Sub-saharan African countries are a lynchpin for measles control and recorded tremendous progress from 2000 to 2009, spurred by support from the Measles Initiative. This latest analysis from WHO’s African Regional office describes that progress, difficult setbacks in 2010 and new efforts to reach the African Region’s 2020 measles elimination goal.

Post by: WHO AFRO

The Ministers of Health of the 46 Member States in the African Region of the WHO set a goal to eliminate measles by 2020 at the Regional Committee meeting held in September 2011. This goal builds on progress in the reduction of measles mortality in the Region since it began implementing the WHO-UNICEF recommended strategies in 2001.

Measles routine immunization coverage has improved in the Region in the past decade from 56% in 2001 to 76% in 2010 (WHO-UNICEF official coverage estimates). In 2010, 16 countries had measles vaccination coverage of 90% and above (an increase from just four in 2000) while only five countries[1] had coverage of less than 60% (down from 19 countries in 2000). From 2001 through 2011, with support of the Measles Initiative, a total of 159 measles supplementary immunization activities (SIAs) were conducted in 44 countries in the Region, reaching a total of 537.6 million children.

Countries in the Region have documented a significant decline in measles cases in the last decade, measured through the case-based surveillance system. However an increasing proportion of measles cases now affect people above 5 years of age- with an increase in proportion from 38% in 2001 to an average of 51% in 2010. This shift of the age of susceptibility requires a change in the approach to SIAs, with a widening of the target age group above the traditional ceiling of 5 years of age.

In 2010, 28 countries experienced measles outbreaks of which six countries[2] in the Southern African sub-region had large outbreaks that lasted six months or more. In 2011, Zambia and the Democratic Republic of the Congo experienced relatively large outbreaks, with more than 13,000 cases in Zambia and more than 133,000 cases reported in DR Congo. The factors that contributed to these outbreaks included prolonged intervals exceeding 36 months between successive measles follow-up SIAs, resistance to measles vaccination amongst followers of certain religious groups, gaps in national and subnational level routine immunisation coverage, delays in scheduled SIAs, and the shift of epidemiological susceptibility to measles towards older age groups.

In 2012, 17 countries in the Region[3] will implement follow-up SIAs targeting a total of 51.2 million children. The full mobilisation of resources and timely conduct of activities is crucial to avert measles outbreaks. As in the past years, the Measles Initiative is mobilising resources to support countries in the Region, purchase bundled vaccines and provide US$ 30 cents per child to support half of the operational costs of the SIAs. The mobilisation of the remaining financial resources from governments and local partners has been a challenge in the past, and needs to be tackled as a matter of priority in the countries targeted.

In order to achieve the 2020 elimination target, advocacy and resource mobilization efforts must be intensified at global and country levels so that the recommended strategies can be widely implemented in all countries of the Region.