It starts with a fever and a cough. Then a rash begins on the face and spreads across the body. For some children, measles infection advances to cause pneumonia or brain inflammation, which can lead to convulsions or mental retardation. Measles is among the most contagious of diseases and kills 1 to 3 percent of children in developing countries who contract it. Among children in refugee settings or the severely malnourished, the case fatality rate is much higher, killing up to one child in four with the illness.

A vaccine against this viral infection was invented decades ago and has been part of routine immunization for children in the developed world ever since. Measles vaccination progressed more slowly in the developing world, but over the past five years, governments of the region and international health agencies have made significant progress in expanding immunization programs to protect children from measles.

In 2001 the World Health Organization (WHO), the U.S. Centers for Disease Control and Prevention (CDC), the American Red Cross, the United Nations Children's Fund (UNICEF), the U.N. Foundation, and other organizations launched the Measles Initiative and began an accelerated measles-control program, aiming to reduce by half the number of deaths caused by measles within five years.

The success of this effort was unveiled in January 2007 with the announcement of a 75 percent decline in deaths due to this viral disease in Africa alone and a 60 percent decline in deaths worldwide.

"One of the clearest messages from this achievement is that with the right strategies and a strong partnership of committed governments and organizations," said CDC Director Dr. Julie Gerberding, "you can rapidly reduce child deaths in developing countries."

The campaign to reduce measles was based on four strategies: improving routine immunization; providing a second opportunity for measles vaccination through supplemental campaigns if necessary; improving measles care; and establishing effective surveillance. From 1999 to 2005, routine immunization coverage worldwide increased from 71 to 77 percent. This increased coverage, together with national measles vaccination campaigns in more than 40 countries, prevented an estimated 2.3 million measles deaths during that period.

The progress against the disease in Africa alone is considered unprecedented. In 1999 WHO estimated that 506,000 measles-related deaths occurred in the African region. In 2005 an estimated 126,000 deaths occurred, representing a 75 percent reduction, according to research presented in the January 20, 2007, edition of The Lancet.

In the more than 40 countries involved, technical and financial support for these activities was provided by national ministries of health and the Measles Initiative (see http://www.measlesinitiative.org).