The Measles Initiative partnership a significant reason for success

The results from a new study published in The Lancet demonstrate that high- quality measles immunization campaigns and improvements in routine immunization services have reduced measles cases by 91% in 19 African nations from 2000-2003, preventing an estimated 90,000 child deaths in 2003 alone.

The study's authors compared disease surveillance data from before and after measles immunization campaigns conducted in the 19 countries from 2000 to June 2003. These campaigns targeted 82.1 million children; reported vaccination coverage was 85% or higher for all of them. Prior to the campaigns, these countries reported an average total of more than 164,000 measles cases. In 2003, after the campaigns, these same countries reported a total of only 15,619 cases.

"One of the clearest messages from this study is that with the right strategies, a strong partnership of committed organizations, and the investment of sufficient resources, you can rapidly reduce child deaths in Africa," said Dr. Mac Otten, medical epidemiologist at the Centers for Disease Control and Prevention (CDC), and lead author of the study. "A big reason for this success is the support from the Measles Initiative."

The Measles Initiative -- a public-private partnership spearheaded by the American Red Cross, WHO, CDC, the United Nations Foundation, UNICEF, and the International Federation of Red Cross and Red Crescent Societies -- provided technical assistance and funding for measles immunization campaigns in 12 countries in western and eastern Africa (i.e., Benin, Burkina Faso, Burundi, Cameroon, Ghana, Kenya, Mali, Rwanda, Senegal, Tanzania, Togo, and Zambia). Campaigns in these countries targeted children 9 months to 14 years of age. Ninety-five percent (95%) of the 90,000 measles deaths prevented in 2003 were from the 12 countries supported by the Measles Initiative. Seven additional countries in southern Africa held follow-up immunization campaigns in 2000- 2003, targeting only children 9 months to 5 years of age.

"The Measles Initiative is a model for public health partnerships," said Senator Timothy E. Wirth, President of the United Nations Foundation. "The Initiative members work closely with Ministries of Health to plan, implement, and evaluate immunization campaigns. This data demonstrates just how effective this collaboration has been."

Measles immunization provided through routine services confers protection for millions and also contributed to the reduction in cases. Routine coverage increased slightly from 2000 to 2003 in 12 of the 19 countries, while remaining stable in the remaining seven. Improving routine immunization and providing a second opportunity for measles vaccination during an immunization campaign are key measles control strategies in the WHO African Region. Case management and disease surveillance are also essential components for controlling measles.

"These are tried and tested strategies that have worked with remarkable results in many parts of the world," said Dr. Jean-Marie Okwo-Bele, Director of the Immunization, Vaccines and Biologicals Department, WHO. "But making this a reality for everyone will mean putting in place a reliable routine immunization service. WHO and its partners are working closely with countries to make this happen."

The total donor costs for the measles immunization campaigns in the 19 countries were $68.1 million USD. From the donors' perspective, the cost per child targeted was 83 cents and the cost per death averted was $224.

"Immunization against measles is one of the most cost-effective public health interventions," said Dr. Mark Grabowsky, Senior Technical Advisor, American Red Cross, and one of the study's authors. "Yet, while in the developed world measles has been virtually eliminated, in the developing world the virus still infects millions. Measles often results in severe complications, including blindness, pneumonia, and encephalitis, and kills hundreds of thousands of children each year. For less than $1.00 per child, all of this can be averted."

"It's the most vulnerable children who die from measles," said Dr. Peter Salama, Chief of UNICEF's immunization program. "Among malnourished children and children displaced through conflict, the death rate from measles can be as high as 25%. If we are going to dramatically decrease child deaths from measles, these strategies must be expanded to protect the lives of the poorest and most under-served children who have not yet been reached with this life- saving vaccine."

The decline in measles deaths represents substantial progress toward the global goal of 50% reduction in measles deaths from 1999 to 2005. Global measles mortality data from 2003 (the most current available) shows that measles deaths have dropped 39% worldwide since 1999, from an estimated 873,000 to 530,000. Global measles mortality data from 2004 is expected by year's end.

Launched in February 2001, the Measles Initiative is a long-term commitment to prevent deaths in Africa by vaccinating 200 million children and preventing 1.2 million deaths over five years. Leading this effort is the American Red Cross, the United Nations Foundation, Centers for Disease Control and Prevention (CDC), UNICEF, and WHO. Other key players in the fight against measles are the International Federation of Red Cross and Red Crescent Societies, the Canadian International Development Agency (CIDA), The Bill and Melinda Gates Foundation, the Church of Jesus Christ and Latter Day Saints, the Global Alliance for Vaccines and Children and countries and governments affected by measles.

http://www.measlesinitiative.org/