This document discusses measles eradication strategies. It provides definitions of eradication, elimination, and WHO targets for measles. Measles is highly contagious and a major cause of death in developing countries. Strategies for eradication include maintaining high vaccination rates, surveillance to rapidly detect outbreaks, and supplemental immunization activities. Effective measles vaccination requires at least 90% national coverage along with follow up campaigns every few years. Hurdles to eradication include weak health systems and difficulties vaccinating all populations.

1. MEASLES
ERADICATION
BY
DR.VENU BOLISETTI

2. ERADICATION : Termination of all
transmission of infection by extermination of
the infectious agent through surveillance and
containment .
It implies that disease will no longer occur in a
population.
The term elimination is sometimes used to
describe "eradication" of disease (e.g.,
measles) from a large geographic region or
political jurisdiction .

3.  WHO defines elimination of
measles as the absence of endemic
measles for a period of > 12
months in the presence of adequate
surveillance.
One indicator of measles
elimination is a sustained measles
incidence < 1/100,0000
population.

4. 63rd world health assembly
These targets are set for 2015 and are to:
 Achieve at least 90% measles vaccination
coverage nationally and 80% coverage in all
districts.
 Reduce measles cases to <5 per million.
 Reduce measles mortality by 95% compared
to 2000 levels.

5. Why do eradicate the measles
?
Measles is an extremely contagious viral
disease that affected almost every child in
the world before the widespread use of
measles vaccine.
Measles is associated with high morbidity
and mortality in developing countries.
 Measles is endemic virtually in all parts
of the world.

6.  It tends to occur in epidemics when
the proportion of susceptible children
reaches about 40 per cent .
 When the disease is introduced into a
virgin community more than 90 per
cent of that community will be infected.

7. Measles tends to be very severe in the
malnourished child, carrying a mortality up to
400 times higher than in well-nourished
children having measles.
 Pneumonia is the most common life-
threatening complication.
Pneumonia occurs in less than 10 per cent of
cases in developed countries and 20-80 per
cent cases in developing countries.

8. Measles is 100 to 400 times more likely to
cause death in a preschool child of a
developing country, than it is in the US and
Europe.
In developing countries, case fatality rates
range from 2 to 15 per cent as compared to
less than 0.2 per 10,000 notified cases in
developed countries.
Pulmonary complications account for more
than 90 per cent of measles related deaths.

9. Measles during pregnancy is not known to
cause congenital abnormalities of the foetus.
 Associated with spontaneous abortion and
premature delivery.
 The World Health Organization estimates that
over 40 million cases still occur worldwide
each year, contributing to approximately
530,000 deaths including 182,000 in the South
East Asian region as reported in 2003.

10. Epidemics often occur every 2 to 3 years
and usually last between 2 to 3 months,
although their duration varies according
to population size, crowding and immune
status of affected population.
In India more than 50% of measles cases
are currently reported in children less than
five years of age, indicating insufficient
routine measles immunization.

11. More than one third of all measles deaths
worldwide (around 56 000 in 2011) are
among children in India.
 With support from WHO, in November
2010, India launched a massive polio-
style measles vaccination project in 14
high-burden states, in a three-phase
campaign.

12. FACTORS AMENABLE TO
ERADICATE MEASLES
 The measles virus is a paramyxovirus, There is
only one antigenic type of measles virus.
 Infection confers life Long immunity.
 Measles virus is rapidly inactivated by heat,
light, acidic pH, ether and trypsin.
It has a short survival time (<2 hours) in air or on
objects and surfaces.

13.  Man is the only natural host of measles virus.
 The only source of infection is a case of
measles.
 Carriers are not known to occur.
 Second attacks are rare.
 Transmission occurs directly from person to
person mainly by droplet infection and
droplet nuclei- No animal reservoirs.

14. A day or two before the appearance of the
rash Koplik's spots like table salt crystals
appear on the buccal mucosa opposite the
first and second lower molars.
They are small, bluish-white spots on a
red base, smaller than the head of a pin.
Their presence is pathgnomonic of
measles.

15. ERUPTIVE PHASE- characterized by a
typical, dusky-red, macular or
maculo-papular rash which begins
behind the ears and spreads rapidly in a
few hours over the face and neck.
Extends down the body taking 2 to 3
days to progress to the lower extremities.

16.  The rash may remain discrete, but often
it becomes confluent and blotchy.
 In the absence of complications, the
lesions and fever disappear in an other 3
or 4 days signaling the end of the disease.
 The rash fades in the same order of
appearance leaving a brownish
discoloration which may persist for 2
months or more.

17. Specific IgM antibodies are being
used for diagnosis.
 Isolation of the patient for a week
from the onset of rash more than
covers the period of
communicability.

18.  Measles is best prevented by active
immunization.
Only live attenuated vaccines are recommended
for use; they are both safe and effective.
 Heat stable measles vaccines able to maintain
their potency for more than 2 years at 2-8 deg C,
have been developed.
 The vaccine has demonstrated to provide
immunity to even severely malnourished
children.
 Single dose vaccine .

19.  Immunity conferred by vaccination against measles
has been shown to persist for at least 20 years and is
generally thought to be life long for most
individuals.
Measles vaccine can be combined with other live
attenuated vaccines such as mumps, and rubella
vaccines (MMR vaccine), measles, mumps, rubella
and varicella (MMRV), and measles and rubella
(MR), and such combinations are also highly
effective .
Measles vaccination definitely constitutes a
protection against the neurological and other
complications by preventing natural measles from

20.  To protect individual high-risk patients
during an outbreak, vaccination within 2
days of exposure may modify the clinical
course of measles or even prevent clinical
symptoms.
 Recipients of measles vaccine are not
contagious to others.
Measles may be prevented by
administration of immunoglobulin
(human) early in the incubation period.

21. Strategies to eradicate measles
WHO's measles elimination strategy
comprises a three parts:
vaccination strategy are
 CATCH-UP (SIA)
KEEP-UP
 FOLLOW-UP (SIA)

22. Catch-up is defined as a one-time, nationwide
vaccination campaign targeting usually all children
aged 9 months to 14 years regardless of history of
measles disease or vaccination status.
 Keep-up is defined as routine services aimed at
vaccinating more than 95 per cent of each
successive birth cohort .
Follow-up is defined as subsequent nationwide
vaccination campaign conducted every 2-4 years
targeting usually a children born after the catch-up
campaign.

23.  Achieving high routine measles vaccination
coverage of infants at 9-12 months of age;
provide measles vaccine to children over 1
year if not vaccinated earlier at the earliest
contact.
 Establish effective measles surveillance that
provides information about number of cases
and deaths by month.
Age and vaccination status of cases and deaths
and conduct outbreak investigation supported
by laboratory confirmation.

24.  Improving management of measles cases,
including vitamin A supplementation and
adequate treatment of cases.
 Based on evaluated measles
immunization coverage and surveillance
data, providing a second opportunity for
measles immunization to appropriate age
groups of children through either a second
routine dose of measles vaccine or through
supplemental immunization activities.

25.  Planning and implementation of regular
immunization sessions at fixed and out reach
immunization sites.
 Special strategies for reaching the un-reached.
 Reduction of missed opportunities and dropout
rates.
 Training to improve management of immunization
services at all levels.
 Enhancement of supervision.
 Design and implementation of information
education and communication activities and
materials.

26. MEASLES SURVEILLANCE
Case definitions
Clinical measles
Laboratory confirmed measles.
Epidemiologically confirmed measles.
MEASLES SURVEILLANCE STRUCTURE
Surveillance activities at the local level
Surveillance activities at the district level
Surveillance activities at the state level .

28. MEASLES OUTBREAK
INVESTIGATION
Objectives of outbreak investigations
Epidemic Response Team (ERT)
Identifying a measles outbreak
Identifying measles outbreaks that need
to be investigated and assigning an
outbreak number.
Preliminary search

29. Measles outbreak should be verified if five
or more than five clinically diagnosed
cases of measles are identified in a block in
a week, (Or)
Five or more than five clinically diagnosed
cases of measles occur in an area bordering
several blocks in a week, (Or)
 One or more than one death due to
clinically diagnosed measles occurs in a
block in a week.

30. Mobilization of Epidemic Response Team
Orientation & planning meeting at the local
level Conducting measles case search
Collection and shipment of specimens to the
laboratory
Laboratory confirmation of the outbreak
Data analysis
Using data for action
Report writing
Giving feedback
Initiating actions.

31. MEASLES CASE MANAGEMENT
 Measles case diagnosis
Clinical assessment
Severity status and case management
Uncomplicated measles
Complicated measles
Administration of vitamin A

33. MEASLES LABORATORY
NETWORK
Categories of laboratories:
Serological tests
Tests to isolate measles virus &
genetic sequencing

35. MONITORING AND
EVALUATION
Monitoring & evaluation of Routine
immunization coverage
Surveillance indicators
Outbreak monitoring & evaluation
Specimen collection and transport
Proficiency testing of laboratories
Project progress indicators .

41. RESULTS OF ERADICATION
 During 2000–2011, the number of countries
providing a second dose of measles-containing
vaccine (MCV2) through routine services increased
from 97 (50%) to 141 (73%).
Overall, 225 million children received measles
vaccination during 39 supplemental
immunization activities (SIAs) conducted during
2011.

42. During 2000–2011, the number of countries
reporting annual measles surveillance data to WHO
increased from 169 (88%) to 188 (97%).
During 2004–2011, the number of countries using
case-based surveillance increased from 120 (62%)
to 182 (94%).
During 2000–2011, the number of measles cases
reported worldwide each year decreased 58%, from
853,480 to 354,922, and
Measles incidence decreased 65%, from 146 to 52
cases per million population per year, with declining
cases and incidence reported in all WHO regions.

45. HURDLES
Weak immunization and disease surveillance
systems.
 Difficulties in vaccinating hard-to-reach
populations (including in areas affected by
conflict or natural disaster).
Lack of political and financial commitment.
 Approximately 15% of children vaccinated at 9
months and 5%-10% of those vaccinated at 12
months of age are not protected after vaccination.

46. STRATEGIES FOR MEASLES
MORTALITY REDUCTION IN INDIA
Achieving high routine immunization
Establish effective measles surveillance system
Improved measles case management
 Providing a second opportunity for measles
immunization
 National level coordination for measles control

47. Thank
you