{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T12:26:11Z","timestamp":1792844771057,"version":"4.5.0"},"reference-count":39,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,1,20]],"date-time":"2022-01-20T00:00:00Z","timestamp":1642636800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["71934002"],"award-info":[{"award-number":["71934002"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Measles is a highly contagious disease that has caused global morbidity and mortality. Though great progress has been made in measles elimination, the resurgence of measles has been observed in recent years. As extant literature were mainly confined to data of local area, we conducted a systematic analysis to explore the trends of the incidence of measles, coverage rate, and the risk factors from 1990 to 2019 on global, regional, and national levels.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Data on cases of incidence, age standardized rate (ASR), vaccine coverage, and risk factors of measles were retrieved from the Global Burden of Disease (GBD) Study 2019 database. Estimated averaged percentage change (EAPC) of ASR was calculated to quantify the trends of measles incidence. Pearson correlation was applied to assess the association of EAPC and measles-containing vaccine coverage rate with socio-demographic index (SDI) in 2019, and the correlation between ASR and measles-containing vaccine coverage rate.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Globally, there was a significant decrease in the number (84.18%) and ASR (6.13%, 95% CI: 5.41\u20136.84%) of measles incidence from 1990 to 2019. More than 80% of incidence cases were attributed to children under 5 and the proportion was highest in low SDI region. Countries and territories with low ASRs are mostly clustered in North America, Southern Latin America, and Western Europe, whereas those with high ASRs are mainly clustered in Africa, East Asia, and South Asia. Lower SDI was associated with higher ASR and lower vaccine coverage rate. The more the SDI value was further away from 0.6, the smaller the absolute value did EAPC have. Child wasting accounted for the most measles-related death cases, followed by child underweight, child stunting, and vitamin A deficiency.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Measles eradication is feasible, but urgently demands political commitment, financial support, and public engagement. In the context of COVID-19 pandemic and the global resurgence of measles, surveillance systems and routine immunization programs should be improved, while vaccine hesitancy needs to be addressed.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fmed.2021.798031","type":"journal-article","created":{"date-parts":[[2022,1,20]],"date-time":"2022-01-20T05:52:38Z","timestamp":1642657958000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":50,"title":["Trends of the Global, Regional, and National Incidence of Measles, Vaccine Coverage, and Risk Factors in 204 Countries From 1990 to 2019"],"prefix":"10.3389","volume":"8","author":[{"given":"Ruitong","family":"Wang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenzhan","family":"Jing","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Min","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jue","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2022,1,20]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"e138","DOI":"10.1016\/s1473-3099(20)30052-9","article-title":"Measles eradication-retreating is not an option","volume":"20","author":"Durrheim","year":"2020","journal-title":"Lancet Infect Dis."},{"key":"B2","doi-asserted-by":"publisher","first-page":"2490","DOI":"10.1016\/s0140-6736(17)31463-0","article-title":"Measles","volume":"390","author":"Moss","year":"2017","journal-title":"Lancet."},{"key":"B3","doi-asserted-by":"publisher","first-page":"e420","DOI":"10.1016\/s1473-3099(17)30307-9","article-title":"The basic reproduction number (R(0)) of measles: a systematic review","volume":"17","author":"Guerra","year":"2017","journal-title":"Lancet Infect Dis."},{"key":"B4","doi-asserted-by":"publisher","first-page":"2543","DOI":"10.1002\/jmv.26041","article-title":"Estimation of the basic reproduction number, average incubation time, asymptomatic infection rate, and case fatality rate for COVID-19: meta-analysis and sensitivity analysis","volume":"92","author":"He","year":"2020","journal-title":"J Med Virol."},{"key":"B5","doi-asserted-by":"publisher","first-page":"1001","DOI":"10.1001\/jama.2021.14811","article-title":"Confronting the delta variant of SARS-CoV-2, summer 2021","volume":"326","author":"del Rio","year":"2021","journal-title":"JAMA"},{"key":"B6","unstructured":"Measles"},{"key":"B7","doi-asserted-by":"publisher","first-page":"2185","DOI":"10.1056\/NEJMp1905099","article-title":"Measles in 2019\u2014going backward","volume":"380","author":"Paules","year":"2019","journal-title":"N Engl J Med."},{"key":"B8","doi-asserted-by":"publisher","first-page":"1700","DOI":"10.15585\/mmwr.mm6945a6","article-title":"Progress toward regional measles elimination\u2014worldwide, 2000\u20132019","volume":"69","author":"Patel","year":"2020","journal-title":"MMWR Morb Mortal Wkly Rep."},{"key":"B9","doi-asserted-by":"publisher","first-page":"1105","DOI":"10.15585\/mmwr.mm6848a1","article-title":"Progress toward regional measles elimination\u2014worldwide, 2000\u20132018","volume":"68","author":"Patel","year":"2019","journal-title":"MMWR Morb Mortal Wkly Rep."},{"key":"B10","unstructured":"GBD Results Tool"},{"key":"B11","doi-asserted-by":"publisher","first-page":"1204","DOI":"10.1016\/S0140-6736(20)30925-9","article-title":"Global burden of 369 diseases and injuries in 204 countries and territories, 1990\u20132019: a systematic analysis for the Global Burden of Disease Study 2019","volume":"396","year":"2020","journal-title":"Lancet"},{"key":"B12","doi-asserted-by":"publisher","first-page":"1223","DOI":"10.1016\/S0140-6736(20)30752-2","article-title":"Global burden of 87 risk factors in 204 countries and territories, 1990\u20132019: a systematic analysis for the Global Burden of Disease Study 2019","volume":"396","author":"GBD","year":"2020","journal-title":"Lancet"},{"key":"B13","doi-asserted-by":"publisher","first-page":"503","DOI":"10.1016\/s0140-6736(21)00984-3","article-title":"Measuring routine childhood vaccination coverage in 204 countries and territories, 1980\u20132019: a systematic analysis for the Global Burden of Disease Study 2020, Release 1","volume":"398","year":"2021","journal-title":"Lancet"},{"key":"B14","doi-asserted-by":"publisher","first-page":"taab046","DOI":"10.1093\/jtm\/taab046","article-title":"Trends of the global, regional and national incidence of malaria in 204 countries from 1990 to 2019 and implications for malaria prevention","volume":"28","author":"Liu","year":"2021","journal-title":"J Travel Med"},{"key":"B15","doi-asserted-by":"publisher","first-page":"210","DOI":"10.3390\/v8080210","article-title":"Measles virus host invasion and pathogenesis","volume":"8","author":"Laksono","year":"2016","journal-title":"Viruses."},{"key":"B16","doi-asserted-by":"publisher","first-page":"610","DOI":"10.1016\/j.jemermed.2020.02.007","article-title":"An update and review of measles for emergency physicians","volume":"58","author":"Alves Graber","year":"2020","journal-title":"J Emerg Med."},{"key":"B17","doi-asserted-by":"publisher","first-page":"893","DOI":"10.1007\/s10654-019-00574-7","article-title":"Measles vaccine immune escape: should we be concerned?","volume":"34","author":"Yang","year":"2019","journal-title":"Eur J Epidemiol."},{"key":"B18","first-page":"59","article-title":"Expanded programme on immunization","volume":"41","author":"Keja","year":"1988","journal-title":"World Health Stat Q."},{"key":"B19","unstructured":"Statement on the second meeting of the International Health Regulations (2005) Emergency Committee regarding the outbreak of novel coronavirus (2019-nCoV)"},{"key":"B20","doi-asserted-by":"publisher","first-page":"1035","DOI":"10.3201\/eid2306.161682","article-title":"Measles cases during ebola outbreak, West Africa, 2013\u20132106","volume":"23","author":"Colavita","year":"2017","journal-title":"Emerg Infect Dis."},{"key":"B21","doi-asserted-by":"publisher","first-page":"161","DOI":"10.1016\/j.ijid.2020.06.072","article-title":"COVID-19 and routine childhood immunization in Africa: leveraging systems thinking and implementation science to improve immunization system performance","volume":"98","author":"Adamu","year":"2020","journal-title":"Int J Infect Dis."},{"key":"B22","doi-asserted-by":"publisher","first-page":"7146","DOI":"10.1016\/j.vaccine.2020.08.019","article-title":"Impact of COVID-19 pandemic response on uptake of routine immunizations in Sindh, Pakistan: an analysis of provincial electronic immunization registry data","volume":"38","author":"Chandir","year":"2020","journal-title":"Vaccine."},{"key":"B23","doi-asserted-by":"publisher","first-page":"591","DOI":"10.15585\/mmwr.mm6919e2","article-title":"Effects of the COVID-19 pandemic on routine pediatric vaccine ordering and administration\u2014United States, 2020","volume":"69","author":"Santoli","year":"2020","journal-title":"MMWR Morb Mortal Wkly Rep."},{"key":"B24","doi-asserted-by":"publisher","first-page":"2000848","DOI":"10.2807\/1560-7917.ES.2020.25.19.2000848","article-title":"Early impact of the coronavirus disease (COVID-19) pandemic and physical distancing measures on routine childhood vaccinations in England, January to April 2020","volume":"25","author":"McDonald","year":"2020","journal-title":"Euro Surveill."},{"key":"B25","unstructured":"At least 80 Million Children Under One at Risk of Diseases Such As Diphtheria, Measles and Polio as COVID-19 Disrupts Routine Vaccination Efforts, Warn Gavi, WHO and UNICEF"},{"key":"B26","doi-asserted-by":"publisher","first-page":"e1264","DOI":"10.1016\/s2214-109x(20)30308-9","article-title":"Routine childhood immunisation during the COVID-19 pandemic in Africa: a benefit-risk analysis of health benefits versus excess risk of SARS-CoV-2 infection","volume":"8","author":"Abbas","year":"2020","journal-title":"Lancet Glob Health."},{"key":"B27","doi-asserted-by":"publisher","first-page":"119","DOI":"10.1038\/s41586-019-1656-7","article-title":"N'Kengasong J, Ng E, Sow S, Kampmann B. Immunization: vital progress, unfinished agenda","volume":"575","author":"Piot","year":"2019","journal-title":"Nature."},{"key":"B28","doi-asserted-by":"publisher","first-page":"193","DOI":"10.1093\/ajcn\/80.1.193","article-title":"Undernutrition as an underlying cause of child deaths associated with diarrhea, pneumonia, malaria, and measles","volume":"80","author":"Caulfield","year":"2004","journal-title":"Am J Clin Nutr."},{"key":"B29","doi-asserted-by":"publisher","first-page":"160","DOI":"10.1056\/nejm199007193230304","article-title":"A randomized, controlled trial of vitamin A in children with severe measles","volume":"323","author":"Hussey","year":"1990","journal-title":"N Engl J Med."},{"key":"B30","doi-asserted-by":"publisher","first-page":"i48","DOI":"10.1093\/ije\/dyq021","article-title":"Effectiveness of measles vaccination and vitamin A treatment","volume":"1","author":"Sudfeld","year":"2010","journal-title":"Int J Epidemiol."},{"key":"B31","doi-asserted-by":"publisher","first-page":"219","DOI":"10.1016\/j.vaccine.2017.07.066","article-title":"Measles vaccines: WHO position paper, April 2017\u2014recommendations","volume":"37","year":"2019","journal-title":"Vaccine."},{"key":"B32","doi-asserted-by":"publisher","first-page":"CD008524","DOI":"10.1002\/14651858.CD008524.pub3","article-title":"Vitamin A supplementation for preventing morbidity and mortality in children from six months to five years of age","volume":"3","author":"Imdad","year":"2017","journal-title":"Cochrane Database Syst Rev"},{"key":"B33","doi-asserted-by":"publisher","first-page":"190","DOI":"10.3390\/nu9030190","article-title":"Vitamin A supplementation programs and country-level evidence of vitamin A deficiency","volume":"9","author":"Wirth","year":"2017","journal-title":"Nutrients."},{"key":"B34","doi-asserted-by":"publisher","first-page":"192","DOI":"10.1093\/ije\/dyn224","article-title":"Estimates of measles case fatality ratios: a comprehensive review of community-based studies","volume":"38","author":"Wolfson","year":"2009","journal-title":"Int J Epidemiol."},{"key":"B35","doi-asserted-by":"publisher","first-page":"S4","DOI":"10.1093\/infdis\/jir100","article-title":"Proceedings of the Global Technical Consultation to assess the feasibility of measles eradication, 28\u201330 July 2010","volume":"1","year":"2011","journal-title":"J Infect Dis"},{"key":"B36","unstructured":"Global vaccine action plan 2011-2020"},{"key":"B37","doi-asserted-by":"publisher","first-page":"359","DOI":"10.1016\/j.bjid.2018.11.001","article-title":"Measles outbreak in Brazil, 2018","volume":"22","author":"Goldani","year":"2018","journal-title":"Braz J Infect Dis."},{"key":"B38","doi-asserted-by":"publisher","first-page":"201","DOI":"10.1007\/s00430-016-0451-4","article-title":"Eradication of measles: remaining challenges","volume":"205","author":"Holzmann","year":"2016","journal-title":"Med Microbiol Immunol."},{"key":"B39","doi-asserted-by":"publisher","first-page":"2584","DOI":"10.4161\/hv.28596","article-title":"What are the factors that contribute to parental vaccine-hesitancy and what can we do about it?","volume":"10","author":"Williams","year":"2014","journal-title":"Hum Vaccin Immunother."}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2021.798031\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,1,20]],"date-time":"2022-01-20T05:52:41Z","timestamp":1642657961000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2021.798031\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,1,20]]},"references-count":39,"alternative-id":["10.3389\/fmed.2021.798031"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2021.798031","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,1,20]]},"article-number":"798031"}}