14 November 2024 | Geneva / Washington, D.C. (PAHO/WHO)– While global measles cases surged to an estimated 10.3 million in 2023, a 20% increase from the previous year, the Americas region has successfully regained its status as free of endemic measles, with Brazil recently re-verified as having eliminated the disease.
Globally, inadequate immunization coverage remains a major driver of the increase in measles cases. According to the World Health Organization (WHO) and the United States. Centers for Disease Control and Prevention (CDC), more than 22 million children missed their first dose of the measles vaccine in 2023. Despite this global surge, countries in the Americas have kept measles at bay, with no reported cases of endemic transmission.
Brazil was re-verified as measles-free following a review by the Measles and Rubella Elimination Regional Monitoring and Re-Verification Commission (RVC), an independent group of experts convened by the Pan American Health Organization (PAHO). This re-verification confirms the interruption of endemic measles transmission in Brazil, following an outbreak that began in 2018 and led to the re-establishment of endemic measles in 2019. Through strong vaccination efforts, enhanced surveillance, and rapid response measures, Brazil successfully interrupted transmission by June 2022.
In 2023, the Region confirmed the lowest number of measles cases in its history, with only 73 reported cases. For the first time since 2019, there was also an increase in vaccination coverage with the first dose of the Measles, Rubella, and Mumps (MMR1) vaccine reaching 87%. However, there is still a significant gap, as 1.4 million children in the region did not receive any dose of the MMR vaccine that year.
In 2024, up to November 8, 389 confirmed measles cases were reported in the region, all of which were imported or related to importation. The rapid response of countries prevented sustained transmission of the disease.
This achievement means that the Americas region is once again free of endemic measles, a milestone first achieved in 2016. In addition to Brazil, Venezuela was re-verified as free of endemic measles in 2023, following the resolution of an outbreak that began in 2018 and lasted for over 12 months.
Global surge in measles, but the Americas Region stays protected
The global rise in measles cases has primarily affected regions such as Africa, Eastern Mediterranean, Europe, Southeast Asia, and the Western Pacific, with large outbreaks reported in 57 countries. Nearly half of all significant outbreaks occurred in the African region. However, the Americas has managed to avoid such outbreaks due to robust immunization programs and quick responses to imported cases.
An estimated 107,500 deaths from measles were recorded globally in 2023, with children under five being the most vulnerable. Although this is an 8% decrease from the previous year, far too many children are still dying from this preventable disease. Despite the rise in cases in other regions, the Americas has not reported measles-related deaths, and it is estimated that between 2000 and 2022, the measles vaccine alone prevented 6 million deaths in the region.
Ongoing efforts to strengthen immunization and surveillance in the Americas
PAHO continues to stress the importance of strengthening immunization programs to prevent future outbreaks. Although measles transmission has been successfully interrupted in the region, achieving and maintaining 95% vaccination coverage is crucial to ensure herd immunity and protect populations.
Dr. Jarbas Barbosa, Director of PAHO, emphasized this week, “Regaining and maintaining measles elimination in the Americas is an incredible achievement, but the work is far from over. We must continue to prioritize vaccination, improve surveillance systems, and strengthen our response capacities to prevent future outbreaks and protect our children.”
In addition to measles, the Americas region also successfully eliminated rubella and congenital rubella syndrome in 2015, maintaining that status to this day.
General recommendations from the Regional Monitoring and Verification Commission
During the fourth annual meeting of the Measles and Rubella Elimination Regional Monitoring and Re-Verification Commission (RVC), held from November 4 to 6, 2024, in Lima, Peru, countries in the region were strongly recommended to:
- Strengthen the supervision and follow-up of immunization activities, surveillance, and rapid response at the subnational and local levels.
- Adopt and adapt the recent PAHO guidelines on active case finding as a strategy to improve the sensitivity of the surveillance system.
- Intensify efforts to close immunity gaps among migrant populations.
The full report with specific recommendations for each country will be available soon.
