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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 [...]

Measles is a highly contagious, vaccine-preventable disease that requires high population immunity in order for transmission to be interrupted. All 6 WHO regions have committed themselves to eliminating measles; however, no region has achieved and sustained elimination. This report describes progress in measles elimination during 2000-2022. Estimated coverage with the first dose of measles-containing vaccine (MCV) worldwide increased from 72% to 86% between 2000 and 2019 and then decreased to 81% in 2021 during the coronavirus disease 2019 (COVID-19) pandemic, the lowest coverage rate since 2008. In 2022, MCV1 coverage increased to 83%. Only 72 (50%) of 144 countries that reported measles cases achieved the measles surveillance indicator target of >2 discarded cases per 100 000 population in 2022. During 2021-2022, estimated measles cases increased by 18%, from 7 802 000 to 9 232 300, and the number of countries experiencing large or disruptive outbreaks increased from 22 to 37. The estimated number of measles deaths increased by 43% during 2021-2022, from 95 000 to 136 200. Nonetheless, an estimated 57 million measles deaths were averted by vaccination during 2000-2022. In 2022, measles vaccination coverage and global surveillance showed some recovery from the setbacks during the COVID-19 pandemic; however, coverage decreased in low-income countries, and, globally, years of suboptimal immunization coverage left millions of children unprotected. Setbacks in coverage during the COVID-19 pandemic must be reversed by renewed efforts to vaccinate all children with 2 MCV doses, strengthen surveillance, prevent outbreaks and accelerate progress towards elimination. La rougeole est une maladie a prevention vaccinale qui est hautement contagieuse et dont la transmission ne peut etre interrompue qu'en presence d'une forte immunite collective. Les 6 Regions de l'OMS se sont toutes engagees a eliminer la rougeole, mais a ce jour, aucune d'entre elles n'a atteint durablement cet objectif. Le present rapport decrit les progres accomplis vers l'elimination de la rougeole au cours de la periode 2000-2022. La couverture mondiale de la vaccination par la premiere dose de vaccin a valence rougeole (MCV) a progresse entre 2000 et 2019, passant de 72% a 86%, mais a ensuite recule pendant la pandemie de COVID-19 pour s'etablir a 81% en 2021, soit le taux le plus faible enregistre depuis 2008. En 2022, la couverture par le MCV1 est remontee a 83%. En 2022, seuls 72 (50%) des 144 pays ayant signale des cas de rougeole ont atteint la cible de l'indicateur de surveillance de la rougeole relatif au nombre de cas ecartes, a savoir >2 cas ecartes pour 100 000 habitants. Dans la periode 2021-2022, le nombre de cas de rougeole signales a augmente de 18%, passant de 7 802 000 a 9 232 300, et, le nombre de pays confrontes a des flambees epidemiques de grande ampleur ou perturbatrices de rougeole est passe de 22 a 37, et le nombre estime de deces dus a la rougeole a augmente de 43%, passant de 95 000 a 136 200. Neanmoins, on estime qu'entre 2000 et 2022, la vaccination a permis d'eviter 57 millions de deces dus a la rougeole. En 2022, on a constate des signes de relevement de la couverture vaccinale et de la surveillance mondiale de la rougeole apres les revers subis lors de la pandemie de COVID-19; la couverture vaccinale a toutefois diminuee dans les pays a faible revenu et, apres des annees de couverture sousoptimale, des millions d'enfants dans le monde restent sans protection contre la maladie. Il est urgent d'inverser le recul de la couverture enregistre pendant la pandemie de COVID-19 en redoublant d'efforts pour vacciner tous les enfants par 2 doses de MCV, renforcer la surveillance, prevenir les flambees epidemiques et accelerer les progres vers l'elimination., Introduction All 6 WHO regions have committed themselves to eliminating measles. (1) The Immunization Agenda 2030 (IA2030) 2 includes measles elimination as a core indicator of impact. IA2030 highlights the [...]

Worldwide, measles remains a major cause of disease and death; the highest incidence is in the WHO African Region (AFR). In 2011, the 46 Member States in the AFR established the goal of regional elimination of measles by 2020; this report describes progress during 2017-2021. Regional coverage with a first dose of measles-containing vaccine (MCV) decreased from 70% in 2017 to 68% in 2021, and the number of countries with [greater than or equal to] 95% coverage decreased from 6 (13%) to 2 (4%). The number of countries that provided a second MCV dose increased from 27 (57%) to 38 (81%), and coverage with a second-dose increased from 25% to 41%. Approximately 341 million people were vaccinated during supplementary immunization activities (SIAs), and an estimated 4.5 million deaths were averted by vaccination. The number of countries that met measles surveillance performance indicators decreased, however, from 26 (62%) to 9 (22%). Measles incidence increased from 69.2 per 1 million population in 2017 to 81.9 in 2021. The number of estimated annual measles cases and deaths increased by 22% and 8%, respectively. By December 2021, no country had received verification of measles elimination. To achieve a renewed regional goal of measles elimination in at least 80% of countries by 2030, intensified work is necessary to recover and surpass levels of surveillance performance and coverage with 2 MCV doses that were achieved before the coronavirus disease 2019 (COVID-19) pandemic. La rougeole demeure une cause majeure de maladie et de deces dans le monde entier, et la Region ou l'incidence est la plus elevee est la Region africaine de l'OMS. En 2011, les 46 Etats Membres de la Region africaine s'etaient fixe l'objectif d'eliminer la rougeole a l'horizon 2020. Le present rapport decrit les progres realises sur la periode 2017-2021. La couverture regionale par la premiere dose de vaccin a valence rougeole (MCV) a baisse, passant de 70% en 2017 a 68% en 2021, de meme que le nombre de pays assurant une couverture [greater than or equal to] 95% par la premiere dose, qui est passe 6 (13%) a 2 (4%). Le nombre de pays qui ont administre la deuxieme dose de MCV et la couverture par la deuxieme dose ont augmente, passant de 27 (57%) a 38 (81%) et de 25% a 41%, respectivement. Environ 341 millions de personnes ont ete vaccinees au cours des activites de vaccination supplementaire (AVS) et on estime que 4,5 millions de deces ont ete evites grace a la vaccination. Le nombre de pays qui ont satisfait aux indicateurs de performance de la surveillance de la rougeole a toutefois chute, passant de 26 (62%) a 9 (22%), tandis que l'incidence de la rougeole a augmente, passant de 69,2 cas par million d'habitants en 2017 a 81,9 en 2021; le nombre annuel estime de cas de rougeole et de deces associes a progresse de 22% et de 8%, respectivement. En decembre 2021, aucun pays n'avait obtenu la verification de l'elimination de la rougeole. Pour atteindre l'objectif regional renouvele consistant a eliminer la rougeole dans au moins 80% des pays de la Region d'ici a 2030, il est necessaire de redoubler d'efforts pour retrouver et depasser les niveaux de performance de la surveillance et de couverture par 2 doses de MCV qui avaient ete atteints avant la pandemie de maladie a coronavirus 2019 (COVID-19)., Introduction Measles remains a major cause of disease and death worldwide, and the highest numbers of cases and deaths occur in AFR. (1) In 2011, the 46 Member States (2) [...]

All 6 WHO regions have committed themselves to eliminate measles. (1) The aim of the Immunization Agenda 2021-2030 (IA2030) (2) is to achieve regional targets as a core indicator of [...]

In 2013, the Member States in the WHO South-East Asia Region (SEAR) (1) adopted the goal of measles elimination and rubella and control of congenital rubella syndrome (2) by 2020. [...]

Rubella virus is a leading cause of vaccine-preventable birth defects and can cause epidemics. Although rubella virus infection usually produces a mild febrile rash illness in children and adults, infection [...]

In 2012, the World Health Assembly (WHA) endorsed the Global Vaccine Action Plan (GVAP), (1) with the objective of eliminating measles (2) in 5 of the 6 WHO regions by [...]

Background: The city of Port-au-Prince, Haiti, is experiencing an epidemic of firearm injuries which has resulted in high burdens of morbidity and mortality. Despite this, little scientific literature exists on the topic. Geospatial research could inform stakeholders and aid in the response to the current firearm injury epidemic. However, traditional small-area geospatial methods are difficult to implement in Port-au-Prince, as the area has limited mapping penetration. Objectives of this study were to evaluate the feasibility of geospatial analysis in Port-au-Prince, to seek to understand specific limitations to geospatial research in this context, and to explore the geospatial epidemiology of firearm injuries in patients presenting to the largest public hospital in Port-au-Prince. Results: To overcome limited mapping penetration, multiple data sources were combined. Boundaries of informally developed neighborhoods were estimated from the crowd-sourced platform OpenStreetMap using Thiessen polygons. Population counts were obtained from previously published satellite-derived estimates and aggregated to the neighborhood level. Cases of firearm injuries presenting to the largest public hospital in Port-au-Prince from November 22nd, 2019, through December 31st, 2020, were geocoded and aggregated to the neighborhood level. Cluster analysis was performed using Global Moran's I testing, local Moran's I testing, and the SaTScan software. Results demonstrated significant geospatial autocorrelation in the risk of firearm injury within the city. Cluster analysis identified areas of the city with the highest burden of firearm injuries. Conclusions: By utilizing novel methodology in neighborhood estimation and combining multiple data sources, geospatial research was able to be conducted in Port-au-Prince. Geospatial clusters of firearm injuries were identified, and neighborhood level relative-risk estimates were obtained. While access to neighborhoods experiencing the largest burden of firearm injuries remains restricted, these geospatial methods could continue to inform stakeholder response to the growing burden of firearm injuries in Port-au-Prince. [ABSTRACT FROM AUTHOR]

Objective To assess the validity of the GLOBOCAN methods for deriving national estimates of cancer Incidence. Methods We obtained incidence and mortality data from Norway by region, year of diagnosis, cancer site, sex and 5-year age group for the period 1983-2012 from the NORDCAN database. Estimates for the year 2010 were derived using nine different methods from GLOBOCAN. These included the projection of national historical rates, the use of regional proxies and the combination of national mortality data with mortality to incidence ratios or relative survival proportions. We then compared the national estimates with recorded cancer incidence data. Findings Differences between the estimates derived using different methods varied by cancer site and sex. Methods based on projections performed better where major changes in recent trends were absent. Methods based on mortality data performed less well for cancers associated with small numbers of deaths and for cancers detectable by screening. In countries with longstanding cancer registries of high quality, regional-based, or trends-based incidence estimates perform reasonably well in comparison with recorded incidence. Conclusion Although the performance of the GLOBOCAN methods varies by cancer site and sex in this study, the results emphasize a need for more high-quality population-based cancer registries--either regional or, where practical and feasible, national registries--to describe cancer patterns and trends for planning cancer control priorities. Objectif Evaluer la validite des methodes GLOBOCAN pour etablir des estimations nationales de Uncidence du cancer. Methodes Nous avons recueilli les donnees de la Norvege sur Uncidence et la mortalite par region, annee de diagnostic, siege du cancer, sexe et tranche d'age de 5 ans pour la periode 1983-2012 dans la base de donnees NORDCAN. Les estimations pour l'annee 2010 ont ete etablies suivant neuf methodes GLOBOCAN differentes, dont 'extrapolation a partir de tauxnationaux passes, l'utilisation d'indicateurs regionaux et la combinaison de donnees nationales sur la mortalite aux rapports mortalite/incidence ou aux taux de survle relatlfs. Nous avons ensuite compare les estimations nationales aux donnees enregistrees sur Uncidence du cancer. Resultats Les estimations obtenues suivant differentes methodes variaient selon le siege du cancer et le sexe. Les methodes conslstant en une extrapolation donnaient de meilleurs resultats en l'absence de changement majeur des tendances recentes. Les methodes utilisant les donnees sur la mortalite s'averalent moins fiables pour les cancers associes a un faible nombre de deces et les cancers detectables par depistage. Dans les pays qui tenaient depuis longtemps des registres du cancer de qualite, les estimations de Uncidence d'apres les indicateurs regionaux ou les tendances etaient plutot fiables par rapport a l'incidence enregistree. Conclusion Bien que, dans cette etude, la habilite des methodes GLOBOCAN varie selon le siege du cancer et le sexe, les resultats revelent la necessite de tenir davantage de registres du cancer de qualite registres regionaux ou, lorsque cela est falsable, nationaux - afin de decrire les profils et tendances en matiere de cancer et de planner les priorltes de lutte contre cette maladle. Objetivo Evaluar la validez de los metodos GLOBOCAN para obtener estimaciones nacionales de la Incidencia de cancer. Metodos Se obtuvieron datos sobre la incidencia y mortalidad en Noruega por regiones, ano de diagnostico, localizacion del cancer, sexo y grupos de edades de cinco anos durante el periodo comprendido entre 1983 y 2012 de la base de datos NORDCAN. Las estimaciones del ano 2010 se obtuvieron utilizando nueve metodos diferentes de GLOBOCAN. Entre ellos se encontraban la proyeccion de tasas nacionales historicas, el uso de indicadores regionales y la combinacion de datos de mortalidad nacionales con coeficientes de incidencia o porcentajes de supervivencia relativos. Posteriormente, se compararon las estimaciones nacionales con los datos de incidencia de cancer registrados. Resultados Las diferencias entre las estimaciones obtenidas utilizando distintos metodos variaron segun la localizacion del cancer y el sexo. Los metodos basados en las proyecciones mostraron mejores resultados cuando se observo una ausencia de cambios importantes en las ultimas tendencias. Los metodos basados en los datos de mortalidad obtuvieron peores resultados en relacion con los canceres asociados a un menor numero de fallecimientos y con los canceres detectables en revisiones. En los paises con registros de cancer prolongados de alta calidad, las estimaciones de incidencia por regiones o por tendencias muestran resultados razonablemente buenos, en comparacion con las incidencias registradas. Conclusion A pesar de que en este estudio el rendimiento de los metodos GLOBOCAN varia segun la localizacion del cancer y el sexo, los resultados destacan la necesidad de obtener registros de cancer de mejor calidad y basados en la poblacion (ya sea a nivel regional o, cuando proceda, a nivel nacional) para describir los patrones y tendencias del cancer para planificar las prioridades para controlarlo., Introduction Cancer is among the most common causes of morbidity and mortality worldwide, with an estimated 14 million new cases and 8 million deaths in 2012, projected to rise by [...]

Background Diarrhea is the second leading cause of death in children younger than 5 years of age globally. The burden of diarrheal mortality is concentrated in low-resource settings. Little is known about the risk factors for childhood death from diarrheal disease in low- and middle-income countries. Methods Data from the World Health Organization (WHO)-coordinated Global Rotavirus and Pediatric Diarrhea Surveillance Networks, which are composed of active, sentinel, hospital-based surveillance sites, were analyzed to assess mortality in children <5 years of age who were hospitalized with diarrhea between 2008 and 2018. Case fatality risks were calculated, and multivariable logistic regression was performed to identify risk factors for mortality. Results This analysis comprises 234 781 cases, including 1219 deaths, across 57 countries. The overall case fatality risk was found to be 0.5%. Risk factors for death in the multivariable analysis included younger age (for <6 months compared with older ages, odds ratio [OR] = 3.54; 95% confidence interval [CI], 2.81–4.50), female sex (OR = 1.18; 95% CI, 1.06–1.81), presenting with persistent diarrhea (OR = 1.91; 95% CI, 1.01–3.25), no vomiting (OR = 1.13; 95% CI,.98–1.30), severe dehydration (OR = 3.79; 95% CI, 3.01–4.83), and being negative for rotavirus on an enzyme-linked immunosorbent assay test (OR = 2.29; 95% CI, 1.92–2.74). Cases from the African Region had the highest odds of death compared with other WHO regions (OR = 130.62 comparing the African Region with the European Region; 95% CI, 55.72–422.73), whereas cases from the European Region had the lowest odds of death. Conclusions Our findings support known risk factors for childhood diarrheal mortality and highlight the need for interventions to address dehydration and rotavirus-negative diarrheal infections. [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.

Measles is a highly contagious, vaccine-preventable disease that requires high population immunity for transmission to be interrupted. All six World Health Organization regions have committed to eliminating measles; however, no region has achieved and sustained measles elimination. This report describes measles elimination progress during 2000-2022. During 2000-2019, estimated coverage worldwide with the first dose of measles-containing vaccine (MCV) increased from 72% to 86%, then declined to 81% in 2021 during the COVID-19 pandemic, representing the lowest coverage since 2008. In 2022, first-dose MCV coverage increased to 83%. Only one half (72) of 144 countries reporting measles cases achieved the measles surveillance indicator target of two or more discarded cases per 100,000 population in 2022. During 2021-2022, estimated measles cases increased 18%, from 7,802,000 to 9,232,300, and the number of countries experiencing large or disruptive outbreaks increased from 22 to 37. Estimated measles deaths increased 43% during 2021-2022, from 95,000 to 136,200. Nonetheless, an estimated 57 million measles deaths were averted by vaccination during 2000-2022. In 2022, measles vaccination coverage and global surveillance showed some recovery from the COVID-19 pandemic setbacks; however, coverage declined in low-income countries, and globally, years of suboptimal immunization coverage left millions of children unprotected. Urgent reversal of coverage setbacks experienced during the COVID-19 pandemic can be accomplished by renewing efforts to vaccinate all children with 2 MCV doses and strengthening surveillance, thereby preventing outbreaks and accelerating 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 and contracts from Gavi, the Vaccine Alliance and the Bill and Melinda Gates Foundation, and travel support to attend meetings from the Bill and Melinda Gates Foundation. Lee Lee Ho reports consulting fees from the World Health Organization. Alyssa Sbarra reports institutional support from the Bill and Melinda Gates Foundation and receipt of a National Institutes of Health training grant, and contract support from the World Health Organization. No other potential conflicts of interest were disclosed.

Worldwide, measles remains a major cause of disease and death; the highest incidence is in the World Health Organization African Region (AFR). In 2011, the 46 AFR member states established a goal of regional measles elimination by 2020; this report describes progress during 2017-2021. Regional coverage with a first dose of measles-containing vaccine (MCV) decreased from 70% in 2017 to 68% in 2021, and the number of countries with ≥95% coverage decreased from six (13%) to two (4%). The number of countries providing a second MCV dose increased from 27 (57%) to 38 (81%), and second-dose coverage increased from 25% to 41%. Approximately 341 million persons were vaccinated in supplementary immunization activities, and an estimated 4.5 million deaths were averted by vaccination. However, the number of countries meeting measles surveillance performance indicators declined from 26 (62%) to nine (22%). Measles incidence increased from 69.2 per 1 million population in 2017 to 81.9 in 2021. The number of estimated annual measles cases and deaths increased 22% and 8%, respectively. By December 2021, no country in AFR had received verification of measles elimination. To achieve a renewed regional goal of measles elimination in at least 80% of countries by 2030, intensified efforts are needed to recover and surpass levels of surveillance performance and coverage with 2 MCV doses achieved before the COVID-19 pandemic., 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.

All six World Health Organization (WHO) regions have committed to eliminating measles.* The Immunization Agenda 2021-2030 (IA2030) † aims to achieve the regional targets as a core indicator of impact and positions measles as the tracer of a health system's ability to deliver essential childhood vaccines. IA2030 highlights the importance of ensuring rigorous measles surveillance systems to document immunity gaps and achieve 95% coverage with 2 timely doses of measles-containing vaccine (MCV) among children. This report describes progress toward measles elimination during 2000-2021 and updates a previous report (1). During 2000-2021, estimated global coverage with a first MCV dose (MCV1) increased from 72% to a peak of 86% in 2019, but decreased during the COVID-19 pandemic to 83% in 2020 and to 81% in 2021, the lowest MCV1 coverage recorded since 2008. All countries conducted measles surveillance, but only 47 (35%) of 135 countries reporting discarded cases § achieved the sensitivity indicator target of two or more discarded cases per 100,000 population in 2021, indicating surveillance system underperformance in certain countries. Annual reported measles incidence decreased 88% during 2000-2016, from 145 to 18 cases per 1 million population, then rebounded to 120 in 2019 during a global resurgence (2), before declining to 21 in 2020 and to 17 in 2021. Large and disruptive outbreaks were reported in 22 countries. During 2000-2021, the annual number of estimated measles deaths decreased 83%, from 761,000 to 128,000; an estimated 56 million measles deaths were averted by vaccination. To regain progress and achieve regional measles elimination targets during and after the COVID-19 pandemic, accelerating targeted efforts is necessary to reach all children with 2 MCV doses while implementing robust surveillance and identifying and closing immunity gaps to prevent cases and outbreaks., 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 grants from the Bill and Melinda Gates Foundation, the World Health Organization (WHO), and Gavi, The Vaccine Alliance to develop measles models. Allison Portnoy reports grant support from the Bill and Melinda Gates Foundation to develop models. Lee Lee Ho reports support as a consultant for WHO. No other potential conflicts of interest were disclosed.

In 2013, member states of the World Health Organization (WHO) South-East Asia Region* (SEAR) adopted the goal of measles elimination and rubella and congenital rubella syndrome control † by 2020 (1). In 2014, to provide impetus toward achieving this goal, the Regional Director declared measles elimination and rubella control one of the Regional Flagship Priorities. In 2019, SEAR member states declared a revised goal of eliminating both measles and rubella § by 2023 (2). The recommended strategies to achieve elimination include 1) achieving and maintaining ≥95% coverage with 2 doses of measles- and rubella-containing vaccine in every district through routine or supplementary immunization activities ¶ (SIAs); 2) developing and sustaining a sensitive and timely case-based surveillance system that meets recommended performance indicators**; 3) developing and maintaining an accredited laboratory network; 4) achieving timely identification, investigation, and response to measles outbreaks; and 5) collaborating with other public health initiatives to achieve the preceding four strategies. This report updates a previous report and describes progress toward measles elimination in SEAR during 2003-2020 (3). In 2002, coverage with the first dose of a measles-containing vaccine in routine immunization (MCV1) was 70%, and only three countries in SEAR had added a second routine dose of measles-containing vaccine in routine immunization (MCV2). During 2003-2020, all countries introduced MCV2, and estimated coverage with MCV1 increased 35%, from 65% to 88%, and coverage with MCV2 increased 1,233% from 6% to 80%. Approximately 938 million persons were vaccinated in SIAs. Annual reported measles incidence declined by 92%, from 57.0 to 4.8 cases per 1 million population, and estimated deaths decreased by 97%; an estimated 9.3 million deaths were averted by measles vaccination. By 2020, five countries were verified as having achieved measles elimination. To achieve measles elimination in the region by 2023, additional efforts are urgently needed to strengthen routine immunization services and improve measles-containing vaccine (MCV) coverage, conduct periodic high-quality SIAs, and strengthen measles case-based surveillance and laboratory capacity., 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 2012, the World Health Assembly endorsed the Global Vaccine Action Plan,* with the objective of eliminating measles † in five of the six World Health Organization (WHO) regions by 2020 (1). The Immunization Agenda 2021-2030 (IA2030) § uses measles incidence as an indicator of the strength of immunization systems. The Measles-Rubella Strategic Framework 2021-2030 ¶ and the Measles Outbreaks Strategic Response Plan 2021-2023** are aligned with the IA2030 and highlight robust measles surveillance systems to document immunity gaps, identify root causes of undervaccination, and develop locally tailored solutions to ensure administration of 2 doses of measles-containing vaccine (MCV) to all children. This report describes progress toward World Health Assembly milestones and measles elimination objectives during 2000-2020 and updates a previous report (2). During 2000-2010, estimated MCV first dose (MCV1) coverage increased globally from 72% to 84%, peaked at 86% in 2019, but declined to 84% in 2020 during the COVID-19 pandemic. All countries conducted measles surveillance, although fewer than one third achieved the sensitivity indicator target of ≥2 discarded †† cases per 100,000 population in 2020. Annual reported measles incidence decreased 88% during 2000-2016, from 145 to 18 cases per 1 million population, rebounded to 120 in 2019, before falling to 22 in 2020. During 2000-2020, the annual number of estimated measles deaths decreased 94%, from 1,072,800 to 60,700, averting an estimated 31.7 million measles deaths. To achieve regional measles elimination targets, enhanced efforts are needed to reach all children with 2 MCV doses, implement robust surveillance, and identify and close immunity gaps., 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 grants from the Bill and Melinda Gates Foundation, the World Health Organization (WHO), and Gavi, the Vaccine Alliance, to develop measles models and travel support from WHO to attend the Strategic Advisory Group of Experts on Vaccines (SAGE) meeting in 2019 and the Measles and Rubella SAGE working group. Allison Portnoy reports grant support from The Pennsylvania State University for time and analytic contributions to this manuscript. No other potential conflicts of interest were disclosed.