Although measles remains a leading cause of vaccine-preventable deaths among children, WHO estimates that global measles mortality decreased by 29% from 1999 to 2002, including a decline of 19% among South-East Asia Region (SEAR) Member countries. (1) In June 2003, the SEAR Regional Technical Advisory Group on Immunization endorsed a Regional Strategic Plan for Measles Mortality Reduction (2003-2005). This report summarizes the progress in measles control in SEAR during 1999-2002 and outlines the plans for future activities.
All SEAR countries include measles as a reportable disease in their routine communicable disease surveillance systems. Before 2001, only Sri Lanka and Thailand collected nationwide information on case characteristics and mortality; other countries relied on passive surveillance of clinically confirmed cases and maintained only aggregated data at the national level. Beginning in 2001, WHO has supported surveillance medical officers in Bangladesh, Indonesia, Myanmar and Nepal; these countries have now added measles and neonatal tetanus to their original focus on acute flaccid paralysis (AFP) surveillance. Furthermore, outbreak investigations are conducted, and case-based data, including information on age, outcome and vaccination status, are collected. In 2002, WHO established a regional network of national measles laboratories, with standardized testing procedures in all SEAR Member States.
From a reported 440 000 cases in 1989, the number of measles cases decreased steadily to 114 000 in 1997. While reported cases dropped further in 1999 to 45 000, the number of cases gradually rose to 88 000 in 2002 primarily as a result of increases in India, Indonesia and Thailand (Table 1). During this period, extensive nationwide outbreaks occurred in several countries of the region. Between September 1999 and May 2000, 15 337 measles cases and 23 deaths were reported in Sri Lanka. An outbreak in the Maldives in 2002 resulted in 926 reported cases. A mix of both routine and outbreak reporting, where information on age groups was available, has shown a broad age distribution, with the majority of cases aged <10 years in all countries except the Maldives, Sri Lanka and Thailand, where the majority of cases occurred in those aged >10 years.
Mortality reported from routine surveillance and outbreak investigations remains low. Nevertheless, based on immunization coverage and available case-fatality data, WHO estimated 243 000 measles deaths in the region in 1999 and 196 000 deaths in 2002.
All countries in SEAR include one dose of measles-containing vaccine (MCV1) in their routine immunization schedule at 9 months. Sri Lanka and Thailand provide a second dose of MCV in their routine programme. Based on administrative reporting, the SEAR average measles immunization coverage for MCV1 remained at more than 85% during the 1990s. WHO/UNICEF best estimates (Table 1), which rely on expert review of national reports and surveys, indicate that the regional average in recent years is substantially lower than previous administrative reporting. Based on WHO/ UNICEF estimates, regional coverage for MCV1 has improved from 58% in 1999 to 70% in 2002, primarily due to increases in India.
Supplementary immunization activities (SIAs) were conducted nationwide in DPR Korea from 1999 to 2002, targeting 9-23-month-olds, and in Bhutan targeting 9 …