Measles
Key facts
- Measles is one of the leading causes of death among young children even though a safe and cost-effective vaccine is available.
- In 2010, there were 139 300 measles deaths globally – nearly 380 deaths every day or 15 deaths every hour.
- More than 95% of measles deaths occur in low-income countries with weak health infrastructures.
- Measles vaccination resulted in a 74% drop in measles deaths between 2000 and 2010 worldwide.
- In 2010, about 85% of the world's children received one dose of measles vaccine by their first birthday through routine health services – up from 72% in 2000.
Measles is a highly contagious, serious disease caused by a virus. In 1980, before widespread vaccination, measles caused an estimated 2.6 million deaths each year.
It remains one of the leading causes of death among young children globally, despite the availability of a safe and effective vaccine. An estimated 139 300 people died from measles in 2010 – mostly children under the age of five.
Measles is caused by a virus in the paramyxovirus family. The measles virus normally grows in the cells that line the back of the throat and lungs. Measles is a human disease and is not known to occur in animals.
Accelerated immunization activities have had a major impact on reducing measles deaths. From 2001 to 2011 more than one billion children aged 9 months to 14 years who live in high risk countries were vaccinated against the disease. Global measles deaths have decreased by 74% from 535 300 in 2000 to 139 300 in 2010.
Signs and symptoms
The first sign of measles is usually a high fever, which begins about 10 to 12 days after exposure to the virus, and lasts four to seven days. A runny nose, a cough, red and watery eyes, and small white spots inside the cheeks can develop in the initial stage. After several days, a rash erupts, usually on the face and upper neck. Over about three days, the rash spreads, eventually reaching the hands and feet. The rash lasts for five to six days, and then fades. On average, the rash occurs 14 days after exposure to the virus (within a range of seven to 18 days).
Severe measles is more likely among poorly nourished young children, especially those with insufficient vitamin A, or whose immune systems have been weakened by HIV/AIDS or other diseases.
Most measles-related deaths are caused by complications associated with the disease. Complications are more common in children under the age of five, or adults over the age of 20. The most serious complications include blindness, encephalitis (an infection that causes brain swelling), severe diarrhoea and related dehydration, ear infections, or severe respiratory infections such as pneumonia. As high as 10% of measles cases result in death among populations with high levels of malnutrition and a lack of adequate health care. People who recover from measles are immune for the rest of their lives.
Who is at risk?
Unvaccinated young children are at highest risk of measles and its complications, including death. Any non-immune person (who has not been vaccinated or was vaccinated but did not develop immunity) can become infected.
Measles is still common in many developing countries – particularly in parts of Africa and Asia. More than 20 million people are affected by measles each year. The overwhelming majority (more than 95%) of measles deaths occur in countries with low per capita incomes and weak health infrastructures.
Measles outbreaks can be particularly deadly in countries experiencing or recovering from a natural disaster or conflict. Damage to health infrastructure and health services interrupts routine immunization, and overcrowding in residential camps greatly increases the risk of infection.
Transmission
The highly contagious virus is spread by coughing and sneezing, close personal contact or direct contact with infected nasal or throat secretions.
The virus remains active and contagious in the air or on infected surfaces for up to two hours. It can be transmitted by an infected person from four days prior to the onset of the rash to four days after the rash erupts.
Measles outbreaks can result in epidemics that cause many deaths, especially among young, malnourished children. In countries where measles has been largely eliminated, cases imported from other countries remain an important source of infection.
Treatment
Severe complications from measles can be avoided though supportive care that ensures good nutrition, adequate fluid intake and treatment of dehydration with WHO-recommended oral rehydration solution. This solution replaces fluids and other essential elements that are lost through diarrhoea or vomiting. Antibiotics should be prescribed to treat eye and ear infections, and pneumonia.
All children in developing countries diagnosed with measles should receive two doses of vitamin A supplements, given 24 hours apart. This can help prevent eye damage and blindness. Vitamin A supplements have been shown to reduce the number of deaths from measles by 50%.
Prevention
Routine measles vaccination for children, combined with mass immunization campaigns in countries with high case and death rates, are key public health strategies to reduce global measles deaths. The measles vaccine has been in use for over 40 years. It is safe, effective and inexpensive. It costs less than one US dollar to immunize a child against measles.
The measles vaccine is often incorporated with rubella and/or mumps vaccines in countries where these illnesses are problems. It is equally effective in the single or combined form.
In 2010, about 85% of the world's children received one dose of measles vaccine by their first birthday through routine health services – up from 72% in 2000. Two doses of the vaccine are recommended to ensure immunity, as about 15% of vaccinated children fail to develop immunity from the first dose.
WHO response
The fourth Millennium Development Goal (MDG 4) aims to reduce the under-five mortality rate by two-thirds between 1990 and 2015. Recognizing the potential of measles vaccination to reduce child mortality, and given that measles vaccination coverage can be considered a marker of access to child health services, routine measles vaccination coverage has been selected as an indicator of progress towards achieving MDG 4.
Overwhelming evidence demonstrates the benefit of providing universal access to measles and rubella-containing vaccines. Globally, an estimated 535 300 children died of measles in 2000. By 2010, the global push to improve vaccine coverage resulted in a 74% reduction in deaths. These efforts, supported by the Measles & Rubella Initiative (MR Initiative), contributed 23% of the overall decline in under-five deaths between 1990 and 2008 and are driving progress towards meeting MDG4.
The MR Initiative is a collaborative effort of WHO, UNICEF, the American Red Cross, the United States Centers for Disease Control and Prevention, and the United Nations Foundation to control measles and rubella.
In April 2012, the MR Initiative launched a new Global Measles and Rubella Strategic Plan which covers the period 2012-2020. The Plan includes new global goals for 2015 and 2020:
By the end of 2015
- To reduce global measles deaths by at least 95% compared with 2000 levels.
- To achieve regional measles and rubella/congenital rubella syndrome (CRS) elimination goals.
By the end of 2020
- To achieve measles and rubella elimination in at least five WHO regions.
The strategy focuses on the implementation of five core components:
- achieve and maintain high vaccination coverage with two doses of measles- and rubella-containing vaccines;
- monitor the disease using effective surveillance, and evaluate programmatic efforts to ensure progress and the positive impact of vaccination activities;
- develop and maintain outbreak preparedness, rapid response to outbreaks and the effective treatment of cases;
- communicate and engage to build public confidence and demand for immunization;
- perform the research and development needed to support cost-effective action and improve vaccination and diagnostic tools.
Implementation of the Strategic Plan can protect and improve the lives of children and their mothers throughout the world, rapidly and sustainably. The Plan provides clear strategies for country immunization managers, working with domestic and international partners, to achieve the 2015 and 2020 measles and rubella control and elimination goals. It builds on years of experience in implementing immunization programmes and incorporates lessons from accelerated measles control and polio eradication initiatives.