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WHO criteria for measles elimination: a critique with reference to criteria for polio elimination

H Kelly1, M Riddell, A Heywood

  • 1WHO Measles Regional Reference Laboratory, Victorian Infectious Diseases Reference Laboratory, North Melbourne, Australia. heath.kelly@mh.orgau

Euro Surveillance : Bulletin Europeen Sur Les Maladies Transmissibles = European Communicable Disease Bulletin
|January 15, 2010
PubMed

Insights

The current measles elimination criteria may disadvantage countries with established surveillance systems. A revised approach emphasizes molecular evidence and high vaccination coverage for accurate global measles eradication assessment.

Area of Science:

  • * Infectious disease epidemiology
  • * Public health surveillance systems
  • * Vaccine-preventable disease control

Background:

  • * Smallpox is the only human infectious disease eradicated to date.
  • * Poliomyelitis has been eliminated from several World Health Organization (WHO) regions, but challenges remain.
  • * Measles elimination criteria are under discussion, with current approaches potentially disadvantaging certain countries.

Purpose of the Study:

  • * To propose an alternative approach for documenting measles elimination.
  • * To highlight the limitations of current surveillance quality-focused criteria.
  • * To suggest principles for developing robust measles elimination criteria.

Main Methods:

  • * Analysis of current approaches to disease elimination and eradication documentation.
  • * Comparative assessment of poliomyelitis and measles elimination strategies.
  • * Proposal of new criteria for measles elimination focusing on molecular evidence and vaccination coverage.

Main Results:

  • * Current measles elimination criteria may unfairly disadvantage countries with long-established surveillance systems.
  • * An alternative approach is proposed, prioritizing molecular evidence of no endemic genotype circulation and high vaccination coverage (95% for one dose, with opportunity for a second).
  • * Annual review of elimination status is recommended.

Conclusions:

  • * Revised measles elimination criteria should include molecular evidence and high vaccination coverage.
  • * Quality surveillance is necessary but insufficient for defining elimination; it should be guided by elimination goals.
  • * Elimination criteria should be consistent across WHO regions unless justified by specific reasons.

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