Outbreaks

Measles outbreaks were reported from 36 countries in the region in 2011 and about one quarter of the reported cases (28%) in 2011 were hospitalized and 9 children died.

Large outbreaks in Bulgaria in 2010 and in France in 2011 accounted for a large percentage of the new cases. The outbreak in France was the largest in the region with more than 14,000 cases accounting for 54% of all the cases in 2011. Six of the nine deaths were from that country. France’s Health Director told the press “France can simply not afford to have deaths, painful and costly hospitalizations, disruptions to work and school from a completely vaccine-preventable disease.”

Vaccination

Approximately three quarters of the European cases have been school age children 5 years of age or older, and most have either been unvaccinated or have had an unknown vaccination history. According to WHO, successful control will required achieving and sustaining high vaccination coverage with not just one but two doses of measles vaccine. Vaccine coverage rates with one dose of vaccine are already estimated to be over 90% in the European Region, however, two dose coverage appears to be much lower.  

Benchmark

While an extremely challenging public health goal, measles elimination has been achieved and sustained in the US and the entire WHO region of the Americas since 2002, thereby creating an attainable benchmark which other regions could also achieve.

Decline in Deaths

In an article entitled “A World Without Measles” in a special supplement to the Journal of Infectious Diseases published earlier this year, Peter Strebel from WHO and colleagues [J Infect Dis. (2011) 204 (suppl 1) ]reported that measles deaths declined by “an impressive 78% from an estimated 733,000 deaths in 2000 to 164,000 in 2008.” This progress was ahead of the 2010 target date for reducing measles mortality by 90% and encouraged global authorities to conclude that measles could be eradicated by 2020 if progress continued through 2015.

Setbacks

According to the same article, “this steady march toward a measles-free world is now facing a setback. Starting in mid-2009, there has been a widespread resurgence of measles with over 200,000 cases and 1,400 deaths with the true number thought to be 10-20 fold higher at 2-4 million cases and 14-28,000 deaths.

Following publication of this article, large outbreaks in 2011 have been seen not only in France but in the Democratic Republic of the Congo (100,000 cases), and Nigeria and Somalia (15,000 cases each) according to global authorities. High numbers of deaths are also continuing to occur in India.

Challenges

The serious challenge in 2011 to measles elimination in the European region by 2015 is caused by numerous factors according to WHO. These are 1) lack of knowledge about the potential seriousness of the disease, 2) skepticism about the benefits of vaccination, 3) increased fear of adverse events after vaccination, 4) limited access to health care for some populations, and 5) religious or philosophical objections to vaccination in some areas.

According to Mark Muscat from the Department of Epidemiology at the Statens Serum Institute in Denmark writing in the same issue of the Journal of Infectious Diseases, “…one of the main obstacles is the false perception of parents that believe Measles, Mumps, Rubella (MMR) vaccination to be more dangerous than the disease itself.”

Doctors As Problems

Doctors and health care providers are key to providing reliable information for parents making vaccination decisions and there is evidence that not all are enthusiastic MMR vaccination proponents. In surveys in France, Germany and elsewhere in Europe according to Muscat, substantial percentages of health care providers are not strongly in favor of vaccination.

At A Crossroads

On a worldwide basis, the setbacks in measles elimination are being attributed to decreases in financial support and political commitment to the elimination goal. According to the Strebel article, WHO has calculated a worst case scenario for lowered financial and political commitment which could translate into more than 500,000 measles-related deaths worldwide in 2013. They add, “Thus, the world is at a crossroads regarding whether it has the will and the means to make the sociopolitical and financial commitment to reverse the resurgence, achieve the 2015 mortality reduction target, and reap the tremendous long-term humanitarian and economic benefits of a world without measles.”