Globally, Deaths From Measles Drop Sharply
SOURCE: World Health Organization, American Red Cross| The Washington Post - November 30, 2007
Friday, November 30, 2007
Worldwide deaths from measles have fallen by two-thirds since 2000, the result of stepped-up immunization efforts and the distribution of vitamin A capsules in developing countries, a partnership of five health organizations said yesterday.
Africa, which has long had the most measles deaths, has seen the biggest drop, 91 percent. In many villages, measles shots, polio vaccines, deworming pills and insecticide-treated mosquito nets for malaria prevention are all being given out together.
The dramatic results are the product of a little-known project, the Measles Initiative, launched in 2001. The news comes as the better-known Global Polio Eradication Initiative is struggling to complete its job, nearly eight years over a self-imposed deadline.
Measles is a potentially eradicable disease, as well, but experts said yesterday that is not their goal now. The initiative hopes to cut annual worldwide measles deaths by 90 percent by 2010.
"At the moment, there is really not the political commitment to embark on another global eradication effort," said Peter Strebel, an epidemiologist at the World Health Organization, one of the measles partners. "It is an unwise strategy to, as it were, fight on two fronts at the same time." Only one disease, smallpox, has ever been eradicated.
Measles is among the most contagious diseases in the world, spread through the air in droplets coughed out by infected people. Symptoms include fever, cough, rash, pneumonia and diarrhea.
In developing countries, mortality rates are 5 to 15 percent of its victims, sometimes higher during epidemics. Most children recover fully, but a few are left blind or deaf. Children deficient in vitamin A, which is essential for robust immunity, are at especially high risk.
In 2000, global measles mortality was 757,000. In 2006, it was down to 242,000 -- a drop of 68 percent. In 1990, there were about 1.06 million measles deaths, more than four times the current annual total.
"This is a major achievement in global health," said Kathy Bushkin Calvin, an official of the United Nations Foundation, one of the partners.
Luis Gomes Sambo, Africa region director of the World Health Organization, one of the other partners, said "individual communities, and especially women, played a very, very important role" in reducing the deaths so much.
The other partners are the American Red Cross, UNICEF, and the Centers for Disease Control and Prevention. The initiative has cost $470 million to date, with $130 million provided by the Red Cross.
The measles vaccine is one of the standard immunizations recommended for all children. The initiative is working to ensure all babies get one shot by their first birthday and have an opportunity to get a second one later. The theory is a second round will reach children who missed the first one and further boost the immunity of those who got it.
Africa has been the focus of efforts so far. The portion of African children receiving the first dose of measles vaccine on time has risen from 56 percent to 73 percent in the last five years. It is now higher than in South Asia's 65 percent. Worldwide, coverage has gone from 72 to 80 percent, an unprecedented high.
Coverage among American kindergartners last year was 96 percent.
In addition to better routine coverage, nearly half a billion supplementary shots have been given since 2000 as part of the measles initiative.
Although injectable vaccines are harder to deliver than oral ones (such as polio), they are preferred in many developing countries.
"What we have actually found is that mothers want injections, the community wants an injection, because the feeling is that it has greater potency and efficacy," Strebel said.
Research in Indonesia in the 1980s showed that vitamin A supplementation cut childhood deaths from all causes, but especially from measles. It also functions as a drug in children already severely ill with measles, reducing their mortality by about half.
In terms of cost-effectiveness, few health measures can rival measles vaccination. In a group of southern African countries where "catch-up" vaccination was done in 2001, the average cost of a life saved was $319.
The initiative is the first mass health project in the developing world to use hand-held computers in coverage surveys conducted to measure the success of interventions. Normally, that work is done with pen, paper and clipboard, and tabulating data takes weeks or months.
In October 2005, surveyors in tsunami-struck Aceh province of Indonesia figured out immediately after a vaccination campaign that as many as 70 percent of children had been missed in some districts. Vaccinators, who had not yet dispersed, were sent back to vaccinate in those areas.
More recently, surveyors in Africa have been using pocket computers loaded with an open-source program, EpiSurveyor, developed by a Washington-based nonprofit, DataDyne, to track coverage after supplemental measles vaccination campaigns.