By David Brown
Washington Post Staff Writer
Friday, January 19, 2007

A partnership of international health organizations said yesterday that it will seek to reduce the global death toll from measles to less than 10 percent of its 2000 level by 2010, spurred in part by bigger-than-expected gains against the disease in the past five years.

The effort seeks to extend the coalition's dramatic success in cutting annual deaths from measles by more than 60 percent since 1999, easily bettering its goal of cutting mortality in half.

The effort will rely on mass vaccination campaigns in the 47 countries where measles is most prevalent, as well as on improvements in the routine immunization programs, to fight a disease that until recently was responsible for about 10 percent of all childhood deaths worldwide.

In many places, measles shots will be delivered along with pills that kill intestinal parasites, insecticide-impregnated mosquito nets that prevent malaria, and immunity-boosting Vitamin A supplements, all as part of a broad, multi-organization effort to cut childhood deaths.

"I think this really serves as a model to solve other global health problems," Julie L. Gerberding, director of the Centers for Disease Control and Prevention, said in a telephone briefing to announce the new goal.

The Measles Initiative -- a partnership including the American Red Cross, CDC, the World Health Organization, the United Nations Children's Fund (UNICEF) and the United Nations Foundation -- has proved unusually successful since its launch in 2001.

The initial goal was to cut annual deaths from measles in half by 2005, using 1999 as a baseline. The final calculation, announced yesterday, showed that mortality had fallen by 60.5 percent, from 873,000 deaths in 1999 to 345,000 in 2005. Of that latest toll, 311,000 were children.

In Africa, where more than half the deaths in 1999 occurred, measles mortality has fallen 75 percent.

The initiative has spent about $390 million to date and will need about $500 million more to reach the goal, according to the partners. The Red Cross has been the largest contributor, raising $118 million, and Vodafone the largest corporate contributor, giving $2 million.

In most parts of the developing world, measles shots are given to infants under age 1. However, about 15 percent remain susceptible because of an inadequate immune response, so a second shot is usually given when they start school. (In the United States, a combined measles, mumps and rubella vaccine is given three times. The Measles Initiative is using measles vaccine alone.) Vaccination costs about 90 cents, with about 35 cents going for the vaccine, a disposable needle and the collecting of needles, said Edward Hoekstra, a physician who helps run UNICEF's measles efforts.

Much of the Measles Initiative's investment in recent years has been in improving the "cold chain" that allows the heat-sensitive vaccine to be delivered still potent to remote places. This requires generators to power freezers and the purchase of large numbers of portable ice chests, said Peter Salama, UNICEF's chief of health.

The CDC has also made a substantial investment in improving surveillance for the disease -- a key activity that allows health officials to know where unvaccinated people are.

Mass vaccination campaigns, done every two to four years, will remain important, although ultimately, routine measles vaccination everywhere is the goal, Salama said.

If the new target is reached, measles could be a realistic target for eradication.

Smallpox was eradicated in 1978. Guinea worm disease, a parasitic infection, is on the verge of eradication. A campaign to wipe out polio, launched in 1988, is struggling to reach its goal seven years after its original deadline. However, at yesterday's briefing, Margaret Chan, who took office as WHO's director general this month, was noncommittal about taking on such a difficult goal with measles.

"I think at this stage it is too early to talk about eradication," she said.

Although virtually absent from United States in the last generation, measles was once a feared disease of childhood. Before vaccination became routine in 1963, this country had 3 million to 4 million cases, and several thousand deaths, each year.

The fatality rate in healthy children is 1 to 3 percent, but it can be as high as 30 percent among those who are malnourished, especially those who get too little Vitamin A. Measles further suppresses their immunity, and many die of diarrhea or pneumonia.

Measles, which is spread by respiratory droplets, is one of the most contagious diseases known, often passing through a susceptible population in a wave of fever and rash. Only when 95 percent of a population becomes immune does the chain of transmission break and the virus disappears.

Measles almost certainly arose when people began to have close, nearly constant contact with domesticated animals. It is closely related to rinderpest, a viral infection of cattle, and to canine distemper virus, which infects dogs.