Deaths of children from measles plummet

WASHINGTON -- The number of measles deaths among children in the developing world has plunged by a startling 60 percent in five years because of intensive vaccination drives in nearly four dozen countries, saving the lives of an estimated 2.3 million children, according to a report released yesterday by a consortium of world health organizations.

The most dramatic improvement happened in sub-Saharan Africa, the poorest area of the world, where the measles mortality rate dropped 75 percent, mostly among children under age 5. Health officials credit immunization campaigns in 37 African countries from 2000 to 2005.

``It is a historic victory for global public health," said Dr. Margaret Chan , director general of the World Health Organization. She attributed the success to cooperation among groups, including UNICEF, the US Centers for Disease Control and Prevention, the American Red Cross, and United Nations Foundation as well as the Bill & Melinda Gates Foundation and the Global Alliance for Vaccines and Immunization.

"In many parts of Africa, the results of this partnership are very visible and very striking," Chan said. "Instead of seeing a number of fresh graves for young children, this is something of the past. We do not see this anymore. Many measles wards have become empty in many hospitals around Africa."

Each national campaign, run in partnership with governments, took more than six months to organize and were held in schools, clinics, churches -- or sometimes on a folding table under a shade tree. In almost all cases, the campaigns evolved into a health bazaar for young children, with health workers giving children drops of vitamin A, along with chewable tablets that destroy intestinal parasites and with insecticide-treated bed netting to protect against malaria.

Although experts predict the programs could result in an historic reduction in African child mortality, they caution that studies must verify any downward trend. Still, early studies have been encouraging, including one in Tanzania that showed deaths among young children had dropped by 30 percent in the past five years.

The campaigns have had the unintended benefit of introducing sterile, disposable syringes throughout Africa, replacing used hypodermic needles that could spread the HIV virus and hepatitis if not properly sterilized. Organizers trained health workers to use the disposable syringes for the measles vaccines, then distributed hundreds of millions of them to public hospitals and clinics.

Edward J. Hoekstra , UNICEF's head of the global measles program, said the organization sent 78 million disposable syringes to Africa and around the world in 2003; last year, it sent more than 900 million.

Overall, the global measles campaign has cost $364 million over five years -- or about one-tenth what the US government now spends a year on fighting AIDS in Africa. The results have been striking: in 1999, before the initiative began, an estimated 873,000 people died from measles around the world; by the end of 2005, measles fatalities had dropped to 345,000.

A highly contagious disease, measles causes high fevers, runny noses, and coughs before a rash develops, spreading over the body. While just one in 1,000 to 2,000 cases is fatal in industrialized countries, the death rate is far higher among malnourished children in the developing world. Death almost always results from complications of the virus, including pneumonia and dehydration from diarrhea.

In North and South America, measles has been eradicated, but cases of measles sometimes occur in the United States, typically transmitted from visitors from industrialized nations with lower vaccination rates, such as Japan, Germany, and Italy. In the United States, measles deaths have become extremely rare; the last major outbreaks occurred from 1989 to 1991, mostly around Chicago.

The global campaign's next challenge is in India and Pakistan, which combined account for more than half of the world's measles deaths.

Hoekstra said that he hopes Pakistan begins immunizing its 68 million children this year, while the campaign is still negotiating with India over the vaccination of its 340 million children. Measles vaccination rates in India stand at 57 percent, including some Indian states with inoculation rates of less than 30 percent.

Campaign officials said yesterday that they hope to reduce measles deaths to fewer than 90,000 by the end of the decade. In the next four years, they said, the campaign will cost about $500 million, but only $140 million has been pledged so far.

"We do have some challenges ahead," said Dr. Julie Gerberding , CDC director, citing the logistical difficulties in India and Pakistan and security concerns in nations such as Somalia and the Democratic Republic of Congo.

Gerberding and WHO's Chan said they were hopeful of meeting their next goal. But Chan also said it was too early to talk about eradicating measles around the world.

"It's something we can talk about and see after we've reached the next goal," the WHO leader said.

John Donnelly can be reached at donnelly@globe.com