Abstract

PIP: Measles kills about 1.4 million children each year. To bring about reductions in measles cases and deaths, WHO has made some recommendations. Public health officials at the community, district, and national levels need to achieve at least 90% measles vaccine coverage. This coverage level reduces cases and deaths, but may not stop transmission. The primary goal should be that health workers deliver at least 1 dose of measles vaccine to all children at the scheduled age. Several complementary strategies are needed within each country to achieve this high coverage. In situations where there is a high incidence of measles in a defined subgroup of older children, older children should receive extra doses of vaccine when they enter school. In-service training of hospital and clinic staff should reduce the number of missed opportunities (i.e., children who visit health facilities but who are not screened and administered needed immunizations). Public health workers need to identify reasons for high drop-out rates and take corrective action. Limited resources should be directed to high risk areas: areas with high population density, low measles immunization coverage, known vitamin A deficiency, or high reported measles incidence or death rate. Unimmunized urban poor children, underserved ethnic minorities, refugees, people in underserved border areas, children admitted to the hospital, and infants of HIV positive mothers comprise high risk groups. Measles outbreaks occur even in areas where measles immunization coverage is high. Control measures are not always effective, especially if taken late in an epidemic. At the very least, health officials should gather data on cases and death (e.g., date of onset and immunization status). They should determine why the outbreak took place. If possible, they should conduct a vaccine efficacy study. To reduce deaths from measles by 95%, immunization, treatment of measles and its complications at an early stage, and vitamin A supplementation are needed.