Measles in the 21st Century: Progress Toward Achieving and Sustaining Elimination

Abstract

The global measles vaccination program has been extraordinarily successful in reducing measles-related disease and deaths worldwide. Eradication of measles is feasible because of several key attributes, including humans as the only reservoir for the virus, broad access to diagnostic tools that can rapidly detect measles-infectious persons, and availability of highly safe and effective measles-containing vaccines (MCVs). All 6 World Health Organization (WHO) regions have established measles elimination goals. Globally, during 2000-2018, measles incidence decreased by 66% (from 145 to 49 cases per million population) and deaths decreased by 73% (from 535 600 to 142 300), drastically reducing global disease burden. Routine immunization with MCV has been the cornerstone for the control and prevention of measles. Two doses of MCV are 97% effective in preventing measles, qualifying MCV as one of the most effective vaccines ever developed. Mild adverse events occur in <20% of recipients and serious adverse events are extremely rare. The economic benefits of measles vaccination are highlighted by an overall return on investment of 58 times the cost of the vaccine, supply chains, and vaccination. Because measles is one of the most contagious human diseases, maintenance of high (≥95%) 2-dose MCV coverage is crucial for controlling the spread of measles and successfully reaching measles elimination; however, the plateauing of global MCV coverage for nearly a decade and the global measles resurgence during 2018-2019 demonstrate that much work remains. Global commitments to increase community access to and demand for immunizations, strengthen national and regional partnerships for building public health infrastructure, and implement innovations that can overcome access barriers and enhance vaccine confidence, are essential to achieve a world free of measles.

Keywords: MMR; elimination; eradication; measles; mumps; rubella vaccine.

Figure 1.

Number of reported measles cases in the United States from 1962 to 2019 (A) and worldwide from 1980 to 2019 (B). Data from US Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report; global data available at http://apps.who.int/immunization_monitoring/globalsummary/timeseries/tsincidencemeasles.html.

Figure 2.

A, Estimated measles-mumps-rubella (MMR) vaccination coverage among children aged 19–35 months or 13–17 years. (Data from National Immunization Surveys, United States, 1995–2019; available at https://www.cdc.gov/vaccines/imz-managers/coverage/childvaxview/data-reports/mmr/trend/index.html and https://www.cdc.gov/vaccines/imz-managers/coverage/teenvaxview/data-reports/mmr/trend/index.html). B, Estimated measles-containing-vaccine (MCV) first dose (MCV1) and MCV second dose (MCV2) coverage (worldwide data from World Health Organization, 1980–2019; available at http://www.who.int/immunization/monitoring_surveillance/data/en). A, B, Horizontal dashed lines represent 90% vaccination coverage.