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The economic crisis in Venezuela has eroded the country's health-care infrastructure and threatened the public health of its people. Shortages in medications, health supplies, interruptions of basic utilities at health-care facilities, and the emigration of health-care workers have led to a progressive decline in the operational capacity of health care. The effect of the crisis on public health has been difficult to quantify since the Venezuelan Ministry of Health stopped publishing crucial public health statistics in 2016. We prepared a synthesis of health information, beyond what is available from other sources, and scholarly discussion of engagement strategies for the international community. Data were identified through searches in MEDLINE, PubMed, and the grey literature, through references from relevant articles, and governmental and non-governmental reports, and publicly available databases. Articles published in English and Spanish until Dec 1, 2018, were included. Over the past decade, public health measures in Venezuela have substantially declined. From 2012 to 2016, infant deaths increased by 63% and maternal mortality more than doubled. Since 2016, outbreaks of the vaccine-preventable diseases measles and diphtheria have spread throughout the region. From 2016 to 2017, Venezuela had the largest rate of increase of malaria in the world, and in 2015, tuberculosis rates were the highest in the country in 40 years. Between 2017 and 2018, most patients who were infected with HIV interrupted therapy because of a lack of medications. The Venezuelan economic crisis has shattered the health-care system and resulted in rising morbidity and mortality. Outbreaks and expanding epidemics of infectious diseases associated with declines in basic public health services are threatening the health of the country and the region. [ABSTRACT FROM AUTHOR]

Measles is a deadly disease that has killed or disabled millions of children over centuries.[1] In 1980, when most children in low-income countries did not have access to measles vaccine, it was estimated that measles led to the deaths of more than 2 million children.[2] Advances in child survival during the next two decades were partly due to the provision of measles vaccine for children in all countries through the Expanded Programme on Immunization.[3] By 2000, estimated global measles mortality was 539 000 deaths per year.[4] Further declines followed the introduction of catch-up vaccination campaigns to immunise children missed by routine immunisation. Globally, estimated measles vaccine coverage in 2019 was 85% and 71% for the first and second doses of measles-containing vaccine respectively,[4] which combined with poor immunisation campaign performance has left major immunity gaps likely to result in measles outbreaks. Non-uniform vaccination coverage, whether due to problems with accessing vaccination services or vaccine hesitancy, leads to clusters of non-immune individuals, even if overall vaccination coverage exceeds 95%. [Extracted from the article]

Measles is a highly contagious disease that results from infection with measles virus and is still responsible for more than 100 000 deaths every year, down from more than 2 million deaths annually before the introduction and widespread use of measles vaccine. Measles virus is transmitted by the respiratory route and illness begins with fever, cough, coryza, and conjunctivitis followed by a characteristic rash. Complications of measles affect most organ systems, with pneumonia accounting for most measles-associated morbidity and mortality. The management of patients with measles includes provision of vitamin A. Measles is best prevented through vaccination, and the major reductions in measles incidence and mortality have renewed interest in regional elimination and global eradication. However, urgent efforts are needed to increase stagnating global coverage with two doses of measles vaccine through advocacy, education, and the strengthening of routine immunisation systems. Use of combined measles-rubella vaccines provides an opportunity to eliminate rubella and congenital rubella syndrome. Ongoing research efforts, including the development of point-of-care diagnostics and microneedle patches, will facilitate progress towards measles elimination and eradication. [ABSTRACT FROM AUTHOR]

The article focuses on the condition of vaccine confidence and issues on measles cases in different countries. Topics being presented include complex determinants of vaccination, such as alternative health beliefs, politics, histories, trust, relationships, and emotions, which contribute to the overall stagnation of childhood and adult vaccine uptake globally as well as on vaccine anxieties.

Background: In 2019, the UK lost its WHO measles-free status, due to circulating measles virus and suboptimal coverage with the measles, mumps, and rubella (MMR) vaccine. The National Health Service (NHS) schedule recommends MMR vaccines at age 12 and 40 months. In England in 2020-21, MMR coverage did not meet the 95% target for herd immunity. This work is part of a project to develop a vaccination intervention delivered in the paediatric emergency department (PED). The aim of this study was to quantify unmet MMR-related vaccination need among PED attendees.Methods: This cross-sectional, single-centre observational study collected data on children (aged 1-5 years) attending a large district general PED in Greater Manchester, UK, from Oct 1 to Oct 31, 2021, with data collected on a single occasion. Ethics approval was for an opt-out approach. Vaccination data were extracted from individual electronic summary care records, as part of the primary care record visible within secondary care. Coverage in the study population was compared with data for the northwest of England from the Cover of Vaccination Evaluated Rapidly surveillance scheme for the period April 1, 2020 to March 31, 2021. χ2 tests were used to examine differences in proportions vaccinated.Findings: 1059 children aged 1-5 years attended the PED in October, 2021, and data for 977 children were included in this study. Among all children, 638 (65·3%) had at least one dose of MMR recorded in their summary care record. The most similar regional comparator was first-dose MMR by the age of 5 years, which was administered in 86 678 (95·2%) of 91 023 children in 2020-21 (p<0·0001). In our cohort, among eligible children older than 40 months (n=339), only 66 (19·5%) had received both MMR doses, compared with regional coverage (by age 5 years) in 79 535 (87·4%) of 91 023 children (p<0·0001). A power calculation showed 577 participants were needed to detect a 5% difference in second-dose MMR.Interpretation: Children younger than 5 years attending the PED had low rates of age-appropriate MMR vaccination coverage, suggesting considerable unmet need in these PED attendees. Other work within this project looks at tetanus coverage and sources of vaccination data.Funding: None. [ABSTRACT FROM AUTHOR]

The article presents a cross-sectional survey that assessed population immunity to measles virus and the effect of HIV-1 infection after a mass vaccination campaign in Lusaka, Zambia. Households in Lusaka, Zambia were randomly selected for a cross-sectional survey three years after a measles supplemental immunisation activity (SIA). Children nine months to five years of age participated in the survey. Information about measles vaccination history and history of measles was obtained from the children's caregivers using a questionnaire. Children's oral fluid samples were tested for antibodies to measles virus and HIV-1. Researchers concluded that population immunity to measles was insufficient to interrupt measles virus transmission three years after an SIA.

The article presents an epidemiological assessment of measles in Europe in relation to the goal of elimination by 2010. Data for age-group, diagnosis confirmation, hospital treatment, vaccination, the presence of acute encephalitis, and death was obtained for 32 European countries. Cases which were clinical, laboratory-confirmed, and epidemiologically linked were analysed. The study found that most cases were from Romania, Germany, Great Britain, Switzerland, and Italy and that most were in unvaccinated or incompletely vaccinated children. The authors explain that suboptimum vaccination coverage raises doubts that elimination by 2010 can be achieved and that maintaining optimum vaccination coverage and improved surveillance are necessary for elimination of measles in Europe.

Background: In 2002, the UN General Assembly Special Session on Children adopted a goal to reduce deaths owing to measles by half by the end of 2005, compared with 1999 estimates. We describe efforts and progress made towards this goal. Methods: We assessed trends in immunisation against measles on the basis of national implementation of the WHO/UNICEF comprehensive strategy for measles mortality reduction, and the provision of a second opportunity for measles immunisation. We used a natural history model to evaluate trends in mortality due to measles. Results: Between 1999 and 2005, according to our model mortality owing to measles was reduced by 60%, from an estimated 873 000 deaths (uncertainty bounds 634 000-1140 000) in 1999 to 345 000 deaths (247 000-458 000) in 2005. The largest percentage reduction in estimated measles mortality during this period was in the western Pacific region (81%), followed by Africa (75%) and the eastern Mediterranean region (62%). Africa achieved the largest total reduction, contributing 72% of the global reduction in measles mortality. Nearly 7 · 5 million deaths from measles were prevented through immunisation between 1999 and 2005, with supplemental immunisation activities and improved routine immunisation accounting for 2 · 3 million of these prevented deaths. Interpretation: The achievement of the 2005 global measles mortality reduction goal is evidence of what can be accomplished for child survival in countries with high childhood mortality when safe, cost-effective, and affordable interventions are backed by country-level political commitment and an effective international partnership. [ABSTRACT FROM AUTHOR]

Summary Background In 2000, the WHO African Region adopted a plan to accelerate efforts to lower measles mortality with the goal of decreasing the number of measles deaths to near zero. By June, 2003, 19 African countries had completed measles supplemental immunisation activities (SIA) in children aged 9 months to 14 years as part of a comprehensive measles-control strategy. We assessed the public-health impact of these control measures by use of available surveillance data. Methods We calculated percentage decline in reported measles cases during 1-2 years after SIA, compared with 6 years before SIA. On the basis of data from 13 of the 19 countries, we assumed that the percentage decline in measles deaths equalled that in measles cases. We also examined data on routine and SIA measles vaccine coverage, measles case-based surveillance, and suspected measles outbreaks. Findings Between 2000 and June, 2003, 82·1 million children were targeted for vaccination during initial SIA in 12 countries and follow-up SIA in seven countries. The average decline in the number of reported measles cases was 91%. In 17 of the 19 countries, measles case-based surveillance confirmed that transmission of measles virus, and therefore measles deaths, had been reduced to low or very low rates. The total estimated number of deaths averted in the year 2003 was 90,043. Between 2000 and 2003 in the African Region as a whole, we estimated that the percentage decline in annual measles deaths was around 20% (90,043 of 454,000). Interpretation The burden of measles in sub-Saharan Africa can be reduced to very low levels by means of appropriate strategies, resources, and personnel. [ABSTRACT FROM AUTHOR]

Measles is the most frequent cause of vaccine-preventable childhood deaths. Infants younger than the recommended age for vaccination are susceptible to the disease, and in developing countries they have a high risk of complications and mortality. Vaccine coverage in excess of 95% interrupts endemic transmission of measles in many countries, but achievement of such coverage almost always requires coordinated supplementary mass vaccination campaigns. There are substantial health gains if countries improve measles vaccine coverage, irrespective of whether or not high coverage is achieved; these gains include much lower measles complication and case fatality rates, long-term interepidemic duration, and possibly non-specific improvements in survival of children. Investigation into the cost-effectiveness of different strategies for measles control, including mass campaigns, two-dose schedules, and young-infant doses, would help countries to formulate control policies appropriate to their setting. Pneumonia is the most common fatal complication associated with measles, and at least 50% of measles-related pneumonias are due to bacterial superinfection. WHO has developed standard case management programmes for measles, but there are several unresolved clinical issues, including optimum indications for antibiotic treatment, the importance of intravenous immunoglobulin, the role of viral coinfection, and the risk of tuberculosis after measles. The priority in worldwide efforts to control measles is to lend support to poor countries, helping them to increase vaccine coverage and sustain improvements to vaccination infrastructure, and to address technical issues with respect to optimum vaccination schedules. Measles represents a specific challenge, whereby partnerships between high-income and developing nations would reduce child mortality in developing countries; such partnerships are not without incentive for high-income countries, since without them imported measles... [ABSTRACT FROM AUTHOR]

Presents letters to the editor about medical topics or research. Measles elimination in South Africa; Statins, fibrates, and ocular myasthenia; Neurological sequelae in in-vitro fertilization babies; Mammographic screening; Schizophrenia and velo-cardio-facial syndrome; Treatment of esophageal rupture; Health needs of Palestinians; Quantification of completeness of follow-up in clinical trials; Opportunities to improve occupational health in Italy; Antibiotic prophylaxis at Caesarean section.

Presents letters to the editor of 'The Lancet' as of June 15, 2002. Autism, bowel inflammation and measles; Multidrug resistance and response to antiretroviral treatment; Dynamic epidemiology of group A streptococcal serotypes; Other topics.

Offers various letters on medical topics as of August 26, 2000. Includes such topics as respiratory distress syndrome, pancreatitis; Benefits of chemotherapy in head and neck cancer; Mutations of Hepatitis B virus and the efficacy of vaccination; Connection between measles virus and autism; Others.

Summary Background: In 1994, ministers of health of countries of North and South America established the goal of measles eradication from the western hemisphere by 2000. To accomplish this goal, the Pan American Health Organization (PAHO) developed an enhanced measles vaccination strategy.Methods: PAHO's measles eradication vaccination strategy has evolved into three principal components; a catch-up measles vaccination campaign, maintenance of high vaccination coverage (keep-up), and periodic follow-up measles vaccination campaigns. To monitor progress towards measles eradication, measles surveillance has been strengthened, including the laboratory investigation of suspected measles cases.Findings: Both the catch-up and follow-up mass campaigns achieved high vaccination coverages in the respective targeted age groups. In 1996, only 2109 confirmed measles cases were reported in the Americas. In 1997, there was a resurgence of measles in the Americas, mostly as a result of a large measles outbreak with over 42000 cases, which occurred mainly among unvaccinated young adults in Sao Paulo State, Brazil. By 1998, there was a reduction in the number of reported confirmed measles cases, with a total of 14474 cases. Reduction of cases continued to the end of 1999, with a total of only 2828 confirmed cases.Interpretation: PAHO's measles eradication strategy has been effective in interrupting transmission and maintaining the absence of measles virus circulation in most parts of the Americas. The PAHO experience provides strong evidence that with full implementation of an appropriate vaccination strategy, measles transmission can be effectively interrupted. [ABSTRACT FROM AUTHOR]

Examines the effect of exposure to natural measles on immunity in vaccinated children. Method of investigation during a 1992 epidemic of measles in Niakhar, a rural area of Senegal; Findings on clinical and subclinical measles occurrences, and antibody concentrations; Interpretation that milder epidemics of wild measles might occur in vaccinated areas.

Comments on a longitudinal study of measles infection in rural Senegal that found a significantly higher case-fatality rate (CFR) for girls than for boys. Examines whether the male/female difference in CFR could be related to different risks for boys and girls of being infected as secondary cases and of being infected by a child of the opposite sex. Study methods, results and discussion.

Presents results of a randomized vaccine trial in a rural area of Senegal in which children were assigned randomly at birth to three vaccine groups. Higher risk of death in two high-titre vaccine groups; Need to reconsider the use of high-titre measles vaccines early in life in less developed countries; Edmonston-Zagreb (EZ-HT); Schwarz (SW-HT); Subjects and methods; More.

The average infection rate was 53-6% among more resistant, older children (grades 5-12) in classrooms without GUV air disinfection, compared with the average infection rate of 13-3% among more susceptible, younger children (grades K-4) in classrooms with GUV air disinfection (appendix). However, when GUV air disinfection was distributed to schools in rural upstate New York, NY, USA and in urban London, UK there was no protective effect.[[2]] In both locations GUV air disinfection was installed in classrooms and common areas, but unlike in suburban Philadelphia, children rode home on school buses in rural upstate New York and played together in crowded tenements in urban London. Properly applied, upper-room GUV air disinfection can safely and effectively reduce measles transmission in high-risk settings as herd immunity is re-established. [Extracted from the article]

The article offers information on an emergency vaccination programme by the ministry of health, with support from WHO in Madagascar. Topics discussed include regional disparities which affect provision of health; criticising the government and the ministry of health's failure to claim responsibility during epidemics of plague or measles could cost the non-governmental organisations; and provides several solutions which can work.

The author comments on a phase 2 trial that assessed the immunogenicity, safety and tolerability of a live-attenuated, measles-vectored vaccine (MV-CHIK) that expresses chikungunya virus structural proteins, resulting in a chikungunya virus-like particle structure. She describes the advantages of the approach used by the researchers over other platforms. She also discusses issues to be addressed despite the potential shown by the vaccine candidate in terms of its safety and immunogenicity.

The article examines the need for compulsory vaccination in Great Britain following the outbreak of a vaccine-preventable disease. About 808 cases of measles have been reported in Swansea, Wales as of April 17, 2013, with 10 percent leading to hospital admission. A discussion on the arguments for compulsory vaccination is provided, with comparisons between the U.S. and Great Britain. It looks at the impact of mandatory vaccination or penalties for non-uptake in the 21st century.

Several letters to the editor are presented in response to the article "Assessment of the 2010 global measles mortality reduction goal: results from a model of surveillance data" by E. Simons, M. Ferrari and J. Fricks in the June 9, 2012 issue along with the reply of the authors.

The article offers information on facing displacement, malnutrition, drought, and poor access to health care by people in Chad Basin. Topics discussed include severe malnutrition and cases of malaria and measles in the region; need of food, safe drinking water, shelter, and health care; and emergency aid and vaccination operations by the United Nations Office for the Coordination of Humanitarian Affairs.

Describes the persistence of measles antibody, at 36 months of age, after immunization with high-dose Edmonston-Zagreb vaccine at four months of age. Compares with the conventional Schwarz vaccine.

Comments on measles and pertussis transmission in developing countries with good vaccine coverage. Occurrence of outbreaks; Antibody transmission to children; Use of measles vaccination schedules with two or three doses; Vaccination of young women before or during pregnancy to improve passive immunity of infants.

The article offers information on the Measles eradication. Topics discussed include 75 percent of measles cases in the USA have occurred within more closed, religious communities such as the Amish in the Midwest and Somali migrants in Minnesota; and mentions according to the U.S. Centers for Disease Control and Prevention, 91 percent of U.S. children between the ages of 19 and 35 months receive Measles, Mumps, and Rubella (MMR) vaccinations.

An editorial that refers to Russian-backed attempts to sabotage Ukraine's economic,political, and health developments have left the country fighting a measles outbreak and continuing a bloody, undeclared war. The author discusses tensions between the ideologies of President Vladimir Putin and countries of the pro-democratic, neoliberal west. Also noted health care reforms by UN Security Council (UNSC) and the security situation in Ukraine and its severe impact on the civilian population.

The article presents a report on the high numbers of measles cases reported in the first two quarters of 2018 are alarming public health experts who fear this highly infectious disease will spread dealing with the rising measles cases in Europe since the beginning of 2018. Topics include rise in number of measles deaths in Europe, refusal for vaccinations, and growing level of scepticism and even active campaigning against vaccinations.

The article discusses the spread of a measles outbreak throughout the Americas, threatening local and indigenous populations that have not received vaccination against the disease. Topics discussed include the rise in the number of people leaving Venezuela out of fear, re-appearance of diphtheria in Venezuela, and malnutrition among children due to chronic food shortages, which has weakened their immune systems.

The article focuses on the growing cases of measles in the regions of Yemen, as per data collected by the United Nations Children's Fund (UNICEF) and World Health Organization (WHO). It reports that about 2000 to 4000 cases per year has been raised within in the time span from 2013 to 2017. The Yemen cases faces the challenges of the Expanded Program on Immunization. UNICEF and WHO has also run risk assessment program to track the very-high-risk for rubella and measles in Yemen.

The article reports on the European Commission's recommendation to strengthen cooperation against vaccine-preventable diseases in European Union (EU) countries. Topics discussed include the outbreak of vaccine-preventable diseases including measles due to the decline of vaccine coverage, supply shortages and vaccine hesitancy and the public response of the European Academies Science Advisory Council (EASAC) and the Federation of European Academies of Medicine (FEAM) to the recommendation.

The author discusses report "Progress Toward Regional Measles Elimination-Worldwide, 2000-2015" by UNICEF, World Health Organization and the U.S. Centers for Disease Control and Prevention focusing on progress of United Nations Millennium Development Goal 4 to reduce child mortality from measles.

The article discusses cases of measles and mumps who were admitted in hospitals in England.

The article reports that Southern Sudan will face some terrible health and humanitarian challenges, because of the shortage of health workers, and only 16 percent people having access to health care, while it became independent on July 9, 2011. It states that the people of South Sudan region face a heavy disease burden, including meningitis, measles and cholera. It mentions that agencies, like International Medical Corps (IMC) are training nurses to meet the acute manpower shortage.

A response by David Heymann and colleagues to several letters to the editor regarding their article "Measles eradication: past is prologue" in the 2010 issue is presented.

The authors examine the developments in measles eradication efforts as of November 20, 2010. They focus on the topics discussed at a World Health Organization (WHO) meeting. They present data on the prevalence of measles globally in 2000. They believe that the feasibility of measles eradication entails several stringent strategies like high-routine coverage of measles immunization and suspension of target for measles eradication unless all countries realize achievable sustainable high routine coverage.

The article reports on the caution by humanitarian organization UNICEF that the health and humanitarian situation in Borno State, Nigeria is likely to worsen in the following months after August in 2016 unless humanitarian aid reaches its people. The insurgency caused by terrorist group Boko Haram in the state since 2009 is explored. The estimation by the organization on a number of children who will suffer from severe acute malnutrition in the state is highlighted.

This article discusses the likely character of the public health crisis that will follow Cyclone Nargis, a natural disaster that occurred in Burma during 2008. It describes the problems of groundwater contamination from corpses and salt water, and speculates that this will cause a cholera epidemic. It describes the health risks faced by children in the area, including fatalities from diarrhoea and measles. It quotes officials from UNICEF, the World Health Organization, and Medicins Sans Frontières discussing efforts to prevent these health problems. It concludes with comments on the risk of long-term food supply issues and malnutrition.

The article presents a letter to the editor in response to "Public-health impact of accelerated measles control in the WHO African region," by M. Otten and colleagues and published in a previous issue of "The Lancet."

Discusses an article in this issue by Mac Otten and others about the dramatic success achieved in the acceleration of efforts to reduce measles mortality in Africa between 2000 and 2003. Conclusion of the study that initial supplemental immunisation campaigns targeting children aged 9 months to 14 years are more effective in reducing measles mortality than those targeting children aged 9 months to 5 years; Statistics regarding measles and efforts to treat it; Challenges that remain in achieving and sustaining measles mortality reduction in all countries.

Examines the importance of measles surveillance to public health. Details of a study on the spread of a measles epidemic in the Netherlands; Findings of the study indicating that a very small number of measles cases were reported to public health officials; Importance of measles surveillance to public health.

Presents a letter to the editor in regard to the continuing efforts in Japan to eliminate measles.

Presents a letter to the editor regarding an article which appeared in the November 1, 2003 issue of "The Lancet," and discussed the relationship between measles, mumps, and rubella (MMR) vaccine and autism.

A fatal measles case in an immunocompromised Indonesian child was associated with nosocomial transmission to health care workers. The virus isolated proved to represent a new genotype within clade G. [ABSTRACT FROM AUTHOR]

Reports on the first phase of eliminating indigenous measles in Caribbean countries by 1995, an effort started on May 18, 1991. Lists the countries involved in the largest coordinated health project in the history of the region. Decision was made to eliminate measles by the Caucus of Caribbean Community (CARICOM) Ministers Responsible for Health in September 1988.

Gives information to physicians on the complex sequence of immunological events in measles. Process; Symptoms; Treatment.