MEASLES a historic victory for public health

[Guest guest]

Measles Deaths Drop by 60 Percent

By MARIA CHENG, The Associated Press

Thursday, January 18, 2007; 10:52 PM

LONDON -- Global measles deaths have dropped by 60 percent, health

authorities announced in a report Friday, and one senior official

called it a " historic victory " for public health.

Nearly 7.5 million children were saved from dying of measles between

1999 and 2005, thanks to increased immunization campaigns, the World

Health Organization said. More than 360 million children aged 9 months

to 15 years were vaccinated against measles during that period.

Measles is one of the most infectious diseases that exists. Though it

is no longer a major problem in the West, in poor countries, the

disease can kill as many as 30 percent of the children it infects,

particularly in those with weakened immune systems.

" This is a historic victory for global public health, " said Dr.

Margaret Chan, WHO's director-general. Health authorities had hoped to

cut measles mortality rates in half by 2005, but found that they had

exceeded that goal by 10 percent. In Africa, the results were even

more striking: measles deaths fell by 75 percent on the continent.

" It's not very often that global health initiatives not only achieve

their goals, but actually exceed their goals faster than expected, "

said Dr. Gerberding, director of the U.S. Centers for Disease

Control and Prevention. The measles success achieved to date,

Gerberding said, has encouraged the global community to aim even

higher, as they set a new goal of reducing measles deaths by 90

percent by 2010.

According to Geneva-based WHO, the next phase of this initiative is

projected to cost about $500 million, of which $150 million has

already been committed.

In a study published Friday in the British medical journal The Lancet,

WHO scientists estimated that the number of measles deaths fell from

873,000 in 1999 to 345,000 in 2005.

Because surveillance figures from countries are not available, WHO

based its figures on a modeling system that estimates the number of

measles cases based on coverage rates achieved during vaccination

campaigns. Experts said the numbers should be reasonably accurate.

If the 2010 goal is met, health officials may then start considering

whether it might be feasible to eradicate measles. Like smallpox and

polio, an effective vaccine exists, making it a potential candidate

for eradication.

Still, the problems plaguing polio, which was originally supposed to

be eradicated by 2000, may undermine any proposed measles campaign.

" The continuing failure to meet the polio eradication goals will cast

much skepticism and pessimism on any similar global venture for

measles, " said Dr. Katz, co-inventor of the measles vaccine.

Katz is also an infectious diseases specialist at Duke University.

" Donor and participant fatigue take their toll, " he said.

To date, the effort to eradicate polio has cost $4 billion. And while

health officials are tantalizingly close to the finish line _ polio

incidence has been cut by 99 percent _ it remains stubbornly endemic

in Afghanistan, India, Nigeria and Pakistan.

Whether or not measles eradication will be attempted will depend

largely on if the 2010 goal can be met.

" That will be another milestone to measure if elimination is

possible, " said Dr. Vance Dietz, chief of the global measles

department at the CDC.

" It may be that by then, we are so far ahead that regardless of what's

happened with polio, people will want to move ahead, " he said.

The Measles Initiative was launched in 2001 to reduce measles deaths

worldwide. Its major partners are the American Red Cross, the CDC, the

U.N. Foundation, UNICEF and WHO.

http://www.washingtonpost.com/wp-dyn/content/article/2007/01/18/AR2007011802061.\

html

Groups Make Headway in Fight Against Measles

By Brown

Washington Post Staff Writer

Friday, January 19, 2007; A16

A partnership of international health organizations said yesterday

that it will seek to reduce the global death toll from measles to less

than 10 percent of its 2000 level by 2010, spurred in part by

bigger-than-expected gains against the disease in the past five years.

The effort seeks to extend the coalition's dramatic success in cutting

annual deaths from measles by more than 60 percent since 1999, easily

bettering its goal of cutting mortality in half.

The effort will rely on mass vaccination campaigns in the 47 countries

where measles is most prevalent, as well as on improvements in the

routine immunization programs, to fight a disease that until recently

was responsible for about 10 percent of all childhood deaths worldwide.

In many places, measles shots will be delivered along with pills that

kill intestinal parasites, insecticide-impregnated mosquito nets that

prevent malaria, and immunity-boosting Vitamin A supplements, all as

part of a broad, multi-organization effort to cut childhood deaths.

" I think this really serves as a model to solve other global health

problems, " L. Gerberding, director of the Centers for Disease

Control and Prevention, said in a telephone briefing to announce the

new goal.

The Measles Initiative -- a partnership including the American Red

Cross, CDC, the World Health Organization, the United Nations

Children's Fund (UNICEF) and the United Nations Foundation -- has

proved unusually successful since its launch in 2001.

The initial goal was to cut annual deaths from measles in half by

2005, using 1999 as a baseline. The final calculation, announced

yesterday, showed that mortality had fallen by 60.5 percent, from

873,000 deaths in 1999 to 345,000 in 2005. Of that latest toll,

311,000 were children.

In Africa, where more than half the deaths in 1999 occurred, measles

mortality has fallen 75 percent.

The initiative has spent about $390 million to date and will need

about $500 million more to reach the goal, according to the partners.

The Red Cross has been the largest contributor, raising $118 million,

and Vodafone the largest corporate contributor, giving $2 million.

In most parts of the developing world, measles shots are given to

infants under age 1. However, about 15 percent remain susceptible

because of an inadequate immune response, so a second shot is usually

given when they start school. (In the United States, a combined

measles, mumps and rubella vaccine is given three times. The Measles

Initiative is using measles vaccine alone.) Vaccination costs about 90

cents, with about 35 cents going for the vaccine, a disposable needle

and the collecting of needles, said Hoekstra, a physician who

helps run UNICEF's measles efforts.

Much of the Measles Initiative's investment in recent years has been

in improving the " cold chain " that allows the heat-sensitive vaccine

to be delivered still potent to remote places. This requires

generators to power freezers and the purchase of large numbers of

portable ice chests, said Salama, UNICEF's chief of health.

The CDC has also made a substantial investment in improving

surveillance for the disease -- a key activity that allows health

officials to know where unvaccinated people are.

Mass vaccination campaigns, done every two to four years, will remain

important, although ultimately, routine measles vaccination everywhere

is the goal, Salama said.

If the new target is reached, measles could be a realistic target for

eradication.

Smallpox was eradicated in 1978. Guinea worm disease, a parasitic

infection, is on the verge of eradication. A campaign to wipe out

polio, launched in 1988, is struggling to reach its goal seven years

after its original deadline. However, at yesterday's briefing,

Margaret Chan, who took office as WHO's director general this month,

was noncommittal about taking on such a difficult goal with measles.

" I think at this stage it is too early to talk about eradication, " she

said.

Although virtually absent from United States in the last generation,

measles was once a feared disease of childhood. Before vaccination

became routine in 1963, this country had 3 million to 4 million cases,

and several thousand deaths, each year.

The fatality rate in healthy children is 1 to 3 percent, but it can be

as high as 30 percent among those who are malnourished, especially

those who get too little Vitamin A. Measles further suppresses their

immunity, and many die of diarrhea or pneumonia.

Measles, which is spread by respiratory droplets, is one of the most

contagious diseases known, often passing through a susceptible

population in a wave of fever and rash. Only when 95 percent of a

population becomes immune does the chain of transmission break and the

virus disappears.

Measles almost certainly arose when people began to have close, nearly

constant contact with domesticated animals. It is closely related to

rinderpest, a viral infection of cattle, and to canine distemper

virus, which infects dogs.

http://www.washingtonpost.com/wp-dyn/content/article/2007/01/18/AR2007011802060.\

html