2.4 Measles control programmes (WHO/UNICEF)

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    2.4.1 Control

    Control is the first step in any vaccination programme. Its aim is to reduce disease morbidity and mortality (the number of cases and the number of deaths). 

     

    Control strategies include:

    • Strengthening surveillance for early case detection.

    • Rapid outbreak response.

      • Improving patient management, including routine administration of vitamin A.

      • Targeted response vaccination campaign.

    • Strengthening routine vaccination to achieve measles vaccination coverage ≥  95%.

      • By routine EPI providing two vaccine doses.

      • By follow-up supplementary immunisation activities (SIAs) giving all children born since the last SIA a chance to be vaccinated (coverage target ≥ 95% of the target age group). The interval between these campaigns should be adjusted depending on the epidemiological situation (2 to 4 years). 
         

    2.4.2 Elimination

    Elimination strategies aim at stopping circulation of the virus in a large geographic area, that is, obtaining zero spread of the measles virus in a given region for at least 12 months, with a high-quality surveillance system in place. It is considered verified if transmission is arrested for at least 36 months.

    While there are no more local cases, the risk of the virus being reintroduced from outside makes maintaining very high immunisation coverage crucial.  

     

    It relies on four activities: 

    • Improving treatment of cases, including routine administration of vitamin A;

    • Setting up surveillance for each suspected case: investigation and laboratory confirmation;

    • Maintaining routine primary measles vaccination coverage ≥ 95% in children less than 1 year;

    • Offering supplementary immunisation activities (SIAs) to keep the cohort of susceptibles below the critical threshold. 

    The Measles and Rubella Strategic Framework 2021–2030 [1]Citation 1.World Health Organization. MEASLES and RUBELLA STRATEGIC FRAMEWORK. 2021. Accessed April 30, 2024. Available from: https://www.immunizationagenda2030.org/images/documents/measles_rubella_initiative_Digital3.pdf  rests on seven strategic priorities (copied and summarized from the document referenced)  aCitation a.Open access document distributed in accordance with the terms of the Creative Commons CC-BY license :


    1. Primary Health Care and Universal Health Coverage 

    • Strengthen the measles data collection and surveillance system to guide action.

    • Improve the ability to manage cases.
       

    2. Commitment and Demand  

    • Improve community ownership and engagement with respect to measles vaccination.
       

    3. Coverage and Equity  

    • Identify and address all missed opportunities to vaccinate by vaccinating at every contact with the health care system and use targeted approaches for vulnerable populations and those farthest removed from the health system.  
       

    4. Life Course and Integration 

    • Use the life course approach to deliver the second routine dose of measles and rubella-containing vaccines and integrate measles activities with other health and non-health activities.
       

    5. Outbreaks and Emergencies 

    • Ensure outbreak preparedness for timely detection and rapid, effective response to limit the spread of measles and thereby reduce related morbidity and mortality. 
       

    6. Supply and Sustainability   

    • Ensure availability of high-quality vaccines, vaccination supplies, and laboratory reagents. 

    • Ensure that measles and rubella activities, including surveillance, are sustainably financed. 
       

    7. Research and Innovation  

    • Foster research and innovation to facilitate measles vaccination and diagnosis. 
       

    These seven strategic priorities are anchored in four core principles: address peoples’ needs and promote progress from the ground up; establish partnerships and align efforts to maximise impact; promote data-based decision-making; and encourage each country to take ownership.

    Measles elimination is considered a key indicator of a well-functioning immunisation system in general. 
     

    2.4.3 Eradication

    Eradication means a complete end to transmission of the wild virus in the world. There are no more cases or transmission, and immunisation activities can be stopped. This final phase cannot be implemented until the virus has been successfully eliminated worldwide.

    Footnotes
    • (a)

      Open access document distributed in accordance with the terms of the Creative Commons CC-BY license

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