Since the beginning of the century, the number of measles-related deaths has fallen substantially; between 2000 and 2014 mass immunisation efforts prevented an estimated 17·1 million deaths worldwide, and the number of cases decreased from 146 to 40 per million. Unfortunately, after this decrease the situation has stagnated and many countries are falling far behind the 2015 elimination targets according to a report by WHO and the US Centers for Disease Control and Prevention (CDC) released in November, 2015. The elimination target was to reduce rates of measles virus infection to fewer than five cases per million people, as well as to reduce worldwide mortality rates by 95% from the 2000 estimate. By contrast, the report points out that although in all countries immunisation schedules include at least one dose of measles-containing vaccine, by 2014 only 122 countries—compared with 131 in 2012—met the target of at least 90% of children receiving the first dose. Moreover, only half the world is receiving the recommended second dose of the vaccine.
In 2011, reported measles cases in the USA were 118 for the period from January to May and 46% of cases were import associated, mostly with the WHO Europe region. As of Nov 15, 2015, the annual number of measles cases in the USA was 189. Of those cases, 113 were related to the outbreak of measles linked to Disneyland (CA, USA) at the beginning of 2015, thought to have been caused by a visitor to the amusement park who had become infected overseas and then visited the park while infectious. This outbreak together with another one in Ohio's Amish country in 2014, in which 383 people fell ill after unvaccinated missionaries travelled to the Philippines and returned with the virus, has raised concerns over the efficiency of the national health-care system. Outbreaks across Canada, where the immunisation coverage for measles fell to 89·6% from 94·5% in the past 15 years, have occurred as well. And some individual countries still had large outbreaks, including Angola, Ethiopia, and India.
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