Research & Innovation
Despite major advances in increasing coverage with measles and rubella vaccine, recent reports note that many countries and regions are not on course to reach Global Vaccine Action Plan targets. Increasing vaccination coverage will require additional investments to address barriers to measles and rubella vaccination and to develop innovative strategies for increasing coverage. Therefore, the M&RI has
asked the U.S. Centers for Disease Control and Prevention, a founding partner of M&RI, to take the lead in forming a Research and Innovations (R&I) working group within the M&RI. The R&I Working Group monitors, prioritizes, and coordinates measles and rubella research and will establish a mechanism for funding the high priority research needed to meet measles and rubella elimination targets. The R&I Working Group will help coordinate periodic updating of the measles and rubella research agenda by working with M&RI partners, government agencies, and academic institutions.
Key Historical Events on the Path to a World Without Measles, Rubella, and CRS.
-Sydenham Documents Measles Infection: English doctor Thomas Sydenham, MD, publishes Observationes medicae circa morborum acutorum historiam et curationem (Medical observations on the history and cure of acute diseases). Although the Persian physician Rhazes was the first to attempt distinguishing smallpox from the measles, Sydenham was the first to do so successfully and in detail. He also recorded details about and distinguished the disease from scarlet fever.
-Infectious Nature of Measles Shown: Scottish physician Francis Home, MD, transmitted measles from infected patients to healthy individuals via blood, demonstrating that the disease was caused by an infectious agent.
-Rubella: The Naming of the “Little Red”: The name “Rubella,” meaning “little red,” was first used to describe an outbreak at a boys’ school in India. Later, this would be referenced by English surgeon Henry Veale in the Edinburgh Medical Journal (Volume 12, 1866) documenting the history of an epidemic of “Rötheln.” Veale proposed that the name Rubella replace “Rötheln,” citing the need for a name that was easy to write and pronounce.
-Measles-specific Antibodies Identified: French researchers Charles Nicolle, MD, and Ernest Conseil, MD, showed that measles patients have specific protective antibodies in their blood. The researchers then demonstrated that serum from measles patients could be used to protect against the disease.
-Rubella: Researchers Demonstrate Transmission of Disease: Japanese scientists S. Tasaka and Y. Hiro used throat washings from children sick with rubella to transmit the disease to healthy children. The causative agent of the disease, however, remained unidentified.
-Rubella Implicated in Congenital Defects: Australian ophthalmologist Norman McAlister Gregg noted a surprising number of infants suffering from cataracts in his practice. Infection with rubella during the first trimester of a pregnancy resulted in a greater than 2 in 3 chance of a baby afflicted with congenital rubella syndrome. Of the syndrome’s various symptoms and complications, ranging from blindness to heart disease to neurological abnormalities, deafness was the most common.
-Measles Virus Isolated: Lab director John Enders asked Thomas Peebles, MD to isolate the virus responsible for measles. Peebles learned of an outbreak at a private school outside of Boston and, after getting permission, collected blood samples from the sick students, telling each boy: “Young man, you are standing on the frontiers of science.” He collected blood containing the virus from student David Edmonston, which was eventually used to create a series of vaccines.
-First Measles Vaccine Is Tested: Sam Katz, MD, working with Thomas Peebles and other researchers in the Boston lab, tested the first version of the lab’s vaccine on mentally and physically disabled children at a school outside of Boston. Each of the 11 vaccinated children developed measles antibodies, but 9 also developed a mild rash—the vaccine didn’t cause full-blown measles, but it did cause symptoms. The researchers realized the virus used for the vaccine had to be weakened even more.
-Rubella Virus Isolated: Maurice Hilleman and Eugene Buynak isolated the Benoit strain of rubella virus. They hoped to develop an inactivated virus vaccine, but eventually gave up this idea in favor of an attenuated virus vaccine.
-Measles Vaccine Licensed: After demonstrating its safety and efficacy, first in monkeys and then humans, John Enders and colleagues declared their measles vaccine capable of preventing infection. Their Edmonston-B strain of measles virus was transformed into a vaccine licensed in the United States in 1963, and nearly 19 million doses would be administered over the next 12 years.
-U.S. Rubella Outbreak Infects Millions: Despite warnings about keeping infected children away from pregnant women, nearly 50,000 women in vulnerable stages of pregnancy were infected with rubella, leading to thousands of miscarriages and birth defects. At least 8,000 were born deaf, 3,500 deaf and blind; the total number of congenital rubella syndrome cases reached 20,000. There were about 12.5 million rubella cases and more than 2,000 deaths. Resulting medical costs reached the billions.
-Rubella: First Vaccine Licensed: Maurice Hilleman, working at Merck, modified a rubella vaccine virus from Paul Parkman and Harry Meyer, scientists at the Division of Biologics Standards. The vaccine entered commercial use in 1969-1970.
-MMR Combination Vaccine Debuts: The U.S. government licensed Merck’s measles, mumps, and rubella combination vaccine (M-M-R). In an article published in the Journal of the American Medical Association, researchers reported that the vaccine induced immunity to measles in 96% of vaccinated children; to mumps in 95%; and to rubella in 94%. Additionally, initial tests in 1968 had already shown that adverse reactions from the MMR vaccine were no greater than from any of the single vaccines.
-Measles Targeted for Elimination: The Centers for Disease Control and Prevention declared a goal of eliminating measles from the United States by 1982. Although this goal would not be met, widespread vaccination drastically reduced the incidence of the disease, and it would be declared eliminated in the country by 2000.
-The Ministers of Health in the Regional Committee for the Pan American Health Organization (PAHO) agree to eliminate measles in the Region of the Americas by 2000.
-WHO established the Measles and Rubella Laboratory Network (LabNet), based on the Global Polio Laboratory Network model. When it started, it included 60 laboratories worldwide.
-The American Red Cross, CDC, UNF, UNICEF and WHO agree to be the founding partners of the Measles Initiative (MI) with a vision of a world without measles.
-The last endemic measles case occurred in the Region of the Americas.
-The Ministers of Health in the PAHO Regional Committee agree to eliminate rubella in the Region by 2010.
-The Ministers of Health in the Regional Committee of the European Region agree to eliminate rubella by 2015.
-Encouraged by the progress being made in reducing measles deaths worldwide, WHO Member States requested that the WHO evaluate the feasibility of the global eradication of measles.
-WHO recommends that all national immunization programs include 2 doses of measles containing vaccine for all children to provide lifelong immunity.
-The last case of endemic rubella is reported in the PAHO Region, in Argentina.
-Global Consultation on the Feasibility of Measles Eradication: Panel concluded that measles can and should be eradicated and that global eradication by 2020 is feasible given evidence of measurable progress towards the 2015 targets. Furthermore, the ad hoc advisory panel stressed that measles eradication activities should be carried out in the context of strengthening routine immunization services and should be used to accelerate rubella control and the prevention of congenital rubella syndrome.
-Executive Board of the World Health Assembly agrees with WHO Strategic Advisory Group of Experts (SAGE) recommendation that measles can and should be eradicated and proposed that demonstration of sufficient progress toward the 2015 control targets and regional measles elimination goals be made as a basis for establishing a target date for measles eradication.
-WHO Position Paper recommends that all countries that have not yet introduced rubella vaccine and are providing 2 doses of measles vaccine include rubella-containing vaccines in their immunization program.
-The MI became the Measles & Rubella Initiative (M&RI), and published the Measles & Rubella Strategic Plan, 2012-2020, expanding the vision to include a world without measles and rubella. -Immunization partners established the Global Vaccine Action Plan (GVAP) that included a goal for measles elimination and rubella control or elimination in 5 of the 6 regions of the world by 2020.
-The Ministers of Health in the Regional Committee of the South-East Asia Region agree to eliminate measles by 2020, marking the first time that all 6 regions of the world have established goals for measles elimination.
-A Record Year for Measles in Elimination Era: The CDC reported 644 cases of measles in 2014, the highest number of U.S. cases in any year since measles was declared eliminated in 2000. -The Western Pacific Region Verification Committee verified Australia, Macao (China), Mongolia and Republic of Korea are verified as having achieved interruption of endemic measles transmission.-The Region of the Americas is the first in the world to be officially declared free of rubella and congenital rubella syndrome.
-The Western Pacific Region Verification Committee verified Brunei Darussalam, Cambodia and Japan as having achieved interruption of endemic measles transmission.
Updated on November 21st, 2017