Using the World Health Organization Measles Programmatic Risk Assessment Tool for Monitoring of Supplemental Immunization Activities in the Philippines

Abstract

In 2012, the World Health Organization Regional Committee for the Western Pacific Region (WPR) reaffirmed its commitment to eliminate measles and urged WPR member states to interrupt endemic measles virus transmission as rapidly as possible. In 2013, a large measles outbreak occurred in the Philippines despite implementation of measles elimination strategies including a nationwide supplemental immunization activity (SIA) in 2011 using measles- and rubella-containing vaccine and targeting children aged nine months to seven years. To prevent future measles outbreaks a new tool was developed to assess district-level risk for measles outbreaks, based on the WPR polio risk assessment tool previously applied in the Philippines. Risk was assessed as a function of combined indicator scores from four data input categories: population immunity, surveillance quality, program performance, and threat assessment. On the basis of the overall score, the tool assigned each district a risk category of low, medium, high, or very high. Of the 122 districts and highly urbanized cities in the Philippines, 58 (48%) were classified as high risk or very high risk, including the district of the Metro Manila area and Region 4A where the outbreak began in 2013. Risk assessment results were used to guide the monitoring and supervision during the nationwide SIA conducted in 2014. The initial tool drafted in the Philippines served as a template for development of the global risk assessment tool. Regular annual measles programmatic risk assessments can be used to help plan risk mitigation activities and measure progress toward measles elimination.

Development of the World Health Organization Measles Programmatic Risk Assessment Tool Using Experience from the 2009 Measles Outbreak in Namibia

“…In addition to Windhoek, the districts most affected by the outbreak were in the north along the border with Angola, and were a mix of very‐high‐, high‐, medium‐, and low‐risk districts. There was no statistically significant correlation between risk category and measles incidence in Namibia, in contrast to the findings in Senegal and the Philippines . There are several factors that could have accounted for these results.…”

“…There was no statistically significant correlation between risk category and measles incidence in Namibia, in contrast to the findings in Senegal and the Philippines. (11,12) There are several factors that could have accounted for these results. The districts of Eenhana, Opuwo, and Kongo reported high incidence of measles during 2009 but were classified as medium-or low risk districts by the assessment; they were situated on the border of Angola, which was also experiencing a large ongoing measles outbreak during the assessment year.…”

Development of a District‐Level Programmatic Assessment Tool for Risk of Measles Virus Transmission

“…The tool was not designed to be predictive of measles outbreaks but rather to assess the level of risk for measles transmission in a district/area if virus were to be introduced, using key programmatic indicators. Comparisons of risk categories with historical outbreak data were performed in three countries used for prototype development, and the results showed correlation between districts with high scores and the occurrence of measles transmission during the following year in two of the three countries . Even if the tool has limited value in predicting outbreaks, results of the risk assessment can be used to guide measles elimination strategies and identify programmatic areas that require strengthening.…”

“…More details of the three countries used for prototype development and visual and statistical comparisons of risk categories with historical outbreak data are described elsewhere. (12)(13)(14)…”

Modeling and Managing the Risks of Measles and Rubella: A Global Perspective Part II

“…(3) Similar to the risk assessment tool previously developed for polio, (70) the second article (71) developed a district-level programmatic assessment tool for measles transmission risks. The third through seventh articles present applications of the risk assessment tool for countries in each of the WHO regions yet to eliminate measles: India, (72) Namibia, (73) the Philippines, (74) Romania, (75) and Senegal, (76) respectively. The last article (77) integrates many of the components presented in Part I into a dynamic transmission model for measles and rubella and it demonstrates the significant costs of delays associated with continuing control instead of eradication.…”