Measles mortality reduction and pre-elimination in the African region, 2001-2009.

Introduction. In 2001, countries in the African region adopted the measles-associated mortality reduction strategy recommended by the World Health Organization and the United Nations Children's Fund. With support from partners, these strategies were implemented during 2001-2009. Methods. To assess implementation, estimates of the first dose of measles vaccination through routine services (MCVI) and reported coverage for measles supplemental immunization activities (SI As) were reviewed. Measles surveillance data were analyzed. Results. During 2001-2009, regional MCV1 coverage increased from 56% to 69%, and >425 million children received measles vaccination through 125 SIAs. Measles case-based surveillance was established in 40 of 46 countries; the remaining 6 have aggregated case reporting. From 2001 through 2008, reported measles cases decreased by 92%, from 492,116 to 37,010; however, in 2009, cases increased to 83,625. Conclusions. The implementation of the recommended strategies led to a marked decrease in measles cases in the region; however, the outbreaks occurring since 2008 indicate suboptimal vaccination coverage. To achieve high MCV1 coverage, provide a second dose through either periodic SI As or routine services, and to ensure further progress toward attaining the regional measles pre-elimination goal by 2012, a renewed commitment from implementing partners and donors is needed.