Measles Elimination Progress Worldwide, 2000–2022 (MMWR)

Estimated annual measles deaths with and without measles vaccination, worldwide, 2000–2022. CDC.

Summary

• Already known: global coverage with measles-containing vaccine (MCV) fell during the COVID-19 pandemic to its lowest since 2008, and surveillance weakened.
• This report: vaccination prevented an estimated 57 million deaths in 2000–2022. But millions of children missed doses during the pandemic: estimated cases rose 18% and deaths 43% in 2022 over 2021, with large or disruptive outbreaks in 37 countries.
• Implication: every child needs 2 MCV doses, and surveillance must be strengthened.

Background

Measles is highly contagious and preventable; stopping it takes very high immunity. All six WHO regions have pledged elimination, but none has achieved and sustained it. The Immunization Agenda 2030 calls for 95% coverage with 2 timely doses. Because measles spreads so easily, outbreaks quickly expose children missed by routine immunization — a tracer of how well health systems deliver vaccines.

Vaccination

• Where children are missed: ten countries — Nigeria (3 million), Democratic Republic of the Congo, Ethiopia, India, Pakistan, Angola, Philippines, Indonesia, Brazil and Madagascar — held 55% of children missing a first dose.
• Regions: coverage fell everywhere in 2019–2021; in 2022 it rose in all regions except the Americas and Europe, but stayed below 2019 levels everywhere except the Eastern Mediterranean.
• New second doses: Chad, DR Congo, Guinea, Guinea-Bissau, Somalia and Uganda introduced MCV2 in 2022; six countries still hadn't.
• Campaigns: about 115 million people were vaccinated in supplementary campaigns in 44 countries in 2022, plus 16 million in outbreak responses; 35 of 41 campaigns delayed by COVID-19 had been held by the end of 2022.

Surveillance and reported cases

• Surveillance: of 144 countries reporting, 72 (50%) met the sensitivity target of two or more discarded (non-measles) cases per 100,000 people — up from 35% in 2021. The 743-lab Global Measles and Rubella Laboratory Network tested 273,080 specimens, nearly twice 2021's number.
• Reported cases: down 85% from 853,479 (2000) to 132,490 (2016); a surge to 837,922 in 2019; down to 123,171 in 2021; up 67% to 205,153 in 2022 (29 per million).
• Outbreaks: large or disruptive outbreaks hit 37 countries in 2022, up from 22 — 28 of them in the African Region.
• Genotypes: only two — D8 and B3 — were detected in 2021 and 2022, down from 13 in 2002.

Estimated cases and deaths

Elimination status

By the end of 2022, 83 countries (43%) had been verified as having eliminated measles, but no WHO region, and no African country. The Americas were verified in 2016, but endemic spread returned in Brazil and Venezuela; since 2016 it has also returned in Albania, Czechia, Lithuania, Slovakia, Uzbekistan, Cambodia and Mongolia. The United Kingdom regained elimination status in 2021.

What it means

Coverage is recovering but unevenly, and has fallen most in low-income countries, where measles is deadliest. Only 36 of 194 countries were above their 2019 coverage by 2022, so children born in the pandemic years are piling up unprotected. Half of countries still miss the surveillance target, and rising discarded-case rates may reflect outbreak testing more than better surveillance. Countries can draw on the Measles and Rubella Strategic Framework to strengthen routine immunization, surveillance and outbreak response — and catch-up campaigns remain essential to close immunity gaps.

Limitations: coverage data quality, few genotyped specimens, and uncertainty in model estimates.

Sources

Based on "Progress Toward Measles Elimination — Worldwide, 2000–2022," by Anna A. Minta and others, of the World Health Organization, Pennsylvania State University, Boston University, the London School of Hygiene & Tropical Medicine and CDC, Morbidity and Mortality Weekly Report, Centers for Disease Control and Prevention; a work of the United States government in the public domain.