When health officials traced the source of the recent measles outbreak in southwestern Pennsylvania to a visitor from India, officials attempting to curb the disease worldwide weren't surprised.

India accounted for an estimated 67 percent of the 197,000 measles deaths worldwide in 2007, prompting efforts to control the measles there.

Athalia Christie, senior technical adviser with the American Red Cross in Washington, D.C., said India is a large and complicated country in which to control any disease.

"We are encouraged by some progress recently," she said. "Four states in India have begun planning immunization campaigns, and certainly the measles initiative is ready and willing to provide support for governments.

"It is our aim to reduce global deaths and reduce importation of measles [into the United States]," she said.

The Red Cross, along with the U.S. Centers for Disease Control and Prevention, UNICEF, the United Nations Foundation and the World Health Organization, among others, launched a partnership in 2001 to reduce measles globally by 90 percent by 2010.

Activities of the measles initiative reduced global measles deaths by 74 percent from 2000 to 2007. But India, Indonesia, Pakistan, Nigeria and Ethiopia are among the larger countries still struggling to bring the disease under control. China currently is going province to province, with the goal of eliminating measles by 2012.

Historically in the United States, serious complications from measles have included pneumonia and encephalitis, with a small percentage of deaths. But complications and the death toll rise notably in impoverished countries plagued by malnutrition and sparse health care resources.

Measles used to be the leading cause of vaccine-preventable deaths among young children, with 750,000 deaths globally each year before the initiative got under way. It remains a leading cause of childhood death worldwide, Ms. Christie said.

The United States, Canada and other countries in the Pan American Health Organization successfully eliminated measles in 2002. "Measles is no longer endemic in the Western Hemisphere," Ms. Christie said.

That's why local officials suspected that a foreign visitor was responsible for importing measles to southwestern Pennsylvania. The Indian child who arrived March 7 in the United States came down with measles and infected at least five others, including two Westmoreland County preschool siblings and their 33-year-old father.

The outbreak prompted a massive investigation by the state Department of Health and the Allegheny County Health Department to find the source of infection. Then attention turned to tracking everyone lacking immunity who might have been exposed to those with measles. Thousands were contacted, and those facing potential infection were advised to stay home to prevent further spread of the disease.

In 2001, when the measles initiative got under way, the focus was on sub-Saharan nations in Africa, where measles deaths were greatest. From 1999 to 2005, deaths in those nations plummeted by 75 percent, with help from the international initiative, said Andrea Gay, executive director of children's health at the United Nations Foundation.

Due to that success, the burden of the disease now has shifted to southern and southeastern Asia.

The measles mortality reduction strategy that UNICEF and the World Health Organization tested and refined in the Western Hemisphere now is being applied worldwide. It includes vaccinating all children by their first birthday through routine health services, with a second opportunity for vaccination offered to all children through routine health care services or mass immunization campaigns.

That strategy also includes establishing lab-based surveillance to identify measles cases and outbreaks along with effective management and treatment of cases.

"The most important thing is, countries have to decide to reduce measles deaths," Ms. Christie said. "They are responsible for implementing the strategies and the measles initiative provides technical and financial support."

Since 2001, the measles initiative has sponsored immunization campaigns in more than 60 countries, prompting the vaccination of more than 600 million children. Ms. Christie and Ms. Gay said the program is cost-effective at about $1 per vaccination. But funding fell $35 million short this year, with a funding gap of about $100 million for 2010. Countries conducting vaccination campaigns also must contribute to the costs.

"The biggest problem is, the international community is paying a large proportion of the campaign," Ms. Gay said. "Progress is still fragile, and many countries cannot afford the full cost of the high-quality campaigns that are needed."