Global & Disaster Medicine

Archive for the ‘Measles’ Category

Weekly Epidemiological Report from the Nigeria CDC

Nigeria CDC

In the reporting week ending on September 30, 2018:

o There were 173 new cases of Acute Flaccid Paralysis (AFP) reported. None was confirmed as polio. The last reported case of polio in Nigeria was in August 2016. Active case search for AFP is being intensified with the goal to eliminate polio in Nigeria.

o There were 2052 suspected cases of Cholera reported from 42 LGAs in seven States (Adamawa – 107, Borno – 702, Gombe – 90, Kaduna – 2, Katsina – 585, Yobe – 162 and Zamfara – 404). Of these, 26 were laboratory confirmed and 18 deaths were recorded.

o Nine suspected cases of Lassa fever were reported from seven LGAs in five States (Bauchi – 1, Edo – 5, FCT – 1, Nasarawa – 1 & Rivers – 1). Four were laboratory confirmed and no death was recorded.

o There were eight suspected cases of Cerebrospinal Meningitis (CSM) reported from five LGAs in five States (Ebonyi – 1, Edo – 2, Ondo – 2, Taraba – 1 & Yobe – 2). Of these, none was laboratory confirmed and no death was recorded.

o There were 124 suspected cases of measles reported from 30 States. None was laboratory confirmed and one death was recorded.


Measles in America: 6,629 confirmed cases, including 72 deaths

In 2018, as of 21 September, a total of 6,629 confirmed cases of measles, including 72 deaths, have been reported in 11 countries of the Region of the Americas:

Antigua and Barbuda (1 case),

Argentina (11 cases),

Brazil (1,735 cases, including 10 deaths),

Canada (22 cases),

Colombia (85 cases),

Ecuador (19 cases),

Guatemala (1 case),

Mexico (5 cases),

Peru (21 cases),

the United States of America (124 cases), and the

Bolivarian Republic of Venezuela (4,605 cases, including 62 deaths).

1 measles case in an international traveler returning to NYC in 2013 triggered an outbreak that sickened 58 people, most of them unvaccinated, and cost the city’s health department $395,000.

JAMA Pediatrics

“…..Between March 13, 2013, and June 9, 2013, 58 persons in New York City with a median age of 3 years (range, 0-32 years) were identified as having measles. Among these individuals, 45 (78%) were at least 12 months old and were unvaccinated owing to parental refusal or intentional delay. Only 28 individuals (48%) visited a medical health care professional who suspected measles and reported the case to the DOHMH at the initial clinical suspicion. Many case patients were not immediately placed into airborne isolation, resulting in exposures in 11 health care facilities. In total, 3351 exposed contacts were identified. Total direct costs to the New York City DOHMH were $394 448, and a total of 10 054 hours were consumed responding to and controlling the outbreak.….”

Brazil: From 1 January through 23 May 2018, there were 995 reported cases of measles


1 June 2018

In Brazil, there is an ongoing measles outbreak. From 1 January through 23 May 2018, there were 995 reported cases (Amazonas State, n=611, and Roraima State n=384). Of these cases, 114 have been laboratory confirmed (30 in Amazonas and 84 in Roraima), including two deaths. Eighty three cases were discarded and 798 remain under investigation.

In Amazonas State, 611 suspected cases were reported from 1 January through 23 May 2018, of which 30 were confirmed1, 63 discarded and 518 are under investigation. In Roraima State, 384 suspected cases were reported, of which 84 were confirmed, 20 discarded and 280 are under investigation2. Of the 84 confirmed cases, 58 are among Venezuelans (69%), 24 Brazilians (28,6%), one from Guiana (1,2%) and 1 Argentinian (1,2%). Of all confirmed cases, 34 are indigenous. Two measles deaths were among Venezuelans from Boa Vista municipality.

The rash onset dates of the confirmed cases in both States were from 4 February through 2 April, 2018. Oswaldo Cruz Foundation (Fiocruz/RJ) conducted an analysis, where they identified the genotype as D8 for all laboratory confirmed cases, which is identical to the 2017 Venezuela outbreak.

Figure 1 shows the progression of the outbreak with a growing upward trend. It is important to consider that there are pending laboratory results for 798 suspected cases under investigation. An exponential increase of confirmed cases could be observed in the coming weeks.

Figure 1. Reported measles cases by rash onset date, Amazonas and Roraima states, Brazil, from 1 January through 12 May, 2018.

Source: Data provided by the Ministry of Health of Brazil and reproduced by PAHO/WHO.

Public health response

Actions implemented include:

  • Roraima and Amazonas states have started a vaccination campaign that targets six month old infants through 49-year-old age groups.
  • Intensified epidemiological surveillance through active and retrospective institutional case finding, contact tracing, and monitoring of contacts has been implemented.
  • Strengthened laboratory network.
  • A risk communication strategy has been implemented.
  • Training of health care workers in case management.

WHO risk assessment

Measles is a highly contagious viral disease which affects susceptible individuals of all ages and remains a cause of death among young children globally. Measles virus is transmitted via droplets from the nose, mouth, or throat of infected persons. Initial symptoms, which usually appear 10–12 days after infection, include high fever, usually accompanied by one of several of the following: runny nose, bloodshot eyes, cough and tiny white spots on the inside of the mouth. Several days later, a rash develops, starting on the face and upper neck and gradually spreading downwards.

A patient is infectious four days before the start of the rash to four days after the appearance of the rash. There is no specific antiviral treatment for measles, and most people recover within two to three weeks. Case management includes vitamin A administration and antipyretics, and antibiotic and anti-diarrheal medications as needed. Among malnourished children and people with greater susceptibility, measles can cause serious complications, including blindness, encephalitis, severe diarrhea, ear infection, and pneumonia. Measles can be prevented by immunization. In countries with low vaccination coverage, epidemics typically occur every two to three years and usually last between two and three months, although their duration varies according to population size, crowding, and the population’s immunity status.

The Region of the Americas was declared free of measles in September 2016, nevertheless, outbreaks caused by imported cases from other regions may occur sporadically.

The risk of spread at the national level in Brazil remains high due to the epidemiological situation and the high potential of transmission. The main challenges are vaccination coverage among immigrants and laboratory diagnostic capacity in local facilities. Because of ongoing transmission, vaccination strategies and other actions are being implemented to control the outbreak by local and federal authorities in Brazil. At the regional level, the potential impact is considered high given the performance of routine immunization programmes and prevention and control capacities in other countries in the Region.

WHO advice

On 1 September 2017, the Pan American Health Organization / World Health Organization (PAHO/WHO) shared information on this outbreak with its Member States and alerted them regarding the risk of outbreaks occurring from imported measles cases, as well as the possibility of re-introduction of the disease in areas with low vaccination coverage. In light of continuous reports of imported measles cases from other Regions and ongoing outbreaks in the Americas, PAHO/WHO urges all Member States to:

  • Vaccinate to maintain coverage of 95% with the first and second doses of measles, mumps, rubella (MMR) vaccine.
  • Vaccinate at-risk populations (without proof of vaccination or immunity against measles and rubella), such as health workers, people working in tourism and transportation (hotel and catering, airports, taxi drivers, etc.), and international travelers.
  • Maintain a reserve of measles-rubella (MR) vaccine and syringes for control of imported cases in each country in the Region.
  • Strengthen epidemiological surveillance of measles for timely detection of all suspected cases of measles in public and private healthcare facilities and ensure that samples are received by laboratories within five days of being taken.
  • Provide a rapid response to imported measles cases through the activation of rapid response teams to prevent the re-establishment of endemic transmission. Once a rapid response team has been activated, continued coordination between the national and local levels must be ensured, with permanent and fluid communication channels between all levels (national, sub-national, and local).

For more information, please see the links below:

1Suspected cases were reported in 14 municipalities: Anori, Beruri, Careiro da Várzea, Humaitá, Itacoatiara, Itapiranga, Iranduba, Jutaí, Manacapuru, Manaus, Novo Airão, Parintins, São Gabriel da Cachoeira and Tefé. All cases are brazilians.

2Suspected cases were reported in 11 municipalities: Alto Alegre, Amajarí, Boa vista, Cantá, Caracaraí, Caroebe, Iracema, Pacaraima, Rorainópolis, São João da Baliza and Uiramutã. Of the 384 suspected cases, 10 cases were notified in Brazil, but their residence is in the following Venezuela municipalities: Santa Helena (04), Gran Sabana (03), Ciudad Bolivar (01), Maracaibo (01) and Sifontes (01).


Measles cases continue to increase in a number of EU/EEA countries with the highest number of cases to date in 2018 were in Romania (1 709), Greece (1 463) France (1 346) and Italy (411) respectively.


Child with measles


Europe: The number of recorded measles cases quadrupled, to 21,315 in 2017 from 5,273 in 2016 with 35 deaths

NY Times

  • The biggest outbreak last year was in Romania, where there were 5,562 cases and which accounted for most of the deaths. The country’s large rural Roma population — also known as Gypsies — often do not vaccinate their children and may not take them to hospitals promptly when they fall ill.
  • The second biggest outbreak was in Italy, with 5,006 cases and three deaths; 88 percent of those cases were in people never vaccinated
  • Ukraine had 4,767 cases of measles in 2017.
  • Other countries reporting outbreaks of up to 1,000 cases were Belgium, Britain, France, Germany, Greece, Russia and Tajikistan.


The highest number of measles cases to date in the EU since 1 January 2017 were in Romania (10 623), Italy (4 991), Greece (1 463) and Germany (926).





Bangladesh steps up vaccination for new Rohingya arrivals as measles cases rise


Press release 1671


Bangladesh steps up vaccination for new Rohingya arrivals as measles cases rise

Cox’s Bazar, Bangladesh, 10 November 2017 – An increase in the number of suspected measles cases among the newly arrived Rohingya and their host communities in southern Bangladesh has prompted the Government and UN partners to step up immunization efforts in overcrowded camps and makeshift shelters close to the border with Myanmar.
Nearly 360 000 people in the age group of six months to 15 years among the new Rohingya arrivals in Cox’s Bazar and their host communities, irrespective of their immunization status, would be administered measles and rubella  vaccine through fixed health facilities, outreach vaccination teams, and at entry points into Bangladesh.
Measles, a childhood killer disease which can be particularly dangerous among unimmunized and malnourished children,  is one of the major health risks among the over  611 000 people who have crossed over to Bangladesh from Myanmar since late August and are now living in cramped and insanitary conditions  in Cox’s Bazar district.

As of 4 November, one death and 412 suspected cases of measles have been reported among the vulnerable populations living in camps, settlements, and among the host communities in Cox’s Bazar. Of them, 352 cases are from Ukhia and 46 from Teknaf sub-districts, and 11 have been reported from the district hospital. Majority of cases – 398 – are among the new arrivals and 14 among the host communities. As many as 82% cases are among children under five years of age.
“Children are especially at risk from outbreaks of measles and other communicable diseases that result from the crowded living conditions, malnutrition and severe lack of water and sanitation in the camps and other sites,” said Edouard Beigbeder, UNICEF Bangladesh Representative. “To halt any wider outbreak, it’s essential that coordinated efforts begin immediately to protect as many children as possible.”
With the risk of measles being high during such health emergencies, Ministry of Health and Family Welfare (MoHFW), with support of WHO, UNICEF and other local partners, was quick to roll out a measles and rubella (MR) vaccination campaign, between 16 September and 4 October, within weeks of the start of the recent influx of Rohingyas from Myanmar. Nearly 136 000 children between six months and 15 years were administered MR vaccine. Additionally, around 72 000 children up to five years of age were given bivalent oral polio vaccine (bOPV) and a dose of Vitamin A to help prevent measles related complication. The number of new arrivals has increased since the MR campaign, which also had challenges reaching out to all children in view of movement of people within the camps and settlements.
“As part of stepped up vaccination efforts, 43 fixed health facility sites, 56 outreach vaccination teams and  vaccination teams at main border entry points will administer MR vaccine to population aged six months to 15 years, along with oral polio vaccine to children under five years and TT vaccine to pregnant women. These efforts are aimed at protecting and preventing the spread of measles among the vulnerable population,” WHO Representative to Bangladesh, Dr N Paranietharan, said.
More than 70 vaccinators from government and partners have been trained to deliver routine vaccination though fixed sites and outreach teams beginning tomorrow, while vaccination at entry points at Subrang, Teknaf, is ongoing since 1 November.
The fixed sites and outreach teams will also cover under two year olds with vaccines available in Bangladesh  EPI schedule, such as BCG, pentavalent vaccine, oral polio vaccine, pneumococcal vaccine and two doses of MR vaccine.
As an additional measure, resources to treat measles cases are being reinforced with the distribution of vitamin A supplements, antibiotics for pneumonia and Oral Rehydration Salt (ORS) for diarrhoea related to measles. To improve hygiene conditions among the refugee population, 3.2 million water purification tablets and a total of 18,418 hygiene kits have been distributed benefitting 92,090 people.
The current initiative is yet another massive vaccination drive being rolled out for the new arrivals from Myanmar and their host communities in Cox’s Bazar since 25 August this year.  After covering 136 000 people in the September- October MR campaign, MoHFW and partners administered 900 000 doses of oral cholera vaccine to these vulnerable populations in two phases. The first phase that started 10 October covered over 700 000 people aged one year and above  – both the new arrivals and their host communities, while the second phase from 4 – 9 November provided an additional dose of OCV to 199,472 children between one and five years, for added protection  and bOPV to 236,696 children under 5 years of age.


For further information please contact:

  • Catalin-Constantin Bercaru, WHO Bangladesh,  +88 01787693318
  • Shamila Sharma, WHO South-East Asia Regional Office, +91 9818287256
  • Jean Jacques Simon, UNICEF Bangladesh,, +880 01713043478
  • AM Sakil Faizullah, UNICEF Bangladesh, +880 1713 049900
  • Faria Selim, UNICEF Bangladesh, +880 1817 586 096

Global Measles: For the first time, annual estimated measles deaths were fewer than 100,000, in 2016.


Progress Toward Regional Measles Elimination — Worldwide, 2000–2016

 Measles image

Alya Dabbagh, PhD1; Minal K. Patel, MD1; Laure Dumolard, PhD1; Marta Gacic-Dobo, MSc1; Mick N. Mulders, PhD1; Jean-Marie Okwo-Bele, MD1; Katrina Kretsinger, MD1; Mark J. Papania, MD2; Paul A. Rota, PhD3; James L. Goodson, MPH2



What is already known about this topic?

The fourth United Nations Millennium Development Goal, adopted in 2000, set a target to reduce child mortality by two thirds by 2015. One indicator of progress toward this target was measles vaccination coverage.

What is added by this report?

For the first time, annual estimated measles deaths were fewer than 100,000, in 2016. This achievement follows an increase in the number of countries providing the second dose of measles-containing vaccine (MCV2) nationally through routine immunization services to 164 (85%) of 194 countries, and the vaccination of approximately 119 million persons against measles during supplementary immunization activities in 2016. During 2000–2016, annual reported measles incidence decreased 87%, from 145 to 19 cases per million persons, annual estimated measles deaths decreased 84%, from 550,100 to 89,780, and an estimated 20.4 million deaths were prevented. However, the 2015 measles elimination milestones have not yet been met, and only one World Health Organization region has been verified as having eliminated measles.

What are the implications for public health practice?

To achieve measles elimination goals, countries and their partners need to act urgently to secure political commitment, raise the visibility of measles elimination, increase vaccination coverage, strengthen surveillance, and mitigate the threat of decreasing resources once polio eradication is achieved. Polio eradication resources have supported routine immunization services and surveillance activities.

The fourth United Nations Millennium Development Goal, adopted in 2000, set a target to reduce child mortality by two thirds by 2015. One indicator of progress toward this target was measles vaccination coverage (1). In 2010, the World Health Assembly (WHA) set three milestones for measles control by 2015: 1) increase routine coverage with the first dose of a measles-containing vaccine (MCV1) among children aged 1 year to ≥90% at the national level and to ≥80% in every district; 2) reduce global annual measles incidence to <5 cases per million population; and 3) reduce global measles mortality by 95% from the 2000 estimate (2).* In 2012, WHA endorsed the Global Vaccine Action Plan, with the objective of eliminating measles in four World Health Organization (WHO) regions by 2015 and in five regions by 2020. Countries in all six WHO regions have adopted goals for measles elimination by or before 2020. Measles elimination is defined as the absence of endemic measles virus transmission in a region or other defined geographic area for ≥12 months, in the presence of a high quality surveillance system that meets targets of key performance indicators. This report updates a previous report (3) and describes progress toward global measles control milestones and regional measles elimination goals during 2000–2016. During this period, annual reported measles incidence decreased 87%, from 145 to 19 cases per million persons, and annual estimated measles deaths decreased 84%, from 550,100 to 89,780; measles vaccination prevented an estimated 20.4 million deaths. However, the 2015 milestones have not yet been met; only one WHO region has been verified as having eliminated measles. Improved implementation of elimination strategies by countries and their partners is needed, with focus on increasing vaccination coverage through substantial and sustained additional investments in health systems, strengthening surveillance systems, using surveillance data to drive programmatic actions, securing political commitment, and raising the visibility of measles elimination goals.


Immunization Activities

To estimate coverage with MCV1 and the second dose of measles-containing vaccine (MCV2) through routine immunization services,§ WHO and the United Nations Children’s Fund (UNICEF) use data from administrative records (administrative coverage is calculated by dividing the vaccine doses administered by the estimated target population) and immunization coverage surveys reported annually by 194 countries. During 2000–2016, estimated MCV1 coverage increased globally from 72% to 85% (Table 1), although coverage has not increased since 2009. Considerable variability in regional coverage exists. Since 2012, MCV1 coverage has remained essentially unchanged in the African Region (AFR) (72%), the Region of the Americas (AMR) (92%), and the Eastern Mediterranean Region (EMR) (77%). In the European Region (EUR), MCV1 coverage has declined from 95% to 93% since 2012, with 51% of EUR member states reporting lower coverage since 2013. In the South-East Asia Region (SEAR), MCV1 coverage increased slightly since 2012, from 84% to 87%. The Western Pacific Region (WPR) is the only region that has achieved and sustained MCV1 coverage >95% (since 2008). Since 2000, the number of countries with MCV1 coverage of ≥90% increased globally from 85 (44%) in 2000 to 119 (61%) in 2015, and to 123 (63%) in 2016. However, among countries with ≥90% MCV1 coverage nationally, the percentage with ≥80% MCV1 coverage in all districts declined from 46% (52 of 112) in 2010 to 45% (49 of 110) in 2015 and 36% (44 of 123) in 2016. Among the estimated 20.8 million infants who did not receive MCV1 through routine immunization services in 2016, approximately 11 million (53%) were in six countries with large birth cohorts and suboptimal coverage: Nigeria (3.3 million), India (2.9 million), Pakistan (2.0 million), Indonesia (1.2 million), Ethiopia (0.9 million), and the Democratic Republic of the Congo (0.7 million).

During 2000–2016, the number of countries providing MCV2 nationally through routine services increased from 98 (51%) to 164 (85%), with four countries (Guatemala, Haiti, Papua New Guinea, and Timor-Leste) introducing MCV2 in 2016. Estimated global MCV2 coverage steadily increased from 15% in 2000 to 60% in 2015 and 64% in 2016 (Table 1). During 2016, approximately 119 million persons received supplementary doses of measles-containing vaccine (MCV) during 33 mass immunization campaigns, known as supplementary immunization activities (SIAs), implemented in 31 countries (Table 2). Based on doses administered, SIA coverage was ≥95% in 20 (61%) SIAs. Among the six countries that conducted post-SIA coverage surveys, estimated coverage was ≥95% in three, 90%–94% in two, and 84% in one.


Disease Incidence

Countries report the aggregate number of incident measles cases**,†† to WHO and UNICEF annually through the Joint Reporting Form. In 2016, 189 (97%) countries conducted case-based surveillance in at least part of the country, and 191 (98%) had access to standardized quality-controlled testing through the WHO Global Measles and Rubella Laboratory Network. Nonetheless, surveillance was weak in many countries; fewer than half of countries (64 of 134; 48%) achieved the sensitivity indicator target of two or more discarded measles and rubella§§ cases per 100,000 population in 2016 compared with 2015 (80 of 135; 59%).

During 2000–2016, the number of measles cases reported annually worldwide decreased 85%, from 853,479 in 2000 to 214,812 in 2015 and then to 132,137 in 2016; measles incidence decreased 87%, from 145 to 19 cases per 1 million population (Table 1). Compared with 2015, 2016 incidence decreased from 29 to 19 cases per million, although three fewer countries (173 of 194; 89%) reported case data in 2016 than did in 2015 (176 of 194; 92%).¶¶ The percentage of reporting countries with fewer than five measles cases per million population increased from 38% (64/169) in 2000 to 69% (119/173) in 2016. During 2000–2016, measles incidence of fewer than five cases per million was sustained in AMR (Table 1).

During 2015–2016, the number of reported measles cases declined globally and in all regions (AFR, 31%; AMR, 98%; EMR, 71%; EUR, 84%; SEAR, 44%, and WPR, 11%). In addition to aggregate reporting, countries report measles case-based data to WHO monthly. In some countries large discrepancies exist between the two reporting systems. During 2016, some countries either did not report or reported only a fraction of monthly reported measles cases through the Joint Reporting Form (e.g., India reported 70,798 measles cases through monthly reporting, but only 17,250 through the Joint Reporting Form).

Genotypes of viruses isolated from measles cases were reported by 60 (55%) of the 110 countries that reported at least one measles case in 2016. Among the 24 recognized measles virus genotypes, 11 were detected during 2005–2008, eight during 2009–2014, six in 2015, and five in 2016, excluding those from vaccine reactions and cases of subacute sclerosing panencephalitis, a fatal progressive neurologic disorder caused by persistent measles infection (4).*** In 2016, among 4,796 reported measles virus sequences,††† 666 were genotype B3 (36 countries); 44 were D4 (four); 1,407 were D8 (43); 87 were D9 (four); and 2,592 were H1 (13).


Disease and Mortality Estimates

A previously described model for estimating measles disease and mortality was updated with new measles vaccination coverage data, case data, and United Nations population estimates for all countries during 2000–2016, enabling derivation of a new series of disease and mortality estimates (5). Based on the updated data, the estimated number of measles cases declined from 29,068,400 (95% confidence interval [CI] = 20,606,800–55,859,000) in 2000 to 6,976,800 (95% CI = 4,190,500–28,657,300) in 2016. During this period, the number of estimated measles deaths declined 84%, from 550,100 (95% CI = 374,000–896,500) in 2000 to 89,780 (95% CI = 45,700–269,600) in 2016 (Table 1). Compared with no measles vaccination, measles vaccination prevented an estimated 20.4 million deaths during 2000–2016 (Figure).


Regional Verification of Measles Elimination

In 2016, four WHO regions had functioning regional verification commissions. In September 2016, the AMR regional verification commission declared the region free of endemic measles (6). In 2016, the EUR commission verified measles elimination in 24 countries (7). Two SEAR countries (Bhutan and Maldives) were verified as having eliminated measles in 2017 (8). The WPR commission reclassified Mongolia as having reestablished endemic measles virus transmission because of an outbreak that lasted >12 months; thus, five WPR countries (Australia, Brunei, Cambodia, Japan, and South Korea) and two areas (Macao Special Autonomous Region [SAR] [China] and Hong Kong SAR [China]) had verified measles elimination status in 2016 (9).



During 2000–2016, increased coverage with MCV administered through routine immunization programs worldwide, combined with SIAs, contributed to an 87% decrease in reported measles incidence and an 84% reduction in estimated measles mortality. Measles vaccination prevented an estimated 20.4 million deaths during this period, and during 2016, for the first time ever, estimated measles deaths declined to fewer than 100,000. Furthermore, the number of countries with measles incidence of fewer than five per million population has increased, although considerable underreporting occurred, and AMR has maintained an incidence of fewer than five cases per million population during 2000–2016. The decreasing number of circulating measles virus genotypes suggests interruption of some chains of transmission. However, the 2015 global control milestones were not met, global MCV1 coverage has stagnated, global MCV2 coverage has reached only 64%, and SIA quality was inadequate to achieve ≥95% coverage in several countries. With suboptimal MCV coverage, outbreaks continued to occur among unvaccinated persons, including school-aged children and young adults.

The 2016 Mid-term Review of the Global Measles and Rubella Strategic Plan 2012–2020 concluded that measles elimination strategies were sound, and the WHO Strategic Advisory Group of Experts on Immunization endorsed its findings. The review noted, however, that implementation of the strategies needs improvement. Measures should focus on strengthening immunization and surveillance systems. The Measles and Rubella Initiative should increase its emphasis on using surveillance data to drive programmatic actions.

The findings in this report are subject to at least three limitations. First, SIA coverage data might be biased by inaccurate reports of the number of doses delivered, doses administered to children outside the target age group, and inaccurate estimates of the target population size. Second, large differences between the estimated and reported incidence indicate variable surveillance sensitivity, making comparisons between countries and regions difficult to interpret. Finally, the accuracy of the results from the measles mortality model is affected by biases in all model inputs, including country-specific measles vaccination coverage and measles case-based surveillance data.

The decrease in measles mortality to fewer than 100,000 deaths in 2016 is one of five main contributors (along with decreases in mortality from diarrhea, malaria, pneumonia, and neonatal intrapartum deaths) to the decline in overall child mortality worldwide and progress toward the fourth United Nations Millennium Development Goal, but continued work is needed to help achieve measles elimination goals (10). Of concern is the possibility that the gains made and future progress in measles elimination could be reversed when polio-funded resources supporting routine immunization services, measles SIAs, and measles surveillance diminish and disappear after polio eradication. Countries with the highest measles mortality rely most heavily on polio-funded resources and are at highest risk for reversal of progress after polio eradication is achieved. Improved implementation of elimination strategies by countries and their partners is needed, with focus on increasing vaccination coverage with substantial and sustained additional investments in health systems, strengthening surveillance systems, using surveillance data to drive programmatic actions, securing political commitment, and raising the visibility of measles elimination goals.

WHO & Somalia working together to curb measles epidemic (almost 19 000 suspected cases reported in 2017)


WHO enhances surveillance capacity in Somalia ahead of nationwide measles campaign

25 October 2017, Puntland, Somalia—The World Health Organization (WHO) and Somali Federal Ministry of Health have conducted a series of trainings to enhance national capacity in early outbreak detection and response for measles ahead of a nationwide measles vaccination campaign in November.

The trainings aim to enhance measles case-based surveillance and laboratory confirmation, improve measles case management during seasonal outbreaks, and achieve the minimum routine measles vaccination coverage of 95%.

Somalia is currently facing its worst measles outbreak in 4 years, with almost 19 000 suspected cases reported in 2017 (as of 24 October). More than 80% of those affected by the current outbreak are children under 10 years of age. Minimum routine measles vaccination coverage is only 60%.

In early 2017, WHO and partners, in collaboration with national health authorities, vaccinated almost 600 000 children aged 6 months to 5 years for measles in hard-to-reach and hotspot areas across the country. Despite these efforts, the transmission of measles continues, compounded by the ongoing pre-famine situation, continued mass displacement, and undernourished children living in unhygienic conditions.

In order to contain the outbreak, a nationwide campaign is planned for November 2017 to stop transmission of the disease, targeting 4.2 million children. The campaign will also intensify efforts to strengthen routine immunization and reach unvaccinated children to boost their immunity.

“The Federal Ministry of Health (FMOH) has repeatedly highlighted the importance of surveillance in public health. Based on this national vision, public health professionals in Somalia are being updated on the measles case-based surveillance process,” said Dr Ghulam Popal, WHO Representative in Somalia. “FMOH and WHO are actively scaling up efforts to improve measles case management during outbreaks in general and ensure the proper implementation and high coverage of the upcoming measles campaign in particular,” he added.

On 24 October, WHO and FMOH concluded a 3-day training course on case-based surveillance for 35 health workers in Puntland. A training of trainers on measles campaign preparation and implementation was conducted in Mogadishu for 18 participants from the Ministry of Health, EPI Directorate, and other health partners on 16 October. At the regional level, a 2-day training course on measles epidemiology and outbreak response took place on 17–18 October for 68 participants from the South Central zones and the two States of Hiran Shabelle and Southwest.

WHO’s response to disease outbreaks, drought, and nutrition needs in Somalia has been made possible through the generous support of Japan, Germany, the Vaccine Alliance (GAVI), the Polio Global Eradication Initiative, the UN Central Emergency Relief Fund (CERF), and the UK Department for International Development (DFID).

Related links

WHO and Federal Ministry of Health of Somalia call for urgent support to address measles outbreak in Somalia
16 August 2017

WHO and partners scale up response in Somalia to protect children from deadly measles outbreak 
25 July 2017

WHO conducts measles surveillance workshop in Hargeisa
13 June 2017

Measles vaccination campaign launched in Mogadishu
21 May 2017

For more information, contact:

Ajyal Sultany, Communications Officer,


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