Measles

Key facts

  • Measles is an important public health issue in China. Measles vaccine was first used in China in 1965, and included in EPI in 1978. Prior to the introduction of measles vaccine, the annual reported incidence ranged between 200 and 1500 cases per 100,000 population, with an average of 3-4 million cases reported each year. The actual number of cases was almost certainly much higher, as nearly everyone got measles in the pre-vaccine era.
  • Measles incidence decreased dramatically following the widespread use of measles vaccine. From 2000 to 2009, the average measles incidence was 6.8 per 100,000.
  • However, given the huge population and large number of unvaccinated children, China still reported around 100, 000 measles cases each year during 2005-2008, and was responsible for over 90% of cases in the Western Pacific Region.
  • In 2005, WHO established the goal of regional elimination of measles by 2012. To help reach this target, China conducted a series of activities to accelerate the progress of measles elimination.
  • Cases of measles in China dropped to 0.76 per 100,000 in 2011 from 2.8 per 100,000 in 2010, a record low.

Strategic plan to eliminate measles

  • In 2006, China set a goal of eliminating measles by 2012 and developed a strategic plan. Major components of the plan included:
    • A two-dose routine measles immunization schedule administered at 8 and 18 months of age;
    • School entry immunization checks;
    • Supplementary immunization activities;
    • Case-based surveillance supported by a strong laboratory network.

Routine immunization

  • China has shown strong commitment to providing immunization services for children. Measles vaccine was introduced into the national Expanded Program on Immunization in 1978, with one dose schedule at 8 months of age, free of charge. A two-dose schedule of measles vaccine at 8 months and 7 years of age was introduced in 1986, and the age for the second dose was changed to 18-24 months in 2005. The coverage of measles vaccine reached a high level of over 90%, as estimated by WHO and UNICEF, and has remained above 90% since 2006.

School entry immunization checks

  • In 2005, the Chinese State Council issued a regulation requiring that all children have their vaccination records checked at the time of entry to kindergarten and primary school. Guidelines that detailed vaccination for under-immunized children and required two doses of measles containing vaccine (MCV) at the time of school entry were jointly issued by the Ministries of Education and Health. Children who are not up-to-date with vaccines at the time of school entry are encouraged to be vaccinated. However, they are not excluded from school.

Reaching hard-to-reach communities

  • Although the administrative coverage of measles vaccine was reported as over 90%, there are still some hard-to-reach populations, such as migrants to urban areas and children in remote areas. Province-wide catch-up vaccination campaigns targeted unvaccinated and under-vaccinated children to fill the immunization gaps. Guizhou was the first province to conduct a catch-up measles campaign, supported by WHO in 2004. The measles incidence has remained at a low level in this underdeveloped western province since then.
  • During 2004-2009, 27 of 31 provinces conducted province-wide measles supplementary immunization activities (SIAs), and 185.7 million people were vaccinated through these efforts. The subsequent measles incidence decreased markedly to 2.8 per 100, 000 in 2010, down from 9.9 per 100,000 in 2008.

Nationwide measles campaign

  • To reach the measles elimination goal, China conducted a nationwide measles supplementary immunization activity (SIA) in September 2010. The target age group varied by province according to their SIA history. Some provinces vaccinated children age 8 months to 4 years; other provinces vaccinated children 8 months to 6 years, or 8 months to 14 years. All children in the age groups were targeted, regardless of resident status and vaccine or disease history. A total of 102 million children were vaccinated through this SIA effort.
  • WHO fully supported this nationwide vaccination campaign, including conducting a capacity-building workshop, a training workshop on risk communication, and a joint press conference with the Ministry of Health.
  • During the national SIA, experts from WHO headquarters, the WHO Western Pacific Regional Office, the Pan American Health Organization and the WHO country office, as well, as the US Centers for Disease Control and Prevention and UNICEF, participated in a three-province monitoring exercise. Monitors were impressed by well-organized vaccination sites, well-trained health workers, rapid responses to adverse events following immunization, and extensive education of the public and media.
  • This campaign was one of the largest mass vaccinations ever held in the world, and resulted in historic low measles incidence of 0.76 per 100, 000 in 2011 in China.

Challenges and moving forward

  • There are still challenges for China to reach its measles elimination goal. Maintaining high routine coverage for migrant and hard-to-reach populations is challenging. A large proportion of cases in some urban areas also makes the situation more complex.
  • At the close of 2011, the Ministry of Health issued an action plan for 2012, which included:
    • 400 high-risk counties selected to conduct additional standard measles SIAs.
    • Western counties selected to conduct measles SIAs targeting unvaccinated and under-vaccinated children.
    • Strengthening surveillance and routine immunization in the whole country.
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