Milestones :: Perspectives :: Research
Measles
Over 20 million children worldwide missed out on measles vaccine annually in past 8 years, creating a pathway to current global outbreaks – UNICEF
NEW YORK, 25 April 2019 – An estimated 169 million children missed out on the first dose of the measles vaccine between 2010 and 2017, or 21.1 million children a year on average, UNICEF said today.
Widening pockets of unvaccinated children have created a pathway to the measles outbreaks hitting several countries around the world today.
“The ground for the global measles outbreaks we are witnessing today was laid years ago,” said Henrietta Fore, UNICEF Executive Director. “The measles virus will always find unvaccinated children. If we are serious about averting the spread of this dangerous but preventable disease, we need to vaccinate every child, in rich and poor countries alike.”
In the first three months of 2019, more than 110,000 measles cases were reported worldwide – up nearly 300 per cent from the same period last year. An estimated 110,000 people, most of them children, died from measles in 2017, a 22 per cent increase from the year before.
Two doses of the measles vaccine are essential to protect children from the disease. However, due to lack of access, poor health systems, complacency, and in some cases fear or skepticism about vaccines, the global coverage of the first dose of the measles vaccine was reported at 85 per cent in 2017, a figure that has remained relatively constant over the last decade despite population growth. Global coverage for the second dose is much lower, at 67 per cent. The World Health Organization recommends a threshold of 95 per cent immunization coverage to achieve so-called ‘herd immunity’.
Top ten high-income countries where children not vaccinated with the first measles vaccine dose 2010 – 2017:
1. United States: 2,593,000
2. France: 608,000
3. United Kingdom: 527,000
4. Argentina: 438,000
5. Italy: 435,000
6. Japan: 374,000
7. Canada: 287,000
8. Germany: 168,000
9. Australia: 138,000
10. Chile: 136,000
In high income countries, while coverage with the first dose is 94 per cent, coverage for the second dose drops to 91 per cent, according to the latest data.
The United States tops the list of high-income countries with the most children not receiving the first dose of the vaccine between 2010 and 2017, at more than 2.5 million. It is followed by France and the United Kingdom, with over 600,000 and 500,000 unvaccinated infants, respectively, during the same period.
In low- and middle-income countries, the situation is critical. In 2017, for example, Nigeria had the highest number of children under one year of age who missed out on the first dose, at nearly 4 million. It was followed by India (2.9 million), Pakistan and Indonesia (1.2 million each), and Ethiopia (1.1 million).
Worldwide coverage levels of the second dose of the measles vaccines are even more alarming. Of the top 20 countries with the largest number of unvaccinated children in 2017, 9 have not introduced the second dose. Twenty-countries in sub-Saharan Africa have not introduced the necessary second dose in the national vaccination schedule, putting over 17 million infants a year at higher risk of measles during their childhood.
UNICEF, with partners such as the Measles and Rubella Initiative and Gavi, the Vaccine Alliance, is helping address this measles crisis by:
:: Negotiating vaccine prices: the cost of the measles vaccine is now at an all-time low;
:: Helping countries identify underserved areas and unreached children;
:: Procuring vaccines and other immunization supplies;
:: Supporting supplementary vaccination campaigns to address gaps in routine immunization coverage;
:: Working with relevant countries to introduce the second dose of the measles vaccine in the national immunization schedule. Cameroon, Liberia and Nigeria are on track to do so in 2019.
:: Introducing innovations like the use of solar power and mobile technologies to maintain vaccines at the right temperature.
“Measles is far too contagious,” said Fore. “It is critical not only to increase coverage but also to sustain vaccination rates at the right doses to create an umbrella of immunity for everyone.”
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Statement from Peter Marks, M.D., Ph.D., director of FDA’s Center for Biologics Evaluation and Research, on FDA’s continued confidence in the safety and effectiveness of the measles, mumps, and rubella (MMR) vaccine
April 22, 2019
The FDA is a public health agency that always strives to use the best available scientific evidence to promote and protect the well being of individuals. It deeply concerns us when we see preventable diseases such as measles or mumps reemerging in the United States and threatening our communities. The World Health Organization recently named vaccine hesitancy one of the top 10 threats to global health. In this time of multiple measles outbreaks, and as we approach National Infant Immunization Week, we want to underscore our continued confidence in the safety and effectiveness of the vaccines that are highly successful at preventing – in some cases, nearly eradicating – preventable diseases.
The MMR vaccine has been approved in the United States for nearly 50 years to prevent measles, mumps and rubella (also known as German Measles). As a result of its use, measles and rubella were completely eradicated in the United States, and mumps cases decreased by 99%. Large well-designed studies have confirmed the safety and effectiveness of the MMR vaccine and have demonstrated that administration of the vaccine is not associated with the development of autism. However we’re seeing an increasing number of outbreaks of measles in communities across the country, including those in New York, New Jersey, Washington, California, and Michigan.
Considered eradicated within the U.S. since 2000, measles has persisted in other areas of the world where the vaccine is not as readily available, including countries in Europe, Asia, the Pacific Islands, and Africa. Unvaccinated U.S. residents may be exposed to measles while they are abroad and bring the disease back into the U.S. and spread it to others. Worldwide, about 20 million people get measles each year. According to the Centers for Disease Control and Prevention (CDC), there have also been outbreaks of mumps reported. It’s an urgent public health priority to monitor these diseases and raise awareness of the importance of timely immunizations, especially as outbreaks are taking hold among unvaccinated populations in this country…
…We cannot state strongly enough – the overwhelming scientific evidence shows that vaccines are among the most effective and safest interventions to both prevent individual illness and protect public health.
Vaccinating against measles, mumps and rubella not only protects us and our children, it protects people who can’t be vaccinated, including children with compromised immune systems due to illness and its treatment, such as cancer.
We do not take lightly our responsibility to ensure the safety and effectiveness of vaccines, and work diligently to assess safety and effectiveness of all licensed vaccines for their intended uses. The MMR vaccine is very effective at protecting people against measles, mumps, and rubella. It also prevents complications caused by these diseases. And we have nearly 50 years of experience and evidence supporting that fact. In fact, according to the CDC, two doses of the MMR vaccine beginning at 12 months of age (the recommended dosing schedule) are 97% effective against measles, 88% effective against mumps, and 97% effective for rubella.
Like many medical products, the MMR vaccine has known potential side effects that are generally mild and short-lived, such as rash and fever. If parents have concerns about these side effects, we recommend that they speak with their health care providers about the benefits and risks of vaccines, along with the potential consequences of not vaccinating against diseases.
The FDA will continue to closely monitor these outbreaks of vaccine-preventable diseases alongside our federal partners at CDC and the Department of Health and Human Services, and will provide any new information about vaccine safety or effectiveness to the public. But just to be clear, the FDA has determined that the MMR vaccine is both safe and effective in preventing these diseases. We join our colleagues at HHS, CDC, National Institutes of Health and state and local health departments across the country in the continued effort to encourage vaccinations against these preventable diseases…
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Featured Journal Content
The Lancet
Apr 27, 2019 Volume 393Number 10182p1669-1772, e39
https://www.thelancet.com/journals/lancet/issue/current
Editorial
Measles eradication: a goal within reach, slipping away
The Lancet
Prior to the introduction of the measles, mumps and rubella vaccine (MMR) in 1963, an estimated 3 to 4 million people in the USA contracted measles annually. As of April 22, 626 children in the USA have become infected with the virus so far in 2019. This fact has led to urgent Congressional hearings, understandably alarmed national news coverage, and the introduction of legislation to address the outbreak. Measles was declared eliminated in the USA in 2000, but the resurgence of the disease and its continued prominence globally are causes for great concern.
In the past 5 years, 75% of measles cases in the USA have occurred within more closed, religious communities such as the Amish in the Midwest and Somali migrants in Minnesota. According to the US Centers for Disease Control and Prevention, 91% of US children between the ages of 19 and 35 months receive MMR vaccinations. But within New York’s ultra-Orthodox Jewish community, for example, the rate is as low as 60%. These communities tend to be extremely close knit, have large families and young populations, and are fairly isolated from their surrounding communities. 90% of unvaccinated people exposed to measles will become infected, and, in communities such as these, even a small rate of vaccination hesitancy could potentially pose an enormous risk for a larger epidemic.
The current measles outbreak has become a major political issue in America. In New York City, Mayor Bill de Blasio controversially ordered mandatory vaccinations for specific areas of Williamsburg, Brooklyn—areas with heavily Orthodox Jewish populations—with a threat of a US$1000 fine. So far, six states have introduced legislation that would limit or eliminate the ability to claim religious or personal exemptions from vaccination for children. In the USA, anti-vaccine views don’t align neatly with political poles. But the fact that views seem to be hardening is an ominous echo of the political divisions that have prevented the near-unanimous scientific consensus on global climate change from being more broadly accepted in the USA. The science on vaccines is just as reliable, and the prospect of vaccination becoming another front in a political cold war could presage incalculable harm.
Global measles deaths have declined by over 80% since 2000—from 550 100 deaths to 89 780 deaths in 2016. But, according to WHO, there have been over 112 000 confirmed measles cases globally to date in 2019—nearly half of these in Africa, an increase of 700% over the same period in 2018. Europe has also seen a 300% increase in measles infection, with the German state of Brandenburg ordering mandatory vaccination at kindergartens. In 2018, 85% of children had received one dose of the two-dose MMR vaccine, while only 67% had received both. WHO reports that vaccine-hesitant parents often find misinformation online, and engagement, listening, and information provided by medical professionals are often the best ways to address concerns. While conflict and infrastructure are also major drivers of the current outbreak in Venezuela, Madagascar, and other nations, WHO called vaccine hesitancy one of its top ten threats to global health in 2019.
Removing vaccine exemptions for non-medical reasons has proven effective in the past. In 2015, California outlawed non-medical vaccination exemptions for school admissions and the vaccination rate rose to greater than 95%. And while we must carefully balance the needs of public health with religious rights, vaccine hesitancy isn’t just a personal issue. With a condition as contagious as measles, the choice not to vaccinate leaves the immunocompromised and children too young to be vaccinated at risk of infection.
Measles continues to spread within the USA and internationally in isolated, under-resourced and conflict-riven areas. The USA spends around $2 billion on vaccination programmes annually, but further government investment and community engagement are required, in America and globally: from efforts to communicate the effectiveness of vaccination and the dangers of diseases parents may have no first-hand knowledge of, to making vaccination as easy as possible by providing the option of community and home vaccination for large families, families with limited means, or vulnerable populations. Fifty-six years ago, millions faced measles every year. Today, only a bare handful do, and that success should spur us to make the effort to engage, inform, and ensure that measles is controlled globally once and for all.
vaccines and global health :: ethics and policy 