CDC Fights Measles

What is measles?

Measles is far too common, but unlike a common cold, this infection can be fatal. Measles virus spreads through the air when an infected person coughs or sneezes and can seriously affect children and adults. Symptoms can include runny nose, fever, watery eyes, skin rash; complications can include pneumonia, encephalitis and death. Worldwide, it is estimated that over 300 children die from measles complications each day. In the United States, 667 measles cases were reported to CDC in 2014—the largest number of cases in a year since 1994. These cases resulted from people infected overseas bringing the virus into the US.

The last endemic case in the US was in 2000 and endemic measles was officially eliminated from the Western Hemisphere in 2016. Unfortunately, cases detected in the US represent only a tiny sliver of the estimated 10 million people affected by measles around the world each year. Thankfully, measles can be prevented by a safe and effective vaccine that has been available for over 50 years.

The global fight against measles is serious business for Robb Linkins, Mark Papania, and Jim Goodson, epidemiologists in the Global Immunization Division (GID) at CDC. Along with staff at WHO, UNICEF, the United Nations Foundation, and the American Red Cross—other partner agencies of the Measles and Rubella Initiative (M&RI) of which Linkins is chair—they work tirelessly to help get vaccine to the 130 million children born each year, before they are exposed to this deadly disease.

“Measles moves fast; we’ve got to move faster” says Papania, lead of the Measles Elimination Team in GID. Their strategies start with delivery of two doses of measles vaccine to all children. Measles elimination requires strong immunization programs that can vaccinate all children on-time, regardless of where they live, and much of the global fight focuses on strengthening immunizations systems to be able to complete this strategy. Other key strategies include conducting large supplemental vaccination campaigns to give vaccine to children missed by the routine systems, and building surveillance systems to detect and respond to measles outbreaks as quickly as possible to limit the number of measles cases.

Linkins, chief of the Accelerated Disease Control and Vaccine Preventable Disease Surveillance Branch in GID, says, “CDC provides the technical muscle for the M&RI by providing technical assistance though deploying Atlanta-based staff to high measles-burden countries, seconding staff long-term to partner agencies, and supporting the Global Measles and Rubella Laboratory Network.” “But measles elimination efforts go way beyond a ‘measles-only,’ silo approach,” Linkins adds. “We’re working with partners to build systems that not only ensure protection from measles, but other vaccine-preventable diseases and public health threats as well.”

Jim Goodson, senior measles epidemiologist in GID, is working closely with Paul Rota, acting chief of the proposed Viral Vaccine Preventable Diseases Branch in CDC’s Division of Viral Diseases, on a new vaccine delivery technology that could make the battle against measles and other vaccine-preventable diseases a whole lot easier. In partnership with Georgia Tech, Goodson and Rota are working on a Band-Aid-like patch to easily deliver vaccines without needles which cause pain and require highly trained healthcare staff for safe injection. The vaccine patches will also be more thermostable, which means easier delivery in areas where refrigeration is not available. “We’re at a point where we’ve achieved huge reductions in the number of measles cases, in fact by 75 percent since 2000,” says Goodson. “But there are still some large reservoirs of measles virus remaining, particularly in parts of Africa and Southeast Asia. Innovative approaches like this vaccine patch would really improve vaccine access and public health equity.”

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Jim Goodson, Robert Linkins, and Mark Papania (Photo by Sarai Thompson)

 

How close are we to measles eradication?

“We’ve prevented more than 20 million deaths from measles since 2000,” says Papania, “and with the elimination of measles from the Americas, we know global eradication is possible.” But Linkins, Papania, and Goodson all agree that measles eradication is not going to happen anytime soon without a substantial scale-up of resources and effort. Fortunately, the road to measles eradication allows for opportunities along the way to strengthen systems for on-time, routine delivery of all immunizations, and development of strong surveillance systems and staff that can detect and respond efficiently and effectively to a wide variety of outbreaks.

“We think of measles elimination efforts as a public health tugboat. In our efforts to ensure all children are protected from this deadly virus, we’ve got the obligation and opportunity to strengthen public health systems worldwide. That’s a fundamental part of our eradication strategy,” says Linkins. “We can’t protect children from measles only to leave them vulnerable to other dangerous diseases. We can protect children from measles forever by getting rid of this deadly disease, and at the same time build a legacy of immunization systems that can deliver all vaccines to all people who need them.”

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Purple pinky means vaccination cleared! (Photo courtesy of UNICEF)

(This Inside Story / CDC by Sarai Thompson)

SAGE endorses Midterm Review of Global Strategy

SAGE endorses Midterm Review of the Global Measles and Rubella Strategic Plan 2012-2020

The Strategic Advisory Group of Experts (SAGE) on Immunization met in Geneva, October 18 to 20, 2016. As part of its intensive three day agenda, SAGE reviewed the independent report presented by Dr. Walt Orenstein, Professor of Medicine at Emory University and Chair of the Midterm Review panel.

Measles mortality has dropped by 79% between 2000 and 2014 with an estimated 17.1 million lives saved through measles vaccination during this same time period. Despite these significant advances, the Midterm Review found the strategies articulated in the Global Measles and Rubella Strategic Plan 2012-2020 have not been fully implemented due to lack of country ownership and global political will as reflected in insufficient resources.

The report also recommends an increased focus with improving immunization systems in general to ensure that the gains made thus far in measles and rubella control can be sustained.

The Measles & Rubella Initiative welcomes this review and continues to work with partners, stakeholders and countries to push measles and rubella elimination activities towards 2020 goals and beyond. Our focus continues to be on increasing resources and ensuring technical work continues apace to ensure that recommendations from the review can be incorporated towards the global elimination of measles and rubella.

The Midterm Review report is available here.

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SAGE is the principal advisory group to WHO for vaccines and immunization, providing guidance on global policies and strategies.

Region of the Americas declared measles free

The region of the Americas will be the first in the world to be declared free of measles

After 22 years of tremendous work, the region of the Americas has been declared free of measles. The elimination of measles was verified  over a six- year period by an International Committee of Experts convened by the Pan American Health Organization (PAHO). The Committee will present its final report to the health ministers of member countries of PAHO, participating this week in the 55th meeting of its Directing Council.

Today, the declaration of measles elimination will be presented to the Director of PAHO, Carissa F. Etienne, in a plenary session. Upon completion of the session, a press conference will be held.

For more information click here.

Background: In 2002, the Americas region reported the last endemic case of measles. However, since measles continues to circulate worldwide, some countries continued to report imported cases. The International Committee of Experts for Documentation and Verification of Measles, Rubella and Congenital Rubella Syndrome Elimination in the Americas received evidence presented by all countries on the elimination of this disease between last year and August this year. The Region of the Americas will be the first in the world to obtain this status. It had been declared free of rubella and congenital rubella syndrome in 2015. Today, measles becomes the fifth vaccine-preventable disease to be eliminated in the Americas.

Social media and technology at work in Kenya

Measles & Rubella Initiative founding partner, the American Red Cross recently supported the Kenya Red Cross with community outreach to ensure as many children were protected against measles during a recent campaign. The Kenya Red Cross used social media to reach its extensive audience and SMS text messaging to ensure that information on the campaign was widely disseminated. Social media expert, Munir Ahmed, explains how and why they’re using technology to reach as many Kenyan families as possible in this interview.

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Focus on: Central Africa Republic Measles SIA

Photo Credit: UNICEF CAR Le Du

Central Africa Republic (CAR) has just begun phase two of its measles SIA targeting 1.9 million children aged 6 months to 10 years. CAR remains a Level Two emergency situation as a result of a complex emergency crisis that has led to the collapse of basic social services including healthcare.

Only half of children less than a year old have been vaccinated against measles since 2013 with recurring outbreaks in all CAR regions. One-third of health facilities have been partially or totally destroyed with approximately half of remaining facilities still capable of providing immunization services.

Phase one of the campaign occurred May 18 – 22 in eastern and northern regions, with the second phase from June 14 – 18 targeting regions in central and western CAR. Deworming medication and vitamin A supplementation was also provided throughout the campaign. More than 1,800 immunization teams have been deployed already.

Funding from the Measles & Rubella Initiative provided vital technical assistance and procurement of measles vaccine. Funding was also provided by the United States Fund for UNICEF. Implementing partners include the CAR Ministry of Health, UNICEF, WHO, ACF, HCR, Centre de Dialogue Humanitaire, PU-AMI, CAR Red Cross, MSF, IMC, MIUSCA, Ugandan Army, CORDAID and Save the Children amongst others.

The anti-vaccination movement

The anti-vaccination movement has a long history, beginning in France in 1763 and continuing through to today. As with all hot-button issues, it’s important to have accurate information and listen to both sides of the story. In the below infographic, developed by Mark Kirkpatrick, a freelance health journalist and dietitian, we discuss the reasoning and history behind the anti-vaccination movement.  In the early days of immunization, distrust in vaccines was well-warranted. There was no official quarantine procedure for those who’d already been inoculated and 18th Century doctors didn’t have quite the same standards as us when it came to sanitation and disease prevention. But as you can see, medical knowledge and standards have progressed greatly since those times and today’s vaccinations are a safe and effective tool in battling global health issues such as measles and rubella.

More than just a timeline of anti-vaccination movements, this infographic also includes useful information about vaccination itself, some of which might very well surprise you. For example: did you know that the first immunizations were administered in China in the 10th Century BCE? Or that the famed French philosopher Voltaire argued strongly for immunizations?

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Click here for a high res version.

Return on Investment From Childhood Immunization

A study led by Sachiko Ozawa of Johns Hopkins University and recently published in the February 2016 edition of the Health Affairs Journal, share findings that show the economic benefits of increased investment in global vaccination programs.  The team compared the program costs for providing 10 antigens in  ninety-four low and middle-income countries during the period of 2011–2020 versus the costs for estimated treatments of unimmunized individuals during the same period.  Their findings show that across the board that prevention of the diseases results in an average return on investment (ROI) of 16 times the original costs. While the ROI varies between antigens each shows a net benefit from the initial amount spent. Of the examples studied measles vaccines showed the greatest ROI with $58 dollars saved in future costs for every $1 dollar spent.  Overall the study confirms that investment in vaccination programs makes sound economic sense and encourages governments and donors step up and meet the requisite initial investments to in order to realize the substantial positive return.

Click here to read abstract

International Task Force for Disease Eradication

The International Task Force for Disease Eradication (ITFDE) met at the Carter Center in Atlanta, Georgia in November, 2015 to review and discuss the potential eradicability of measles and rubella. The ITFDE was formed nearly thirty years ago to evaluate disease control and prevention, and the potential to eradicate eight infectious diseases.

The ITFDE still firmly believes that both measles and rubella eradication are technically feasible, while noting that a number of vital factors require sustained global commitment and significant increases to both human and financial resources. In its final report, the ITFDE notes that combining measles and rubella eradication provides “enormous additional benefit” and that “the opportunity exists to position measles-rubella elimination as the highest disease control priority within GVAP and to instil real accountability for achieving these goals.”

While the decrease in measles mortality is among the main contributors to the decline in overall child mortality and progress toward Millennium Development Goal 4, measles and rubella elimination efforts have been “greatly overshadowed in magnitude of resources and political commitment by the Global Polio Eradication Initiative.”

At the turn of the century, measles was one of the top five leading killers of children with an estimated 546,800 deaths globally. Measles deaths have since dropped 79% to an estimated 114,900 in 2014. The ITFDE stresses that this mortality burden is entirely unacceptable given the availability of a cheap and effective vaccine for the past 50 years.

The panel also acknowledged the progress of introducing the use of rubella vaccine in lower-income countries which has greatly decreased the number of reported CRS and rubella cases, now estimated at 100,000 per year.

A robust strategy is needed to communicate the urgency of measles and rubella eradication to decision-makers, identify champions, and promote as an issue of global equity for children. The impending completion of polio eradication opens a window of opportunity to devote greater attention to measles and rubella eradication so the time to act is now.

The full report is published in the 12 February 2016 edition of WHO’s World Epidemiological Record.

Migration & Measles Prevention

Story by Carmela Burke, American Red Cross Volunteer, Los Angeles, California

Migrants’ stories and photos appear above the newspaper fold line.  Images dominate traditional and social media which draw attention to their harrowing journeys through Asia, the Middle East, and Europe.

Rand Corporation analyst Shelly Culbertson cites a staggering statistic from the United Nations Refugee Agency, (UNHCR): “60 million people have been displaced due to war, conflict and persecution—the highest level of displacement in the history of the world.”

In light of current events, the terms “migrant” and “refugee” are used interchangeably referring to people who flee war, conflict and/or persecution.

The American Red Cross continues to work with the global Red Cross and Red Crescent network to meet the needs of the world’s most vulnerable populations, including children.  In the past four years, we have spent and committed more than $2.5 million on relief efforts in Syria and its neighboring countries affected by conflict such as Iraq, Turkey, Lebanon and Jordan.  As the crisis continues, the American Red Cross is providing information management and mapping support to the global operation to ensure that Red Cross and Red Crescent Societies are not responding independently of each other, but rather, have greater situational awareness of the broader crisis. The American Red Cross also provided 10,000 cots to help families in Germany. For more information on the Red Cross response, please click here.

For millions of children, experiencing this level of trauma at such a young age causes developmental consequences.  For a family trying to land on their feet in a new environment, access to adequate education, accommodations, and health care are priorities.  Where do they start?

A joint report from WHO-UNHCR-UNICEF reveals that those most at risk for vaccine-preventable diseases are young children, and that “refugees and migrants be vaccinated against these diseases as a priority in line with national vaccination schedules.”

Help Locally to Protect Children Globally

Launched in 2001, the Measles & Rubella Initiative is a global health partnership led by the American Red Cross, the United Nations Foundation, the US Centers for Disease Control and Prevention, UNICEF and the World Health Organization. The Initiative provides technical and financial support to governments and communities for mass vaccination campaigns and disease surveillance around the world.

As travel between countries—during peacetime or wartime—becomes more frequent, it is even more imperative that we immunize our children against vaccine preventable diseases.  “While some countries have been successful in eliminating certain diseases within their borders, as long as these diseases continue to thrive elsewhere, they are still vulnerable to outbreaks due to risk of importation from other countries,” according to James Noe of the Measles & Rubella Initiative at the American Red Cross.

Using measles as an example, in the United States through a strong vaccination program the disease was eliminated in 2000 with no endemic cases seen since then.  However cases of measles and subsequent outbreaks have been reported regularly within the country with at least 7 recorded outbreaks since 2013.  Through laboratory confirmation and observation, the genotypes of these viruses have been linked to outbreaks in other countries which have travelled across borders, said Noe.  “With a virus as contagious as measles, which has a 90% transmission rate, it is incredibly important to continue to vaccinate children here and abroad to effectively protect them from this deadly disease.”