Perspective on Global Measles Epidemiology and Control and the Role of Novel Vaccination Strategies

Abstract

Measles is a highly contagious, vaccine preventable disease. Measles results in a systemic illness which causes profound immunosuppression often leading to severe complications. In 2010, the World Health Assembly declared that measles can and should be eradicated. Measles has been eliminated in the Region of the Americas, and the remaining five regions of the World Health Organization (WHO) have adopted measles elimination goals. Significant progress has been made through increased global coverage of first and second doses of measles-containing vaccine, leading to a decrease in global incidence of measles, and through improved case based surveillance supported by the WHO Global Measles and Rubella Laboratory Network. Improved vaccine delivery methods will likely play an important role in achieving measles elimination goals as these delivery methods circumvent many of the logistic issues associated with subcutaneous injection. This review highlights the status of global measles epidemiology, novel measles vaccination strategies, and describes the pathway toward measles elimination.

Keywords: elimination; measles; novel vaccination strategies; surveillance; vaccine.

Figure 1

Current measles incidence and countries with verified elimination. Depiction of 2015 per-country measles incidence per million population, overlaid with countries for which measles elimination has been officially verified (grey) [53,54,55,56]. Grey circles indicate countries not readily viewable on the map. Verified elimination was obtained from documentation produced by the World Health Organization (WHO) regional elimination verification commissions [53,54,55]. Shapefile was obtained from NaturalEarth.com, 10-meter resolution, version 3.1.0, and was produced in R version 3.2.3.

Figure 2

Year of first and last detection of Measles virus (MeV) wild-type genotypes. The first and last years of documented circulation reported to MeaNS for all 24 MeV genotypes is shown. First year detection determined from earliest reference strain reported to MeaNS and does not necessarily indicate first year of circulation. All viruses in red with a date of 2016 are currently circulating genotypes. Measles vaccine was derived from genotype A virus, which is not shown, and the earliest detection of genotype A was in 1954. Dates obtained from reference [62].