Measles Outbreak Guide

WHO and partners have developed the Measles Outbreak Guide to assist with measles outbreak management in all settings that are striving for and approaching measles elimination. This guide also draws on the standard operating procedures (SOPs) to apply for measles outbreak response support from the Measles & Rubella Initiative Outbreak Response Fund and includes a section on measles outbreak recovery so that contributing factors and potential root causes are identified and addressed systematically after a measles outbreak. The target audience of this guide are health authorities, at all levels, and immunization partners. The purpose is to support countries in measles outbreak preparedness, early detection, response and recovery. This document provides guidance on the preparedness for measles outbreaks; the detection, verification, investigation and response to measles outbreaks, including vaccination strategies; and the development of recovery plans, including post-outbreak health systems strengthening.

This guide describes in detail the current challenges and activities needed to interrupt measles transmission, to prevent and respond rapidly to emerging measles outbreaks, and to ensure sensitive surveillance is in place. It is presented in a form that can be readily adapted by national immunization managers to suit country situations.

The seventh edition of the Canadian Immunization Guide was developed by the National Advisory Committee on Immunization (NACI), with the support ofthe Immunization and Respiratory Infections Division, Public Health Agency of Canada, to provide updated information and recommendations on the use of vaccines in Canada. The Public Health Agency of Canada conducted a survey in 2004, which confi rmed that the Canadian Immunization Guide is a very useful and reliable resource of information on immunization.

The Regional Strategy and Plan of Action for Measles and Rubella Elimination in the Western Pacific was endorsed by the 68th session of the WHO Regional Committee in 2017. This document was developed in consultation with Member States and technical partners through carefully analysing the unsolved issues and emerging challenges that led to the regional resurgence of measles and outbreaks of rubella during 2013-2016. The document will guide development of national plans of action for achieving and sustaining measles and rubella elimination with country-specific strategies and activities that are tailored for addressing issues and challenges faced by each country and area of the region.

Current WHO guidance on measles outbreak response published in 1999, emphasized that most outbreaks were either detected too late or spread too rapidly to allow for an effective immunization response. This recommendation was based primarily on a literature review of manuscripts published on the impact of immunization control activities on measles outbreaks in middle- and low-income countries from 1977 to 1993. The validity of these recommendations was reviewed given recent evidence (published and from filed experience) on the impact of outbreak response immunization on measles outbreaks. This review of the evidence was carried out as follows: A consultation meeting was organized by WHO in 2006 to discuss the need for updated guidelines and to review the new evidence which supports the guidance provided in the updated document. The meeting was attended by experts from the CDC, Epicentre, MSF Belgium and MSF France, WHO and UNICEF. An extensive literature review of data (published from 1995-2006) to re-assess the impact of immunization response to measles outbreaks was carried out and the results were summarized and submitted for publication. This included a review of 277 articles. The key findings of this review are summarized in section F below. Review of data from the field and from unpublished studies on the duration of measles outbreaks and effectiveness of interventions with non-selective vaccination. Based on the initial consultations, a draft document was prepared by the Departments of Immunization, Vaccines and Biologicals and Epidemic and Pandemic Alert and Response and comments from experts were solicited. Experts were from, the CDC, the 6 WHO regional offices, MSF, Epicentre, UNICEF and from country level immunization staff and partners.

This is the third edition of this publication which contains the latest information on vaccines and vaccination procedures for all the vaccine preventable infectious diseases that may occur in the UK or in travellers going outside of the UK, particularly those immunisations that comprise the routine immunisation programme for all children from birth to adolescence. It is divided into two sections: the first section covers principles, practices and procedures, including issues of consent, contraindications, storage, distribution and disposal of vaccines, surveillance and monitoring, and the Vaccine Damage Payment Scheme; the second section covers the range of different diseases and vaccines.

These field guidelines provide countries with a technical resource to use in developing comprehensive standard operating procedures for measles, rubella and congenital rubella syndrome surveillance. The largest part of these guidelines is devoted to developing a surveillance system for cases of measles, rubella and congenital rubella syndrome, including case investigation, outbreak response, laboratory procedures for measles and rubella testing and surveillance monitoring and feedback. This publication is primarily intended for use by surveillance and national immunization managers and their staff, but many other health professionals and technical staff working in surveillance, immunization and laboratories at the country level will find it useful in improving measles, rubella and congenital rubella syndrome surveillance. It can be used at various levels of the health care system and countries can adapt the guidelines according to their local situations.