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WHO: Two doses of measles vaccine needed in eastern Mediterranean region
To achieve measles elimination in the eastern Mediterranean region, an increase in second-dose vaccination is needed, particularly in countries with a high incidence of measles and those affected by conflict. Further, populations at high risk in areas with poor access to vaccination services or with political conflict should be targeted, according to a report in MMWR.
Although significant progress was made between 1997 and 2007, 22 countries in the WHO eastern Mediterranean region did not reach the goal of measles elimination by 2010. The date was revised to 2015.
Nadia Teleb, MD, of WHO’s regional office for the eastern Mediterranean, and colleagues assessed the progress made toward measles elimination in this region between 2008 and 2012.
Overall, estimated coverage of the first dose of measles vaccination increased from 83% in 2008 to 85% in 2010 and decreased to 83% in 2012. In 2012, first-dose measles vaccination coverage was unavailable for one of the 23 countries in the eastern Mediterranean region; coverage was less than 90% in 10 countries; 90% to 94% in two countries; and at least 95% in 10 countries. Of those with at least 95% coverage, five reported at least 95% coverage in all districts.
Among the 20 countries with a routine two-dose or more vaccination schedule, coverage was at least 95% in 11 countries; 50% to 94% in six countries; and less than 50% in three countries.
Between 2008 and 2012, 186,760,207 doses of measles vaccine were administered to children through 93 supplementary measles immunization activities.
The annual number of measles cases in the eastern Mediterranean region increased from 12,186 in 2008 to 36,456 in 2012. Measles incidence increased from 21.4 to 59.5 cases per 1 million population from 2008 to 2012.
Large outbreaks occurred in countries with conflict or with a high incidence of measles. There were 709 cases in Djibouti in 2012; 35,822 cases in Iraq in 2008; 16,753 cases in Pakistan from 2010 to 2012; 27,281 cases in Somalia in 2011; 3,208 cases in South Sudan in 2011; 14,139 cases in Sudan in 2011; and 4,843 cases in Yemen in 2011. Large outbreaks of more than 1,500 measles cases occurred annually in Afghanistan between 2008 and 2012. The aforementioned countries made up more than 90% of measles cases in the eastern Mediterranean region in 2012. Together, they had an incidence of 105.3 cases per 1 million population vs. 7.9 cases per 1 million population in the rest of the region’s countries.
Six countries with strong surveillance systems — Bahrain, Egypt, Oman, the West Bank and Gaza Strip, Syria and Tunisia — had a measles incidence of fewer than five cases per 1 million population.
Genotype B3 was reported in 15 of the 16 countries with genotype results for 2008 to 2012. Conversely, genotype D4 was predominant between 2003 and 2007.
“To achieve measles elimination, the key strategies outlined in the Global Vaccine Action Plan and the Measles and Rubella Initiative Strategic Plan need to the implemented in all [eastern Mediterranean region] countries. Efforts should focus on increasing [first dose of measles-containing vaccine] and [second dose of measles-containing vaccine] coverage and ensuring that routine immunization services and [supplementary immunization activities] reach at-risk populations who reside in areas with poor access to vaccination services or with civil strife,” the researchers concluded.
Disclosure: The researchers report no relevant financial disclosures.
