Measles increasing!!!
The World Health Organization and the CDC just came out with a rather disturbing report on the resurgence of measles cases. For the WHO news release, see http://www.who.int/news-room/detail/29-11-2018-measles-cases-spike-globally-due-to-gaps-in-vaccination-coverage . For the CDC report, see https://www.cdc.gov/mmwr/volumes/67/wr/mm6747a6.htm .
Details:
--The decision body of the WHO, the World Health Assembly, set 3 milestones in 2010 for measles prevention, to be achieved by 2015
--increase routine coverage with the first dose of measles-containing vaccine (MCV1) among children aged 1 year to ≥90% at the national level and to ≥80% in every district
--reduce global annual measles incidence to less than five cases per million population
--reduce global measles mortality by 95% from the 2000 estimate
--In 2012, they endorsed the objective of eliminating measles in four of the six World Health Organization (WHO) regions by 2015 and in five regions by 2020
--During 2000–2017, vaccine coverage:
--MCV1 coverage increased globally from 72% to 85%, based on data from 194 countries, though unevenly around the world:
--worst in Africa (69-70%), though this region has had the largest increase in the percentage of countries with ≥90% MCV1, from 9% to 34%, along with the South-East Asia region, from 27% to 64%
--the six countries with the most unvaccinated infants were Nigeria (3.9 million), India (2.9 million), Pakistan (1.2 million), Indonesia (1.2 million), Ethiopia (1.1 million), and Angola (0.7 million).
--MCV2 (2nd and final dose) coverage increased globally from 15% in 2000 to 67% in 2017, largely from an increase in the number of countries actually providing MCV2 from 98 (51%) in 2000 to 167 (86%) in 2017
-- During 2000–2017, measles Incidence:
--annual measles incidence decreased 83% from 145 to 25 cases per million population, though the incidence increased in 2017 in 5 of the 6 WHO regions, in part because eight more countries reported case data in 2017 (184 of 194) than did in 2016 (176 of 194)
--endemic measles has been re-established in Venezuela (ie, they have had sustained transmission of measles virus for >12 months, with virus exported to neighboring countries)
-- During 2000–2017, measles-related deaths:
--annual estimated measles deaths decreased 80% from 545,174 to 109,638
--measles vaccination prevented an estimated 21.1 million deaths over the time period
Commentary:
--as an example of the data: in the Americas (35 countries): from 2000 to 2017 MCV1 coverage went from 93% to 92%, MCV2 from 89% to 97%, reported measles cases went from 1,754 to 775, measles incidence from 2.1 to 1.7 per 1 million population, and 92,777 deaths were averted by vaccination
--in Sout-East Asia (11 countries): from 2000 to 2017 MCV1 coverage went from 63% to 87%, MCV2 from 3% to 77%, reported measles cases went from 78,558 to 28,474, measles incidence from 51 to 14 per 1 million population, and 6,699,720 deaths were averted by vaccination
--BUT, measles elimination milestones have not been met
--the goal of ≥90% getting MCV1: coverage is at 85% (though these numbers were varied dramatically through the world, as low as 69% in Africa)
--the goal of reducing annual measles incidence to <5cases per million population: achieved in only 65% of the countries
--the goal of decreasing measles mortality by 95% from the 2000 estimate (ie, down to 27,250 deaths): there were 109,638 deaths
--AND, measles cases have increased by more than 30% worldwide since 2016!!!, with three regions experiencing a large measles resurgence: the Americas, the Eastern Mediterranean, and Europe: reasons for this??
--falsehoods about the vaccine in Europe
--implosion of the health system in Venezuela
--continued pockets of poor vaccination rates in Africa and other regions
So, these numbers show a few important things:
--overall, in the past 18 years, immunization rates, measles cases and measles death rates have dropped dramatically (ie, public health initiatives to control measles have had pretty remarkable success)
--the WHO goals, however, were never met (ie, there really needed to be even more aggressive world-wide efforts to stem this really devastating disease)
--the current level of preventable measles-related deaths plummeted from almost 550K to 110K, but that still leaves a huge population of people who died unnecessarily
--income disparities and fragile health systems reinforce the need for extensive world-wide interventions
--false advertising about the dangers of vaccination have a very real toll…
--increase routine coverage with the first dose of measles-containing vaccine (MCV1) among children aged 1 year to ≥90% at the national level and to ≥80% in every district
--reduce global annual measles incidence to less than five cases per million population
--reduce global measles mortality by 95% from the 2000 estimate
--In 2012, they endorsed the objective of eliminating measles in four of the six World Health Organization (WHO) regions by 2015 and in five regions by 2020
--During 2000–2017, vaccine coverage:
--MCV1 coverage increased globally from 72% to 85%, based on data from 194 countries, though unevenly around the world:
--worst in Africa (69-70%), though this region has had the largest increase in the percentage of countries with ≥90% MCV1, from 9% to 34%, along with the South-East Asia region, from 27% to 64%
--the six countries with the most unvaccinated infants were Nigeria (3.9 million), India (2.9 million), Pakistan (1.2 million), Indonesia (1.2 million), Ethiopia (1.1 million), and Angola (0.7 million).
--MCV2 (2nd and final dose) coverage increased globally from 15% in 2000 to 67% in 2017, largely from an increase in the number of countries actually providing MCV2 from 98 (51%) in 2000 to 167 (86%) in 2017
-- During 2000–2017, measles Incidence:
--annual measles incidence decreased 83% from 145 to 25 cases per million population, though the incidence increased in 2017 in 5 of the 6 WHO regions, in part because eight more countries reported case data in 2017 (184 of 194) than did in 2016 (176 of 194)
--endemic measles has been re-established in Venezuela (ie, they have had sustained transmission of measles virus for >12 months, with virus exported to neighboring countries)
-- During 2000–2017, measles-related deaths:
--annual estimated measles deaths decreased 80% from 545,174 to 109,638
--measles vaccination prevented an estimated 21.1 million deaths over the time period
Commentary:
--as an example of the data: in the Americas (35 countries): from 2000 to 2017 MCV1 coverage went from 93% to 92%, MCV2 from 89% to 97%, reported measles cases went from 1,754 to 775, measles incidence from 2.1 to 1.7 per 1 million population, and 92,777 deaths were averted by vaccination
--in Sout-East Asia (11 countries): from 2000 to 2017 MCV1 coverage went from 63% to 87%, MCV2 from 3% to 77%, reported measles cases went from 78,558 to 28,474, measles incidence from 51 to 14 per 1 million population, and 6,699,720 deaths were averted by vaccination
--BUT, measles elimination milestones have not been met
--the goal of ≥90% getting MCV1: coverage is at 85% (though these numbers were varied dramatically through the world, as low as 69% in Africa)
--the goal of reducing annual measles incidence to <5cases per million population: achieved in only 65% of the countries
--the goal of decreasing measles mortality by 95% from the 2000 estimate (ie, down to 27,250 deaths): there were 109,638 deaths
--AND, measles cases have increased by more than 30% worldwide since 2016!!!, with three regions experiencing a large measles resurgence: the Americas, the Eastern Mediterranean, and Europe: reasons for this??
--falsehoods about the vaccine in Europe
--implosion of the health system in Venezuela
--continued pockets of poor vaccination rates in Africa and other regions
So, these numbers show a few important things:
--overall, in the past 18 years, immunization rates, measles cases and measles death rates have dropped dramatically (ie, public health initiatives to control measles have had pretty remarkable success)
--the WHO goals, however, were never met (ie, there really needed to be even more aggressive world-wide efforts to stem this really devastating disease)
--the current level of preventable measles-related deaths plummeted from almost 550K to 110K, but that still leaves a huge population of people who died unnecessarily
--income disparities and fragile health systems reinforce the need for extensive world-wide interventions
--false advertising about the dangers of vaccination have a very real toll…
geoff
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