Key facts Measles is one of the leading causes of death among young children even though a safe and

costeffective vaccine is available. In 2008, there were 164 000 measles deaths globally nearly 450 deaths every day or 18 deaths every hour. More than 95% of measles deaths occur in low-income countries with weak health infrastructures. Measles vaccination resulted in a 78% drop in measles deaths between 2000 and 2008 worldwide. In 2010, about 85% of the world's children received one dose of measles vaccine by their first birthday through routine health services up from 72% in 2000. Measles is a highly contagious, serious disease caused by a virus. In 1980, before widespread vaccination, measles caused an estimated 2.6 million deaths each year. It remains one of the leading causes of death among young children globally, despite the availability of a safe and effective vaccine. An estimated 164 000 people died from measles in 2008 mostly children under the age of five. Measles is caused by a virus in the paramyxovirus family. The measles virus normally grows in the cells that line the back of the throat and lungs. Measles is a human disease and is not known to occur in animals. Accelerated immunization activities have had a major impact on reducing measles deaths. From 2001 to 2011 an estimated one billion children aged 9 months to 14 years who live in high risk countries were vaccinated against the disease. Global measles deaths has decreased by 78% from 733 000 in 2000 to 164 000 in 2008. Signs and symptoms The first sign of measles is usually a high fever, which begins about 10 to 12 days after exposure to the virus, and lasts four to seven days. A runny nose, a cough, red and watery eyes, and small white spots inside the cheeks can develop in the initial stage. After several days, a rash erupts, usually on the face and upper neck. Over about three days, the rash spreads, eventually reaching the hands and feet. The rash lasts for five to six days, and then fades. On average, the rash occurs 14 days after exposure to the virus (within a range of seven to 18 days). Severe measles is more likely among poorly nourished young children, especially those with insufficient vitamin A, or whose immune systems have been weakened by HIV/AIDS or other diseases. Most measles-related deaths are caused by complications associated with the disease. Complications are more common in children under the age of five, or adults over the age of 20. The most serious complications include blindness, encephalitis (an infection that causes brain swelling), severe diarrhoea and related dehydration, ear infections, or severe respiratory infections such as pneumonia. As high as 10% of measles cases result in death among populations with high levels of malnutrition and a lack of adequate health care. People who recover from measles are immune for the rest of their lives. Who is at risk?

Unvaccinated young children are at highest risk of measles and its complications, including death. Any non-immune person (who has not been vaccinated or previously recovered from the disease) can become infected. Measles is still common in many developing countries particularly in parts of Africa and Asia. More than 20 million people are affected by measles each year. The overwhelming majority (more than 95%) of measles deaths occur in countries with low per capita incomes and weak health infrastructures. Measles outbreaks can be particularly deadly in countries experiencing or recovering from a natural disaster or conflict. Damage to health infrastructure and health services interrupts routine immunization, and overcrowding in residential camps greatly increases the risk of infection. Transmission The highly contagious virus is spread by coughing and sneezing, close personal contact or direct contact with infected nasal or throat secretions. The virus remains active and contagious in the air or on infected surfaces for up to two hours. It can be transmitted by an infected person from four days prior to the onset of the rash to four days after the rash erupts. Measles outbreaks can result in epidemics that cause many deaths, especially among young, malnourished children. In countries where measles has been largely eliminated, cases imported from other countries remain an important source of infection. Treatment Severe complications from measles can be avoided though supportive care that ensures good nutrition, adequate fluid intake and treatment of dehydration with WHO-recommended oral rehydration solution. This solution replaces fluids and other essential elements that are lost through diarrhoea or vomiting. Antibiotics should be prescribed to treat eye and ear infections, and pneumonia. All children in developing countries diagnosed with measles should receive two doses of vitamin A supplements, given 24 hours apart. This can help prevent eye damage and blindness. Vitamin A supplements have been shown to reduce the number of deaths from measles by 50%. Prevention Routine measles vaccination for children, combined with mass immunization campaigns in countries with high case and death rates, are key public health strategies to reduce global measles deaths. The measles vaccine has been in use for over 40 years. It is safe, effective and inexpensive. It costs less than one US dollar to immunize a child against measles. The measles vaccine is often incorporated with rubella and/or mumps vaccines in countries where these illnesses are problems. It is equally effective in the single or combined form. In 2010, about 85% of the world's children received one dose of measles vaccine by their first birthday through routine health services up from 72% in 2000. Two doses of the vaccine are recommended to ensure immunity, as about 15% of vaccinated children fail to develop immunity from the first dose.

Global health response The fourth Millennium Development Goal (MDG 4) aims to reduce the under-five mortality rate by twothirds between 1990 and 2015. Recognizing the potential of measles vaccination to reduce child mortality, and given that measles vaccination coverage can be considered a marker of access to child health services, routine measles vaccination coverage has been selected as an indicator of progress towards achieving MDG 4. The Measles Initiative is a collaborative effort of WHO, UNICEF, the American Red Cross, the United States Centers for Disease Control and Prevention, and the United Nations Foundation. Building on over a decade of experience in reducing measles mortality, the Measles Initiative advocates with governments and appeal to donors around the world for: two doses of measles vaccine to all children delivered through either routine services and/or mass vaccination campaigns; effective surveillance, monitoring and evaluation to determine the impact of vaccination activities and adapting policies and strategies; rapid response to measles outbreaks; effective treatment of measles cases, to include vitamin A supplements, antibiotics if needed, and supportive care that prevents complications. What are other names for measles? Other terms have been used to describe measles. These include (erroneously) rubella, hard measles, red measles, seven-day measles, eight-day measles, nine-day measles, 10-day measles, and morbilli. What is the history of measles?

Cases of measles were described as early as the seventh century. However, it was not until 1963 that researchers first developed a vaccine to prevent measles. Before the vaccine was made available, almost every child became infected with the virus because it is so easily spread. Before routine vaccination, there were approximately 3-4 million cases of measles and 500 deaths due to measles each year in the United States. There were initially two types of vaccines developed against measles. One was developed from a virus that had been killed, and the other was developed using a live measles virus that was weakened (attenuated) and could no longer cause the disease. Unfortunately, the killed measles virus (KMV) vaccine was not effective in preventing people from getting the disease, and its use was discontinued in 1967. The live virus vaccine has been modified a number of times to make it safer (further attenuated) and today is extremely effective in preventing the disease. The currently used vaccine is a live attenuated vaccine. Who is at risk for getting measles? Those people at high risk for measles include: children less than 1 year of age (although they have some immunity passed from their mother, it is not 100% effective);

people who have not received the proper vaccination series;

people who received immunoglobulin at the time of measles vaccination;

people immunized from 1963 until 1967 with an older ineffective killed measles vaccine. Are measles deadly?

Measles can kill you. In 2008, approximately 164,000 people died of measles in the world. However, measles is rarely fatal in the United States. This is due to the fact that most people are immunized, which results in very infrequent outbreaks. Also, people most likely to have complications (including death) are those who are malnourished or who have weakened immune systems What is the danger of getting measles while pregnant? If you contract measles while you are pregnant, you may have a miscarriage, a stillbirth, or a preterm delivery. There appears to be no risk of having birth defects (unlike an infection with the rubella virus, known as German measles). How is the diagnosis of measles made? The diagnosis of suspected measles is mostly clinical, meaning that the appearance and history of the patient suggest the diagnosis. In a person with known exposure to someone with measles or travel to a foreign country, measles should always be considered when faced with a patient who has high fever and characteristic rash. Until the rash appears, the presence of Koplik's spots should help to suggest the diagnosis. Most cases of suspected measles in the United States turn out not to be measles (see below). It is recommended that the diagnosis be confirmed using a blood test for IgM, a type of antibody against the virus. If the IgM test is positive, viral cultures should be obtained. The state and local health department should be contacted immediately for any suspected case in order to follow the correct procedures for viral culture and isolation of the patient. Further information on laboratory testing of suspected cases is available from the CDC (http://www.cdc.gov/vaccines/pubs/surv-manual/chpt07measles.htm).