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Cited by 125Vaccine Coverage and HesitancyVirology and Viral DiseasesGlobal Maternal and Child Health

Mapping routine measles vaccination in low- and middle-income countries

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Local Burden of Disease Vaccine Coverage Collaborators, Sbarra, Alyssa N., Rolfe, Sam, Nguyen, Jason Q., Earl, Lucas, Galles, Natalie C., Marks, Ashley, Abbas, Kaja M. +632 more·2021·Nature
DOI 10.1038/s41586-020-03043-4PMC PMC7739806
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Abstract

The safe, highly effective measles vaccine has been recommended globally since 1974, yet in 2017 there were more than 17 million cases of measles and 83,400 deaths in children under 5 years old, and more than 99% of both occurred in low- and middle-income countries (LMICs) 1–4 . Globally comparable, annual, local estimates of routine first-dose measles-containing vaccine (MCV1) coverage are critical for understanding geographically precise immunity patterns, progress towards the targets of the Global Vaccine Action Plan (GVAP), and high-risk areas amid disruptions to vaccination programmes caused by coronavirus disease 2019 (COVID-19) 5–8 . Here we generated annual estimates of routine childhood MCV1 coverage at 5 × 5-km 2 pixel and second administrative levels from 2000 to 2019 in 101 LMICs, quantified geographical inequality and assessed vaccination status by geographical remoteness. After widespread MCV1 gains from 2000 to 2010, coverage regressed in more than half of the districts between 2010 and 2019, leaving many LMICs far from the GVAP goal of 80% coverage in all districts by 2019. MCV1 coverage was lower in rural than in urban locations, although a larger proportion of unvaccinated children overall lived in urban locations; strategies to provide essential vaccination services should address both geographical contexts. These results provide a tool for decision-makers to strengthen routine MCV1 immunization programmes and provide equitable disease protection for all children.

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Collaborators, L. B. O. D. V. C., Sbarra, A. N., Rolfe, S., Nguyen, J. Q., Earl, L., Galles, N. C., Marks, A., Abbas, K. M., Abbasi-Kangevari, M., Abbastabar, H., Abd-Allah, F., Abdelalim, A., Abdollahi, M., Abegaz, K. H., Abiy, H. A. A., Abolhassani, H., Abreu, L. G., Abrigo, M. R. M., Abushouk, A. I., Accrombessi, M. M. K., Adabi, M., Adebayo, O. M., Adekanmbi, V., Adetokunboh, O. O., Adham, D., Afarideh, M., Aghaali, M., Ahmad, T., Ahmadi, R., Ahmadi, K., Ahmed, M. B., Alanezi, F. M., Alanzi, T. M., Alcalde-Rabanal, J. E., Alemnew, B. T., Ali, B. A., Ali, M., Alijanzadeh, M., Alinia, C., Alipoor, R., Alipour, V., Alizade, H., Aljunid, S. M., Almasi, A., Almasi-Hashiani, A., Al-Mekhlafi, H. M., Altirkawi, K. A., Amare, B., Amini, S., Amini-Rarani, M., Amiri, F., Amit, A. M. L., Amugsi, D. A., Ancuceanu, R., Andrei, C. L., Anjomshoa, M., Ansari, F., Ansari-Moghaddam, A., Ansha, M. G., Antonio, C. A. T., Antriyandarti, E., Anvari, D., Arabloo, J., Arab-Zozani, M., Aremu, O., Armoon, B., Aryal, K. K., Arzani, A., Asadi-Aliabadi, M., Asgari, S., Atafar, Z., Ausloos, M., Awoke, N., Quintanilla, B. P. A., Ayanore, M. A., Aynalem, Y. A., Azadmehr, A., Azari, S., Babaee, E., Badawi, A., Badiye, A. D., Bahrami, M. A., Baig, A. A., Bakhtiari, A., Balakrishnan, S., Banach, M., Banik, P. C., Barac, A., Baradaran-Seyed, Z., Baraki, A. G., Basu, S., Bayati, M., Bayou, Y. T., Bedi, N., Behzadifar, M., Bell, M. L., Berbada, D. A., Berhe, K., Bhattarai, S., Bhutta, Z. A., Bijani, A., Birhanu, M., Bisanzio, D., Biswas, A., Bohlouli, S., Bolla, S. R., Borzouei, S., Brady, O. J., Bragazzi, N. L., Briko, A. N., Briko, N. I., Nagaraja, S. B., Butt, Z. A., Cámera, L. A., Campos-Nonato, I. R., Car, J., Cárdenas, R., Carvalho, F., Castaldelli-Maia, J. M., Castro, F., Chattu, V. K., Chehrazi, M., Chin, K. L., Chu, D.-T., Cook, A. J., Cormier, N. M., Cunningham, B., Dahlawi, S. M. A., Damiani, G., Dandona, R., Dandona, L., Danovaro, M. C., Dansereau, E., Daoud, F., Darwesh, A. M., Darwish, A. H., Das, J. K., Weaver, N. D., De Neve, J.-W., Demeke, F. M., Demis, A. B., Denova-Gutiérrez, E., Desalew, A., Deshpande, A., Desta, D. M., Dharmaratne, S. D., Dhungana, G. P., Dianatinasab, M., Diaz, D., Dipeolu, I. O., Djalalinia, S., Do, H. T., Dorostkar, F., Doshmangir, L., Doyle, K. E., Dunachie, S. J., Duraes, A. R., Kalan, M. E., Leylabadlo, H. E., Edinur, H. A., Effiong, A., Eftekhari, A., El Sayed, I., El Sayed Zaki, M., Elema, T. B., Elhabashy, H. R., El-Jaafary, S. I., Elsharkawy, A., Emamian, M. H., Enany, S., Eshrati, B., Eskandari, K., Eskandarieh, S., Esmaeilnejad, S., Esmaeilzadeh, F., Esteghamati, A., Etisso, A. E., Farahmand, M., Faraon, E. J. A., Fareed, M., Faridnia, R., Farioli, A., Farzadfar, F., Fattahi, N., Fazlzadeh, M., Fereshtehnejad, S.-M., Fernandes, E., Filip, I., Fischer, F., Foigt, N. A., Folayan, M. O., Foroutan, M., Fukumoto, T., Fullman, N., Gad, M. M., Geberemariyam, B. S., Gebrehiwot, T. T., Gebrehiwot, A. M., Gebremariam, K. T., Gebremedhin, K. B., Gebremeskel, G. G., Gebreslassie, A. A., Gedefaw, G. A., Gezae, K. E., Ghadiri, K., Ghaffari, R., Ghaffarifar, F., Ghajarzadeh, M., Gheshlagh, R. G., Ghashghaee, A., Ghiasvand, H., Gholamian, A., Gilani, S. A., Gill, P. S., Girmay, A., Gomes, N. G. M., Gopalani, S. V., Goulart, B. N. G., Grada, A., Guimarães, R. A., Guo, Y., Gupta, R., Hafezi-Nejad, N., Haj-Mirzaian, A., Haj-Mirzaian, A., Handiso, D. W., Hanif, A., Haririan, H., Hasaballah, A. I., Hasan, M. M., Hasanpoor, E., Hasanzadeh, A., Hassanipour, S., Hassankhani, H., Heidari-Soureshjani, R., Henry, N. J., Herteliu, C., Heydarpour, F., Hollerich, G. I., Rad, E. H., Hoogar, P., Hossain, N., Hosseini, M., Hosseinzadeh, M., Househ, M., Hu, G., Huda, T. M., Humayun, A., Ibitoye, S. E., Ikilezi, G., Ilesanmi, O. S., Ilic, I. M., Ilic, M. D., Imani-Nasab, M. H., Inbaraj, L. R., Iqbal, U., Irvani, S. S. N., Islam, S. M. S., Islam, M. M., Iwu, C. J., Iwu, C. C. D., Jadidi-Niaragh, F., Jafarinia, M., Jahanmehr, N., Jakovljevic, M., Jalali, A., Jalilian, F., Javidnia, J., Jenabi, E., Jha, V., Ji, J. S., John, O., Johnson, K. B., Joukar, F., Jozwiak, J. J., Kabir, Z., Kabir, A., Kalani, H., Kalankesh, L. R., Kalhor, R., Kamal, Z., Kanchan, T., Kapoor, N., Karami, M., Matin, B. K., Karch, A., Karimi, S. E., Kayode, G. A., Karyani, A. K., Keiyoro, P. N., Khader, Y. S., Khafaie, M. A., Khammarnia, M., Khan, M. S., Khan, E. A., Khan, J., Khan, M. N., Khatab, K., Khater, M. M., Khatib, M. N., Khayamzadeh, M., Khazaei, M., Khazaei, S., Khosravi, A., Khubchandani, J., Kianipour, N., Kim, Y. J., Kimokoti, R. W., Kinyoki, D. K., Kisa, A., Kisa, S., Kolola, T., Komaki, H., Kosen, S., Koul, P. A., Koyanagi, A., Kraemer, M. U. G., Krishan, K., Kuate Defo, B., Kumar, M., Kumar, P., Kumar, G. A., Kusuma, D., La Vecchia, C., Lacey, B., Lad, S. D., Lal, D. K., Lam, F., Lami, F. H., Lansingh, V. C., Larson, H. J., Lasrado, S., Lee, S. W. H., Lee, P. H., LeGrand, K. E., Lenjebo, T. L., Li, S., Liang, X., Liu, P. Y., Lopukhov, P. D., Machado, D. B., Mahasha, P. W., Mahdavi, M. M., Maheri, M., Mahotra, N. B., Maled, V., Maleki, S., Malik, M. A., Malta, D. C., Mansour-Ghanaei, F., Mansouri, B., Mansourian, M., Mansournia, M. A., Martins-Melo, F. R., Masaka, A., Mayala, B. K., Mehndiratta, M. M., Mehri, F., Mehta, K. M., Memiah, P. T. N., Mendoza, W., Menezes, R. G., Mengesha, M. B., Mengesha, E. W., Mestrovic, T., Mihretie, K. M., Miller-Petrie, M. K., Mills, E. J., Milne, G. J., Mirabi, P., Mirrakhimov, E. M., Mirzaei, R., Mirzaei, M., Mirzaei, H. R., Mirzaei, H., Mirzaei-Alavijeh, M., Moazen, B., Moghadaszadeh, M., Mohamadi, E., Mohammad, D. K., Mohammad, Y., Mohammad, K. A., Mohammad Gholi Mezerji, N., Mohammadbeigi, A., Mohammadian-Hafshejani, A., Mohammadpourhodki, R., Mohammed, S., Mohammed, A. S., Mohammed, H., Mohebi, F., Mokdad, A. 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M., Pilgrim, T., Pirsaheb, M., Poljak, M., Postma, M. J., Pourjafar, H., Pourmalek, F., Pourmirza Kalhori, R., Prada, S. I., Prakash, S., Quazi Syed, Z., Quintana, H., Rabiee, N., Rabiee, M., Radfar, A., Rafiei, A., Rahim, F., Rajati, F., Rameto, M. A., Ramezanzadeh, K., Ranabhat, C. L., Rao, S. J., Rasella, D., Rastogi, P., Rathi, P., Rawaf, S., Rawaf, D. L., Rawal, L., Rawassizadeh, R., Rawat, R., Renjith, V., Renzaho, A. M. N., Reshmi, B., Reta, M. A., Rezaei, N., Rezai, M. S., Rezapour, A., Riahi, S. M., Ribeiro, A. I., Rickard, J., Rios-Blancas, M., Rios-González, C. M., Roever, L., Rostamian, M., Rubino, S., Rwegerera, G. M., Saad, A. M., Saadatagah, S., Sabour, S., Sadeghi, E., Moghaddam, S. S., Saeidi, S., Sagar, R., Sahebkar, A., Sahraian, M. A., Sajadi, S. M., Salahshoor, M. R., Salam, N., Salem, H., Salem, M. R., Salomon, J. A., Kafil, H. S., Sambala, E. Z., Samy, A. M., Saraswathy, S. Y. I., Sarmiento-Suárez, R., Saroshe, S., Sartorius, B., Sarveazad, A., Sathian, B., Sathish, T., Schaeffer, L. E., Schwebel, D. C., Senthilkumaran, S., Shabaninejad, H., Shahabi, S., Shaheen, A. A., Shaikh, M. A., Shalash, A. S., Shams-Beyranvand, M., Shamsi, M., Shamsizadeh, M., Sharafi, K., Sharifi, H., Sheikh, A., Sheikhtaheri, A., Shetty, R. S., Shiferaw, W. S., Shigematsu, M., Shin, J. I., Shirkoohi, R., Siabani, S., Siddiqi, T. J., Silverberg, J. I. S., Simonetti, B., Singh, J. A., Sinha, D. N., Sinke, A. H., Soheili, A., Sokhan, A., Soltani, S., Soofi, M., Sorrie, M. B., Soyiri, I. N., Spotin, A., Spurlock, E. E., Sreeramareddy, C. T., Sudaryanto, A., Sufiyan, M. B., Suleria, H. A. R., Abdulkader, R. S., Taherkhani, A., Tapak, L., Taveira, N., Taymoori, P., Tefera, Y. M., Tehrani-Banihashemi, A., Teklehaimanot, B. F., Tekulu, G. H., Tesfay, B. E., Tessema, Z. T., Tessema, B., Thankappan, K. R., Tohidinik, H. R., Topor-Madry, R., Tovani-Palone, M. R., Tran, B. 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  • University of Ljubljana (SI)
  • University Medical Center Groningen (NL)
  • Alborz University of Medical Sciences (IR)
  • University of British Columbia (CA)
  • Fundación Valle del Lili (CO)
  • Sharif University of Technology (IR)
  • Amirkabir University of Technology (IR)
  • University of Central Florida (US)
  • Government of Nepal (NP)
  • Universidade Federal da Bahia (BR)
  • Public Health England (GB)
  • University College Hospital (GB)
  • Royal College of Surgeons in Ireland - Bahrain (BH)
  • Universal Scientific Education and Research Network (IR)
  • Birjand University of Medical Sciences (IR)
  • University of Minnesota (US)
  • Instituto Nacional de Salud Pública (MX)
  • Universidade Federal de Uberlândia (BR)
  • Gonabad University of Medical Sciences (IR)
  • University of Sassari (IT)
  • University of Botswana (BW)
  • Cleveland Clinic (US)
  • All India Institute of Medical Sciences (IN)
  • Cihan University-Erbil (IQ)
  • Central University of Punjab (IN)
  • Stanford University (US)
  • Foundation for Advancement of International Medical Education and Research (US)
  • Instituto de Salud Carlos III (ES)
  • Mahatma Gandhi Memorial Medical College (IN)
  • Hamad Medical Corporation (QA)
  • Population Health Research Institute (CA)
  • University of Alabama at Birmingham (US)
  • Shiraz University (IR)
  • An-Najah National University (PS)
  • University of Borås (SE)
  • National Institute of Infectious Diseases (JP)
  • Yonsei University (KR)
  • University of Technology Sydney (AU)
  • Dow University of Health Sciences (PK)
  • George Washington University (US)
  • University of Sannio (IT)
  • United States Department of Veterans Affairs (US)
  • Patna University (IN)
  • Pathfinder International (US)
  • Semnan University of Medical Sciences (IR)
  • Kharkiv National Medical University (UA)
  • University of Hull (GB)
  • IMU University (MY)
  • Muhammadiyah University of Surakarta (ID)
  • University of Lisbon (PT)
  • Wollo University (ET)
  • Central University of Kerala (IN)
  • Hanoi Medical University (VN)
  • Deakin University (AU)
  • Iqra National University (PK)
  • Federal Teaching Hospital Abakaliki (NG)
  • Amity University Jaipur (IN)
  • Medical University of Ilam (IR)
  • IRCCS Azienda Ospedliero-Universitaria di Bologna Policlinico di Sant'Orsola (IT)
  • Foundation University Islamabad (PK)
  • Naresuan University (TH)
  • Wenzhou Medical University (CN)
  • University of Sheffield (GB)
  • Milad Hospital (IR)
  • The University of Tokyo (JP)
  • University of Jos (NG)
  • University of Hong Kong (HK)
  • Juntendo University (JP)
  • Jackson State University (US)
  • Wuhan University (CN)
  • International Centre for Diarrhoeal Disease Research (BD)
  • Dilla University (ET)
  • Wuhan University of Science and Technology (CN)
  • Wuhan Polytechnic University (CN)
  • Chinese Center For Disease Control and Prevention (CN)
Corresponding author
  • Hay, Simon I.
  • Lim, Stephen S.
  • Mosser, Jonathan F.
ORCID
Venue
Nature
Publisher
Springer Science and Business Media LLC
Published
2020-12-16
Volume
589
Issue
7842
Pages
415-419
ISSN
  • 0028-0836 (ISSN-L)
  • 1476-4687
DOI
10.1038/s41586-020-03043-4
PMC
PMC7739806
OpenAlex
W3118415022
Cited by
125
References
49
Citations by year
2026: 12 · 2025: 27 · 2024: 18 · 2023: 19 · 2022: 24 · 2021: 23 · 2020: 2
FWCI
9.41
Type
journal article
Language
en
Open access
Licence
Locations
  • Nature (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DR-NTU (Nanyang Technological University) (publishedVersion, cc-by)
  • Research Portal (King's College London) (publishedVersion, other-oa)
  • University of Groningen research database (University of Groningen / Centre for Information Technology) (publishedVersion, cc-by)
  • Lincoln Repository (University of Lincoln) (acceptedVersion)
  • ePrints Soton (University of Southampton) (acceptedVersion)
  • City Research Online (City University London) (acceptedVersion)
  • Research Open (London South Bank University) (acceptedVersion, cc-by)
  • LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
  • SHURA (Sheffield Hallam University Research Archive) (Sheffield Hallam University) (acceptedVersion)
  • Informationszentrum Lebenswissenschaften (ZB MED) (submittedVersion, cc-by)
  • Digital Access to Scholarship at Harvard (DASH) (Harvard University) (submittedVersion)
  • Nazarbayev University Repository (Nazarbayev University) (submittedVersion)
  • Archivio Istituzionale della Ricerca (Universita Degli Studi Di Milano) (submittedVersion, other-oa)
  • Archivio istituzionale della ricerca (Alma Mater Studiorum Università di Bologna) (submittedVersion, cc-by)
  • Figshare (submittedVersion, cc-by)
  • Työväentutkimus Vuosikirja (submittedVersion)
  • Repository@Hull (Worktribe) (University of Hull) (submittedVersion, cc-by)
  • YUHSpace (Yonsei University Medical Library) (submittedVersion, cc-by-nc-nd)
  • Minerva Access (University of Melbourne) (submittedVersion, cc-by)
  • NORA - Norwegian Open Research Archives (submittedVersion, other-oa)
  • NORA - Norwegian Open Research Archives (submittedVersion, cc-by)
  • GoeScholar The Publication Server of the Georg-August-Universität Göttingen (Georg-August-Universität Göttingen) (submittedVersion, cc-by)
  • UWA Profiles and Research Repository (UWA) (submittedVersion, cc-by)
  • King Abdullah University of Science and Technology Repository (King Abdullah University of Science and Technology) (submittedVersion, cc-by)
  • Repositorio - Universidad de Ciencias Aplicadas y Ambientales UDCA. (submittedVersion, cc-by)
  • The Sydney eScholarship Repository (The University of Sydney) (submittedVersion)
  • UniSA Research Outputs Repository (University of South Australia) (submittedVersion, cc-by)
  • University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion, cc-by)
Funders
  • Bill and Melinda Gates Foundation (#OPP1132415, OPP1106023, OPP1119467)
  • World Health Organization (OPP1132415)
  • Alexander von Humboldt-Stiftung
  • Florida International University
  • Johns Hopkins University
  • Birmingham City University
  • Wellcome Trust (206471/Z/17/Z, 109949/Z/15/Z)
  • Iran University of Medical Sciences
  • Australian Government
  • National Authority for Scientific Research and Innovation
  • Rafsanjan University of Medical Sciences
  • Maragheh University of Medical Sciences
  • National Institute for Health and Care Research (NIHR300791)
  • British Heart Foundation
  • University of Leicester
  • University of Oxford
  • Department of Science and Technology, Ministry of Science and Technology, India
  • RMIT University
  • Mazandaran University of Medical Sciences
  • Tabriz University of Medical Sciences
  • Tehran University of Medical Sciences and Health Services
  • Universiti Sains Malaysia
  • Katolicki Uniwersytet Lubelski Jana Pawla II
  • Zahedan University of Medical Sciences
  • Ahvaz Jundishapur University of Medical Sciences
  • Birjand University of Medical Sciences
  • Kermanshah University of Medical Sciences
  • BHF Centre of Research Excellence, Oxford
  • Babol University of Medical Sciences
  • Autoritatea Natională pentru Cercetare Stiintifică
  • Shahid Beheshti University of Medical Sciences
  • National Institute for Genetic Engineering and Biotechnology
  • Unitatea Executiva pentru Finantarea Invatamantului Superior, a Cercetarii, Dezvoltarii si Inovarii (PN-III-P4-ID-PCCF-2016-0084, PN-III-P4-ID-PCCF-2016)
  • Yasuj University of Medical Sciences
  • University of the Philippines
  • Universitas Sebelas Maret
  • Universitatea de Medicină şi Farmacie "Carol Davila" Bucureşti
  • University of Tabriz
  • University of Gondar
  • Xiamen University
  • African Population and Health Research Center
  • Alexandria University
  • National Institute for Medical Research Development
  • Razi Vaccine and Serum Research Institute
  • Universidad Autónoma de Sinaloa
  • Western Sydney University
  • NIHR Oxford Biomedical Research Centre
  • Fogarty International Center (K43TW010716)
  • Health Data Research UK
Topics
  • Social Sciences › Health › Vaccine Coverage and Hesitancy
  • Health Sciences › Medicine › Epidemiology › Virology and Viral Diseases
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
Keywords
measles vaccination, routine childhood immunization, low- and middle-income countries, Global Vaccine Action Plan, urban-rural differences, measles mortality
MeSH terms
Vaccination Refusal, Child, Child, Preschool, Humans, Measles, Rural Health, Urban Health, Vaccination, Developed Countries, Uncertainty, Internationality, Healthcare Disparities, Geographic Mapping

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