Measles Vaccine Coverage Remains Suboptimal in Eastern Mediterranean

Large-scale measles outbreaks in the Eastern Mediterranean region have drawn attention to suboptimal vaccination coverage there, according to the US Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report.

The report highlights the ebb and flow of the disease in the region, which saw cases nearly triple from 2013 to 2018 before declining in 2019. Measles elimination was achieved in 3 of the 21 countries in the Eastern Mediterranean Region (EMR) (Bahrain, Iran and Oman) by the end of 2019, according to the EMR Verification Commission for Measles Elimination, which was established in February 2018.

Still, vaccination rates remain below recommended levels in many areas, and work remains to reach the World Health Organization region’s 1997 goal of eliminating the disease, which was included as a priority in the Eastern Mediterranean Vaccine Action Plan of 2016—2020.

“To accelerate progress toward measles elimination in EMR, the visibility of efforts to achieve the measles elimination goal must be raised, including the benefits of achieving measles elimination,” authors of the report noted.

Strategies to achieve measles elimination include boosting vaccination coverage to ≥95% for first- and second-dose of measles containing vaccine through routine and supplementary vaccination activities, conduct surveillance and provide clinical case management. The vaccination coverage goal of ≥95% was achieved in 11 of the region’s 21 countries in 2018, and only Somalia had yet to introduce the second dose of the vaccine. Supplementary vaccination activities resulted in vaccination of 326.4 million people during 2013-2019.

First-dose coverage increased from 79% in 2013 to 82% in 2018. Second-dose coverage increased from 59% in 2013 to 74% in 2018.

Reported measles cases in the region hit a record low of 9,499 before rising to 21,734 in 2015, 34,286 in 2017 and 64,198 in 2018 and falling to 16,703 in 2019. The number of genotypes detected decreased from 4 in 2013 to 2 in 2019.

Outbreaks in Pakistan, Somalia, and Yemen drove a near tripling of measles cases from 33.5 per 1 million persons in 2013 to 91.2 in 2018, before a significant drop to 23.3 in 2019.

“In several EMR countries, major challenges to implementing measles elimination activities include civil unrest, armed conflict, and unpredictable mass population displacements and resettlements that can disrupt all aspects of planning and implementation of immunization services delivery,” the report noted.

The Eastern Mediterranean Regional Technical Advisory Group on Immunization recommended forming a task force to apply lessons learned from the Global Polio Eradication Initiative, such as mapping areas where vaccinations were missed and developing a plan to deploy resources.

Measles infections resulted in 140,000 deaths worldwide in 2019, placing the disease among the infectious diseases considered by WHO as urgent challenges to address this decade. A comeback of the disease in the United States and abroad placed it among the top outbreaks of the year, with the United States nearly losing its elimination status.