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Measles vaccination effectively prevents measles, a highly contagious disease that can cause severe complications and death and requires high population immunity to interrupt transmission. This report describes progress in measles elimination during 2000-2023. During 2000-2023, an estimated 60.3 million deaths due to measles were averted by vaccination. Despite commitment by all 6 WHO regions to eliminate measles, however, no region has successfully achieved and maintained measles elimination as of the end of 2023. During the coronavirus disease 2019 (COVID-19) pandemic, estimated worldwide coverage with a first dose of measles-containing vaccine (MCV1) decreased to 81%, the lowest rate since 2008. MCV1 coverage improved to 83% in 2022 but was unchanged in 2023. During 2022-2023, the estimated number of measles cases increased by 20% globally, from 8 645 000 to 10 341 000; and the number of countries that experienced large or disruptive outbreaks increased from 36 to 57. The estimated number of deaths due to measles decreased by 8% as compared with 2022, from 116 800 to 107 500 in 2023, because of an increased number of cases in countries with a lower risk for death. The stagnation in MCV1 coverage means that millions of children remain unprotected, leading to increases in the numbers of cases and outbreaks. Measles-containing vaccine (MCV) coverage is lower and measles incidence is higher in low-income countries and in fragile, conflict-affected and vulnerable (FCV) settings, which exacerbates inequity. Urgent, targeted efforts are necessary to ensure that all children receive 2 MCV doses and that surveillance is strengthened, hastening progress towards measles elimination. La vaccination contre la rougeole permet de prevenir efficacement cette maladie tres contagieuse qui peut entrainer des complications severes et la mort, et dont l'interruption de la transmission necessite une forte immunite collective. Le present rapport decrit les progres accomplis vers l'elimination de la rougeole au cours de la periode 2000-2023. On estime que 60,3 millions de deces dus a la rougeole ont ete evites grace a la vaccination entre 2000 et 2023. Malgre l'engagement des 6 Regions de l'OMS a eliminer la rougeole, aucune d'entre elles n'a reussi a atteindre et a maintenir cet objectif a la fin de l'annee 2023. Le present rapport decrit les progres accomplis vers l'elimination de la rougeole au cours de la periode 2000-2023. Pendant la pandemie de maladie a coronavirus 2019 (COVID-19), la couverture mondiale estimee par la premiere dose de vaccin a valence rougeole (MCV1) est tombee a 81%, le taux le plus bas depuis 2008. Elle a progresse en 2022 pour atteindre 83%, mais est restee inchangee en 2023. En 2022-2023, le nombre estime de cas de rougeole a augmente de 20% a l'echelle mondiale, passant de 8 645 000 a 10 341 000, et le nombre de pays confrontes a des flambees epidemiques de grande ampleur ou perturbatrices est passe de 36 a 57. Le nombre estime de deces dus a la rougeole a diminue de 8% par rapport a 2022, passant de 116 800 a 107 500 en 2023, en raison d'une augmentation du nombre de cas dans des pays ou le risque de deces est plus faible. La stagnation de la couverture par la MCV1 signifie que des millions d'enfants restent sans protection, ce qui entraine une augmentation du nombre de cas et de flambees epidemiques. La couverture par le vaccin antirougeoleux (MCV) est plus faible et l'incidence de la rougeole plus elevee dans les pays a faible revenu et dans les zones en situation de fragilite, de conflit ou de vulnerabilite, ce qui exacerbe les inegalites. Afin d'accelerer les progres vers l'elimination de la rougeole, il est urgent de deployer des efforts cibles pour que tous les enfants recoivent 2 doses de vaccin MCV et pour renforcer la surveillance., Introduction Measles is a highly contagious disease that can cause severe complications and death. (1) Vaccination is highly effective in preventing measles and, during the past 50 years, has saved [...]

Rubella virus is a leading cause of vaccine-preventable birth defects. Infection during pregnancy can result in miscarriage, fetal death, stillbirth or a constellation of birth defects, known as congenital rubella syndrome (CRS), which includes cataracts, deafness, heart defects and developmental delay. A single dose of rubella-containing vaccine can provide lifelong protection against rubella. The Global Vaccine Action Plan 2011-2020 set a target to achieve elimination of rubella in at least 5 of the 6 WHO regions by 2020, and rubella elimination is a critical goal of the Immunization Agenda 2030. This report updates a previous report and describes progress towards rubella and CRS elimination in 2012-2022. During this period, the number of WHO Member States that included rubella-containing vaccine (RCV) in their immunization schedules increased from 132 (68%) to 175 (90%), and the percentage of the world's infants were vaccinated against rubella increased from 40% to 68%. The reported number of rubella cases decreased by 81%, from 93 816 in 2012 to 17 407 in 2022. Verification of rubella elimination was achieved in 98 (51%) of 194 countries by 2022, an increase from 84 (43%) countries in 2019. Despite significant progress in introduction of RCV into routine immunization programmes worldwide, nearly 25 million infants annually still do not receive RCV. Nevertheless, the increasing number of countries that have achieved and sustained rubella elimination, even in complex settings, represents progress towards global rubella elimination. L'infection par le virus de la rubeole est l'une des principales causes de malformations congenitales evitables par la vaccination. Lorsqu'elle survient pendant la grossesse, elle peut entrainer une fausse couche, la mort foetale, une mortinaissance ou une constellation de malformations congenitales (notamment cataracte, surdite, malformations cardiaques et retards de developpement) connue sous le nom de syndrome de rubeole congenitale (SRC). Une dose unique de vaccin a valence rubeole peut conferer une protection a vie contre la rubeole. Parmi les cibles fixees dans le Plan d'action mondial pour les vaccins 2011-2020 figurait l'elimination de la rubeole dans au moins 5 des 6 Regions de l'OMS a l'horizon 2020. L'elimination de la rubeole fait en outre partie des objectifs cles du Programme pour la vaccination a l'horizon 2030. Le present rapport actualise les informations fournies dans le rapport precedent et decrit les progres accomplis vers l'elimination de la rubeole et du SRC dans la periode 2012-2022. Au cours de cette periode, les nombre d'Etats Membres de l'OMS ayant inclus le vaccin a valence rubeole (RCV) dans leur calendrier de vaccination a progresse, passant de 132 (68%) a 175 (90%); et le pourcentage de nourrissons dans le monde vaccines contre la rubeole est passe de 40% a 68%. Le nombre de cas notifies de rubeole a recule de 81%, passant de 93 816 en 2012 a 17 407 en 2022. En 2022, l'elimination de la rubeole avait ete verifiee dans 98 (51%) des 194 Etats Membres de l'OMS, contre 84(43%) en 2019. Toutefois, meme si l'introduction du RCV dans les programmes de vaccination systematique a fortement progresse a l'echelle mondiale, pres de 25millions de nourrissons sont encore prives de ce vaccin chaque annee. Le nombre croissant de pays ayant reussi a eliminer durablement la rubeole, meme parmi ceux confrontes a des situations complexes, temoigne neanmoins des progres realises vers l'elimination de cette maladie a l'echelle mondiale., Introduction Rubella virus is a leading cause of vaccine-preventable birth defects and can cause epidemics. Rubella virus infection usually produces a mild febrile rash illness in children and adults; however, [...]

Introduction: The incidence of varicella in Canada has decreased by almost 99% since vaccination was introduced. However, variation in the timing and eligibility of vaccination programs across the country has resulted in some cohorts being under-vaccinated and therefore potentially susceptible to infection. Methods: We used nationally representative specimens from the Biobank of Statistics Canada's Canadian Health Measures Survey (CHMS) as well as residual specimens from Ontario collected between 2009–2014 to estimate population immunity across age-groups and geography, and identify any groups at increased risk of varicella infection. Results: The weighted proportion of specimens with antibody levels above the threshold of protection was 93.6% (95% CI: 92.4, 95.0). Protection was lowest among those aged 3–5 years (54.3%; 95% CI: 47.3, 61.4), but increased with age. Individuals born outside Canada had more than twice the odds of varicella susceptibility than those born in Canada (aOR: 2.7; 95% CI: 1.4, 5.0; p = 0.004). There were no differences by sex or geography within Canada, and there were no statistically significant differences when Ontario CHMS sera were compared to Ontario residual sera, apart from in participants aged 12–19 year age-group, for whom the CHMS estimate (91.2%; 95% CI: 86.7, 95.7) was significantly higher (p = 0.03) than that from residual specimens (85.9%, 95% CI: 81.1, 90.8). Discussion: Varicella immunity in Canada is changing. Children appear to have low population immunity, placing them at greater risk of infection and at increased risk of severe disease as they age. Our results underscore the importance of performing periodic serosurveys to monitor further population immunity changes as the proportion of vaccine-eligible birth-cohorts increases, and to continually assess the risk of outbreaks. [ABSTRACT FROM AUTHOR]

Since the World Health Assembly (WHA) in 2012 endorsed the Global Vaccine Action Plan (GVAP), which included regional measles and rubella elimination goals by 2020, global progress towards verification of measles and rubella elimination has been incremental. Even though the 2020 elimination goals were not achieved, commitment towards achieving measles and rubella elimination has been firmly established in the Immunization Agenda 2030 (IA2030) and the Measles and Rubella Strategic Framework (MRSF) 2021–2030. In 2023, the six Regional Verification Commissions for measles and rubella elimination (RVCs) reviewed data as of 31 December 2022 and confirmed that 82 (42%) Member States have been verified for measles elimination, and 98 (51%) Member States have been verified for rubella elimination. The six RVCs are composed of independent public health and immunization experts who are well-placed to support accelerating measles and rubella elimination. RVCs should be leveraged not only to review elimination documents but also to advocate for and champion public health programming that supports measles and rubella activities. The verification of elimination process is one of many tools that should be deployed to reinforce and accelerate efforts towards achieving a world free of measles and rubella. [ABSTRACT FROM AUTHOR]

Background Randomized trials conducted in low- and middle-income settings demonstrated efficacy of influenza vaccination during pregnancy against influenza infection among infants <6 months of age. However, vaccine effectiveness (VE) estimates from settings with different population characteristics and influenza seasonality remain limited. Methods We conducted a test-negative study in Ontario, Canada. All influenza virus tests among infants <6 months from 2010 to 2019 were identified and linked with health databases to ascertain information on maternal-infant dyads. VE was estimated from the odds ratio for influenza vaccination during pregnancy among cases versus controls, computed using logistic regression with adjustment for potential confounders. Results Among 23 806 infants tested for influenza, 1783 (7.5%) were positive and 1708 (7.2%) were born to mothers vaccinated against influenza during pregnancy. VE against laboratory-confirmed infant influenza infection was 64% (95% confidence interval [CI], 50%–74%). VE was similar by trimester of vaccination (first/second, 66% [95% CI, 40%–80%]; third, 63% [95% CI, 46%–74%]), infant age at testing (0 to <2 months, 63% [95% CI, 46%–75%]; 2 to <6 months, 64% [95% CI, 36%–79%]), and gestational age at birth (≥37 weeks, 64% [95% CI, 50%–75%]; < 37 weeks, 61% [95% CI, 4%–86%]). VE against influenza hospitalization was 67% (95% CI, 50%–78%). Conclusions Influenza vaccination during pregnancy offers effective protection to infants <6 months, for whom vaccines are not currently available. [ABSTRACT FROM AUTHOR]

Measles is a highly infectious disease leading to high morbidity and mortality impacting people's lives and economies across the globe. The measles vaccine saves more lives than any other vaccine in the Essential Programme of Immunization and is also the most cost-effective vaccine, with an extremely high return on investment. This makes achieving measles elimination through vaccination a key child health intervention, particularly in low-income countries, where the overwhelming majority of measles deaths continue to occur. All countries and regions of the world have committed to achieving measles elimination, yet many have faced challenges securing political commitment at national and global levels and predictable, timely, and flexible support from global donors, and experienced setbacks during the COVID-19 pandemic. This has happened against a backdrop of stagnant measles vaccination coverage and declining enthusiasm for vertical programmes, culminating in a World Health Organization Strategic Advisory Group of Experts (WHO SAGE) review of the feasibility of measles eradication in 2019. Sustaining the elimination of measles long term is extremely difficult, and some countries have lost or nearly lost their measles elimination status in the face of ongoing importation of cases from neighbouring or closely connected countries in which elimination had been delayed. Thus, a widening equity gap in measles immunisation coverage creates challenges for all countries, not just those facing the greatest burden of measles morbidity and mortality. Delaying elimination of measles in some countries makes it cumulatively harder for all countries to succeed for three principal reasons: increased inequity in measles immunisation coverage makes outbreaks more likely to happen and to be larger; political will is very difficult to sustain; and immunity may wane to a point that transmission is re-established. New strategies are needed to support countries and regions in their vision for a world without measles, including ways to galvanise domestic, regional and global resources and ignite the political will that is essential to make the vision a reality. [ABSTRACT FROM AUTHOR]

• Country ownership is one of the four guiding principles for the Immunization Agenda 2030. • There is little practical guidance on what country ownership is and how to operationalize it. • Measles and rubella programs are used to illustrate country ownership in operation. • Five elements of country ownership - commitment, coordination, capacity, community participation, and accountability - are described. • Our work is a useful guide for immunization program strategy development. Country-owned, as opposed to donor-driven, is a principle within the development sector that recognizes the centrality of countries' leadership, systems, and resources in executing programs and achieving sustainable development. In alignment with this notion, the Immunization Agenda 2030 was developed with country ownership as one of four core principles of the ambitious ten-year plan. This means that the success of immunization programs, including those with eradication and elimination goals such as polio, measles, and rubella, and those with broader equity goals to "leave no one behind" on immunization, would be largely driven by country systems. In this paper we deconstruct country ownership into five operational principles: commitment, coordination, capacity, community participation, and accountability. Through this lens, we illustrate how two countries, Nepal and Nigeria, have exemplified country ownership in their measles and rubella elimination programs and we infer the ways in which country ownership drives system performance and sustains program efforts. [ABSTRACT FROM AUTHOR]

Measles and rubella have long been recognized as priorities for disease prevention because of their devastating consequences for child health; hence, all World Health Organization (WHO) regions currently have a goal to eliminate measles and four out of six WHO regions have a goal to eliminate rubella. Significant global progress has been made in the twenty-first century, with more than 40% of countries in the world verified by a Regional Verification Commission as having eliminated measles and more than 50% of countries having sustained rubella elimination. Making further progress will require addressing fundamental gaps in health systems, a particular challenge in the current global context where many countries face multiple barriers to both sustaining and achieving measles and rubella elimination. These challenges require a strategic shift toward a holistic approach that embeds immunization at the center of primary health care at all levels, which will have broad benefits beyond preventing measles and rubella. Progress will be supported through technological innovations such as microarray patch vaccines. Whether this holistic approach will be more effective than vertical initiatives at achieving measles and rubella elimination remains to be seen. Measles is so infectious and its immediate impact so visible on individuals and health systems that any weaknesses in global or national strategy are immediately evident. The tools exist to prevent every death from measles and every case of congenital rubella syndrome. Countries and partners - at all levels - share accountability for ensuring children are protected from these entirely preventable diseases., Competing Interests: Conflict of interest. None declared.

Measles vaccination effectively prevents measles, a highly contagious disease that can cause severe complications and death and requires high population immunity to interrupt transmission. This report describes measles elimination progress during 2000-2023. During 2000-2023, an estimated 60.3 million measles deaths were averted by vaccination. However, despite commitment from all six World Health Organization regions to eliminate measles, no region has successfully achieved and maintained measles elimination as of the end of 2023. During the COVID-19 pandemic, estimated global coverage with the first dose of measles-containing vaccine (MCV1) declined to 81%, the lowest level since 2008. MCV1 coverage improved to 83% in 2022 but was unchanged in 2023. From 2022 to 2023, estimated measles cases increased 20% worldwide, from 8,645,000 to 10,341,000; the number of countries experiencing large or disruptive outbreaks increased from 36 to 57. Estimated measles deaths decreased 8%, from 116,800 in 2022 to 107,500 in 2023, primarily because an increased number of cases occurred in countries with lower risk for death. The stagnation in MCV1 coverage means millions of children remain unprotected, leading to increases in cases and outbreaks. Coverage with measles-containing vaccine (MCV) is lower, and measles incidence is higher, in low-income countries and countries experiencing fragile, conflict-affected, and vulnerable settings, which exacerbate inequities. Urgent and targeted efforts are needed to ensure that all children receive 2 MCV doses and that surveillance is strengthened to hasten progress toward measles elimination., Competing Interests: All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. Matt Ferrari reports institutional support from the World Health Organization, Gavi, the Vaccine Alliance, and the Bill and Melinda Gates Foundation; grants or contracts from Gavi, the Vaccine Alliance, the Bill and Melinda Gates Foundation, and the National Science Foundation; and travel support from the World Health Organization, the Bill and Melinda Gates Foundation, and Imperial College. No other potential conflicts of interest were disclosed.

Rubella virus is a leading cause of vaccine-preventable birth defects. Infection during pregnancy can result in miscarriage, fetal death, stillbirth, or a constellation of birth defects, including cataracts, deafness, heart defects, and developmental delay, known as congenital rubella syndrome (CRS). A single dose of rubella-containing vaccine can provide lifelong protection against rubella. The Global Vaccine Action Plan 2011-2020 included a target to achieve elimination of rubella in at least five of the six World Health Organization (WHO) regions by 2020, and rubella elimination is a critical goal of the Immunization Agenda 2030. This report updates a previous report and describes progress toward rubella and CRS elimination during 2012-2022. During 2012-2022, among 194 WHO countries, the number that included rubella-containing vaccine (RCV) in their immunization schedules increased from 132 (68%) to 175 (90%) and the percentage of the world's infants vaccinated against rubella increased from 40% to 68%. Reported rubella cases declined 81%, from 93,816 in 2012 to 17,407 in 2022. Verification of rubella elimination was achieved in 98 (51%) of 194 countries by 2022, an increase from 84 (43%) countries in 2019. Despite significant progress in the introduction of RCV into routine immunization programs worldwide, approximately 25 million infants annually still do not have access to RCV. Nevertheless, even in complex settings, the increasing number of countries that have achieved and sustained rubella elimination demonstrates progress toward global rubella elimination., Competing Interests: All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. No potential conflicts of interest were disclosed.

In 2015, all 22 World Health Organization Eastern Mediterranean Region (EMR) countries and areas (countries) pledged to achieve measles elimination by 2020. Despite success in several countries, most countries in the region still have not eliminated measles. This report updates a previous report and describes progress toward measles elimination in EMR during 2019-2022. During that period, estimated regional coverage with the first and second doses of a measles-containing vaccine (MCV) was 82%-83% and 76%-78%, respectively. During 2019-2022, approximately 160 million children were vaccinated during national or subnational supplementary immunization activities. Reported confirmed regional measles incidence decreased from 29.8 cases per 1 million population in 2019 to 7.4 in 2020, but then increased 68%, to 50.0 in 2022 because of challenges providing immunization services and conducting surveillance during the COVID-19 pandemic. Surveillance indicators deteriorated in 11 (50%) of the 22 EMR countries. During 2019-2022, four countries in the region were verified as having achieved measles elimination, but other countries reported immunity gaps and increased measles incidence in 2022. To achieve measles elimination in EMR, national immunization programs, especially in those countries with high measles incidence, will need to continue to recover from the COVID-19 pandemic, increase overall vaccination coverage to close immunity gaps, and maintain high-quality disease surveillance., Competing Interests: All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. No potential conflicts of interest were disclosed.

BackgroundWaning immunity from seasonal influenza vaccination can cause suboptimal protection during peak influenza activity. However, vaccine effectiveness studies assessing waning immunity using vaccinated and unvaccinated individuals are subject to biases.AimWe examined the association between time since vaccination and laboratory-confirmed influenza to assess the change in influenza vaccine protection over time.MethodsUsing linked laboratory and health administrative databases in Ontario, Canada, we identified community-dwelling individuals aged ≥ 6 months who received an influenza vaccine before being tested for influenza by RT-PCR during the 2010/11 to 2018/19 influenza seasons. We estimated the adjusted odds ratio (aOR) for laboratory-confirmed influenza by time since vaccination (categorised into intervals) and for every 28 days.ResultsThere were 53,065 individuals who were vaccinated before testing for influenza, with 10,264 (19%) influenza-positive cases. The odds of influenza increased from 1.05 (95% CI: 0.91-1.22) at 42-69 days after vaccination and peaked at 1.27 (95% CI: 1.04-1.55) at 126-153 days when compared with the reference interval (14-41 days). This corresponded to 1.09-times increased odds of influenza every 28 days (aOR = 1.09; 95% CI: 1.04-1.15). Individuals aged 18-64 years showed the greatest decline in protection against influenza A(H1N1) (aOR per 28 days  = 1.26; 95% CI: 0.97-1.64), whereas for individuals aged ≥ 65 years, it was against influenza A(H3N2) (aOR per 28 days  = 1.20; 95% CI: 1.08-1.33). We did not observe evidence of waning vaccine protection for individuals aged < 18 years.ConclusionsInfluenza vaccine protection wanes during an influenza season. Understanding the optimal timing of vaccination could ensure robust protection during seasonal influenza activity.