Missed Measles Immunisations Places Individuals and Communities at Risk: The Equity Argument for Including Measles in...

Area of Science:

• Global Health
• Pediatric Infectious Diseases
• Vaccinology

Background:

• Measles remains a leading cause of vaccine-preventable childhood mortality, with global cases and deaths rising since 2019.
• Current global definitions of under-immunized children focus on diphtheria-tetanus-pertussis (DTP) vaccines, potentially overlooking critical measles vaccination gaps.
• Measles outbreaks often signal broader weaknesses in health systems and immunization programs.

Purpose of the Study:

• To analyze global measles and DTP vaccination coverage disparities.
• To advocate for the inclusion of measles vaccination status in global definitions of under-immunized children.
• To highlight inequities in measles immunization, particularly in low- and middle-income countries (LMICs).

Main Methods:

• Utilized World Health Organization/UNICEF (WHO/UNICEF) estimates of national immunization coverage (WUENIC) data for 2019 and 2022.
• Assessed the number and proportion of children missing routine immunizations globally.
• Stratified countries by income status to identify vaccine coverage inequalities.

Main Results:

• In 2022, 50% more children missed their first measles-containing vaccine dose compared to the first dose of DTP vaccine.
• A significant majority (96%) of children missing measles vaccination reside in LMICs, underscoring global inequities.
• Countries with the highest number of children missing DTP1 were not necessarily those with the lowest measles immunization coverage, indicating a need for tailored strategies.

Conclusions:

• Measles immunization coverage should be a key metric in global reporting and estimation of under-immunized children.
• Including measles vaccination in definitions will improve the identification of at-risk populations and guide targeted public health interventions.
• Addressing measles vaccination gaps is essential to mitigate the high transmissibility and inequitable burden of measles outbreaks, especially in LMICs.