Measles vaccine coverage decreased in more than half of districts in low- and middle-income countries between 2010 and 2019, according to a paper published in Nature. This decline may have contributed to more than 17 million measles cases and 83,400 deaths in children under 5 years old in 2017.
The safe, highly effective measles vaccine has been recommended globally since 1974, yet in 2017 there were a record number of measles cases and deaths in children. Although high-income locations, such as the United States and Europe, have recently begun to experience extended measles outbreaks, over 99% of cases occurred in low- and middle-income countries. Globally comparable, annual, local estimates of routine first-dose measles-containing vaccine coverage are critical for understanding geographically precise immunity patterns, progress toward Global Vaccine Action Plan targets, and high-risk areas amidst COVID-19-related disruption of vaccination programmes.
Jonathan Mosser and colleagues have generated annual estimates of routine childhood measles vaccine coverage from 2000 to 2019 in 101 low- and middle income countries. They quantified geographic inequality, and assessed vaccination status by geographic remoteness. The authors show that after widespread increases in vaccination from 2000 to 2010, coverage declined in over half of districts between 2010 and 2019, leaving many low- and middle-income countries far from the Global Vaccine Action Plan goal of 80% coverage in all districts by 2019. Vaccine coverage was lower in rural than urban locations, although a larger proportion of unvaccinated children overall lived in urban locations. The three districts with the lowest measles vaccine coverage in 2000 were located in Hari Rasu, Ethiopia, Gabi Rasu, Ethiopia, and Isa, Nigeria. In 2019, the three lowest-coverage districts were located in Afghanistan.
The authors conclude their findings can be used as a tool for decision-makers to use in immunization programmes that provide equal protection for all children globally.
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