in their vaccination strategies.
The IA2030 Measles & Rubella Partnership, comprising esteemed organizations like the American Red Cross, the United Nations Foundation, the CDC, the Bill and Melinda Gates Foundation, and WHO, plays a pivotal role in achieving the Immunization Agenda 2030 targets. Through planning, funding, and measurement, this partnership aims to eliminate measles and prevent congenital rubella syndrome, leaving no child vulnerable to these preventable diseases.
“Without sustained attention, hard-fought gains can easily be lost. Where children are unvaccinated, outbreaks occur.” – WHO