Should measles be eradicated?

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F T Cutts (fcutts@lshtm.ac.uk), readera,
R Steinglass, senior technical officerb

^a Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London WC1E 7HT,
^b Basic Support for Institutionalising Child Survival, Arlington, VA 22209, USA

Correspondence to: Dr Cutts

Accepted 9 September 1997

Before measles vaccine was introduced, around 5.7 million people worldwide died each year of measles; by 1995 this total had fallen by 88%.1 In Latin America, measles incidence and mortality fell by 99% after vaccination was introduced. As a result, an international meeting in July 1996 recommended a global programme of measles eradication by a target date between 2005 and 2010.2 We discuss whether such a goal is feasible and appropriate.

Case for eradicating measles

Reducing mortality due to measles is a public health priority in developing countries. Measles eradication—defined as the interruption in the transmission of measles globally so that vaccination can be stopped—is possible theoretically because no animal reservoir is known to exist and measles vaccine is highly effective. 2 3 Eradication of the measles virus would obviate the need for the continuous monitoring of changes in measles epidemiology (and responses to this) induced by measles vaccination. 4 5 These epidemiological changes include a shift in the age distribution of measles towards older children and adults 6 7; the occurrence of “post honeymoon” outbreaks, when numbers of susceptible people grow over years of moderate vaccination coverage until their total surpasses the epidemic threshold 5 6 8; and the fact that babies born to mothers whose immunity is not natural but induced by vaccine have a shorter period of passive protection. 5 9

Do we need to know more?

The World Health Organisation recommends that countries aiming to eliminate measles adopt the strategy used in Latin America of an initial catch-up campaign, with high coverage of routine infant vaccination, intensive surveillance, and periodic follow up campaigns. 2 10 However, questions remain on which age range to vaccinate in campaigns, maintaining safe injection practices, and the feasibility and cost of achieving high enough coverage in the poorest countries. Cost-benefit analyses need to compare programmes that aim …