Dear Editor,
Recent reports from different parts of the world highlight a concerning resurgence of measles, which shows the critical need for robust public health interventions to prevent further outbreaks and mitigate the severe consequences of this highly contagious disease.
A recent outbreak in Chicago, where measles was declared eliminated in 2000, vividly illustrates the rapid spread of the virus in congregate settings with low vaccination rates. In March 2024, a single case in a migrant shelter resulted in the transmission of the infection to 57 individuals, mostly unvaccinated. However, a swift mass vaccination achieved 93 % coverage among shelter residents and prevented a potentially larger outbreak. This result highlights the necessity of ensuring high vaccination rates, especially in high-risk environments [1].
The global situation mirrors this local challenge. After two years without indigenous cases in Romania, measles re-emerged in late 2022, resulting in 460 confirmed cases across 17 counties by August 2023, predominantly among unvaccinated children [2]. Similarly, Ethiopia experienced a significant outbreak in 2022, with over 10,000 cases and 56 deaths, which was aggravated by disruptions due to the Coronavirus disease 2019 (COVID-19) pandemic and internal conflicts [3]. In South Africa, measles outbreak has targeted the population since October 2022. Among different outbreaks, it was revealed that children younger than 14 years old (86 %) are the main infected population, with only 10 % received at least one dose of vaccine [4]. These outbreaks depict the devastating impact of insufficient vaccination coverage and underscore the need for uninterrupted immunization services even amid crises.
The decline in measles vaccination rates during the COVID-19 pandemic has been particularly alarming. An estimated 24.7 million children worldwide missed their first measles vaccine dose in 2021 and another 14.7 million missed their second dose. These indicate the reduction in the global measles vaccine coverage to the lowest level since 2008. The Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) caution that as a result of these setbacks, millions of children are now at risk of contracting measles [5].
Of note, vaccine hesitancy remains a significant barrier in the way of achieving immunity. A striking example is England, where the measles-mumps-rubella (MMR) vaccine coverage has fallen across all regions over the past decade, with no area meeting the WHO target of 95 % coverage necessary for herd immunity of both doses. Factors such as convenience, complacency, and confidence are important in vaccine uptake. Therefore, targeted interventions are essential to address these issues. Public health campaigns, community-specific immunization services, and web-based decision aids can help address misconceptions and increase vaccine uptake. Interestingly, vaccine hesitancy is not limited to impoverished areas with uneducated populations. Vaccine hesitancy to MMR and other vaccines is becoming prevalent in middle-to high-income areas, especially among mothers with a college-level education or higher who believe in social media narratives more than scientific information.
Efforts to fight measles should also focus on innovative public health strategies. The use of real-time dynamic disease models, as demonstrated in the Chicago outbreak, can aid in forecasting outbreak sizes and estimating the impact of interventions.
The resurgence of measles shows the urgent need for sustained and comprehensive vaccination efforts. Achieving high coverage through routine immunization, addressing vaccine hesitancy, and utilizing innovative public health strategies are crucial to prevent future outbreaks and protect vulnerable populations. The lessons learned from recent outbreaks must solidify global and local efforts to achieve and maintain measles elimination.
Declaration of competing interest
The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
Acknowledgement
During the preparation of this work the author used ChatGPT version 3.5 (OpenAI LP, CA) in order to enhance the language readability of the manuscript. After using this tool/service, the authors reviewed and edited the content as needed and take full responsibility for the content of the publication.
Handling Editor: Patricia Schlagenhauf
References
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