CASE 17: Eliminating measles in southern Africa

Health Condition: Measles, one of the most contagious infections known to humans, ranks among the top four childhood killers worldwide. Despite the existence of a safe and effective vaccine, an estimated 30 to 40 million cases of the disease and some 454,000 deaths occurred in 2004. Just under half of these deaths were in sub-Saharan Africa, where measles kills more children than HIV/AIDS. In 1996, the seven countries of southern Africa reported a total of 60,000 measles cases and 166 measles deaths.

Intervention or Program: In 1996, seven southern African countries agreed on a plan to eliminate measles. The strat­egy consisted of:

• routine immunization for babies at nine months;
• a nationwide "catch-up" campaign to provide a second opportunity for immunization to all children aged 9 months to 14 years; and
• follow-up campaigns in young children every three to four years.

In addition, the countries organized surveillance for cases of measles and improved laboratory fa­cilities so that suspect cases could be confirmed.

Impact: Between 1996 and 2000, the number of measles cases across southern Africa fell from 60,000 to 117. The number of measles deaths fell from 166 to zero.

Cost and Cost-Effectiveness: The majority of the funding for the measles initiative came from national budgets. An esti­mate of the total cost of the program is $26.4 million, with the average cost per immunized child at $1.10. The cost of in­creasing routine coverage from 50 to 80 percent has been estimated at about $2.50 per year of healthy life gained, making measles immunization an extremely cost-effective intervention.