Progress Toward Measles Elimination - South-East Asia Region, 2003-2020

Abstract

In 2013, member states of the World Health Organization (WHO) South-East Asia Region* (SEAR) adopted the goal of measles elimination and rubella and congenital rubella syndrome control^† by 2020 (1). In 2014, to provide impetus toward achieving this goal, the Regional Director declared measles elimination and rubella control one of the Regional Flagship Priorities. In 2019, SEAR member states declared a revised goal of eliminating both measles and rubella^§ by 2023 (2). The recommended strategies to achieve elimination include 1) achieving and maintaining ≥95% coverage with 2 doses of measles- and rubella-containing vaccine in every district through routine or supplementary immunization activities^¶ (SIAs); 2) developing and sustaining a sensitive and timely case-based surveillance system that meets recommended performance indicators**; 3) developing and maintaining an accredited laboratory network; 4) achieving timely identification, investigation, and response to measles outbreaks; and 5) collaborating with other public health initiatives to achieve the preceding four strategies. This report updates a previous report and describes progress toward measles elimination in SEAR during 2003-2020 (3). In 2002, coverage with the first dose of a measles-containing vaccine in routine immunization (MCV1) was 70%, and only three countries in SEAR had added a second routine dose of measles-containing vaccine in routine immunization (MCV2). During 2003-2020, all countries introduced MCV2, and estimated coverage with MCV1 increased 35%, from 65% to 88%, and coverage with MCV2 increased 1,233% from 6% to 80%. Approximately 938 million persons were vaccinated in SIAs. Annual reported measles incidence declined by 92%, from 57.0 to 4.8 cases per 1 million population, and estimated deaths decreased by 97%; an estimated 9.3 million deaths were averted by measles vaccination. By 2020, five countries were verified as having achieved measles elimination. To achieve measles elimination in the region by 2023, additional efforts are urgently needed to strengthen routine immunization services and improve measles-containing vaccine (MCV) coverage, conduct periodic high-quality SIAs, and strengthen measles case-based surveillance and laboratory capacity.

FIGURE

Number of reported measles cases, by country,^, and estimated percentage of children who received their first and second dose of measles-containing vaccine — World Health Organization South-East Asia Region, 2003–2020 Abbreviations: MCV = measles-containing vaccine; MCV1 = first dose of MCV in routine immunization; MCV2 = second dose of MCV in routine immunization; SEAR = South-East Asia Region; WHO = World Health Organization. * Cases of measles reported to WHO and UNICEF through the Joint Reporting Form from WHO-SEAR. ^† Others include Bangladesh, Bhutan, Burma, Maldives, Nepal, North Korea, Sri Lanka, and Timor-Leste. ^§ MMWR uses the U.S. Department of State’s short-form name “Burma”; WHO uses “Myanmar”. ^¶ Data were from WHO and UNICEF estimates, 2021 revision (as of July 2022). http://immunizationdata.who.int