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Measles remains an important cause of childhood mortality, especially in developing countries. In the joint strategic plan for measles mortality reduction, 2001-2005, (1) WHO and UNICEF targeted 45 priority countries with high measles burden for implementation of a comprehensive strategy for accelerated and sustained measles mortality reduction. Components of this strategy include achieving high routine immunization coverage ([greater than or equal to]90%) in every district and ensuring that all children receive a second opportunity for measles immunization.
In May 2003, the World Health Assembly endorsed resolution WHA56.20 urging Member countries to achieve the goal adopted by the United Nations General Assembly Special Session on Children (2002) to reduce measles deaths by half by the end of 2005 (compared with 1999 estimates). This article provides an update on progress towards this goal and summarizes recent recommendations by a panel of experts on methods to estimate global measles mortality.
By July of each year, all countries are requested to submit information on vaccination coverage from the previous year using the WHO/UNICEF Joint Reporting Form. Estimates of routine coverage with 1 dose of measles vaccine are based on review of coverage data from administrative records, surveys, national reports and consultation with local and regional experts. Coverage achieved during nationwide supplementary immunization activities (SIAs) against measles is reported based on tally sheets of the number of doses administered divided by the target population.
Based on WHO/UNICEF estimates, global routine measles vaccination coverage has increased from 71% in 1999 to 77% in 2003. Coverage varied significantly by geographical region (Table 1). Moreover, there has been an increase in the proportion of countries offering children a second opportunity for measles immunization. In 2003, 164 (85%) countries offered children a second opportunity compared with 150 (78%) countries in 2001 (data not available before 2001). From 2000 to 2003, more than 197 million children aged from 9 months to 14 years received measles vaccine through SIAs in 30 of the 45 WHO/UNICEF priority countries (Map 1). Of the 30 countries that carried out measles SIAs during this period, 23 (77%) conducted nationwide SIAs and 7 conducted subnational SIAs. Of the 30 countries that conducted SIAs, 23 (77%) were in Africa. Of the SIAs in Africa, 18 (78%) were nationwide. Reported coverage for SIAs in the priority countries ranged from 65% to 99% (median, 98%).
Given limited disease surveillance and death registration in many countries with weak infrastructure and high measles burden, routine reporting systems are …