title: Development of a District-Level Programmatic Assessment Tool for Risk of Measles Virus Transmission.
abstract: All six World Health Organization (WHO) regions have now set goals for measles elimination by or before 2020. To prioritize measles elimination efforts and use available resources efficiently, there is a need to identify at-risk areas that are offtrack from meeting performance targets and require strengthening of programmatic efforts. This article describes the development of a WHO measles programmatic risk assessment tool to be used for monitoring, guiding, and sustaining measles elimination efforts at the subnational level. We outline the tool development process; the tool specifications and requirements for data inputs; the framework of risk categories, indicators, and scoring; and the risk category assignment. Overall risk was assessed as a function of indicator scores that fall into four main categories: population immunity, surveillance quality, program performance, and threat assessment. On the basis of the overall score, the tool assigns each district a risk of either low, medium, high, or very high. The cut-off criteria for the risk assignment categories were based on the distribution of scores from all possible combinations of individual indicator cutoffs. The results may be used for advocacy to communicate risk to policymakers, mobilize resources for corrective actions, manage population immunity, and prioritize programmatic activities. Ongoing evaluation of indicators will be needed to evaluate programmatic performance and plan risk mitigation activities effectively. The availability of a comprehensive tool that can identify at-risk districts will enhance efforts to prioritize resources and implement strategies for achieving the Global Vaccine Action Plan goals for measles elimination.
authors.affiliation: Centers for Disease Control and Prevention (CDC), Center for Global Health, Global Immunization Division, Atlanta, GA, USA.
authors.forename: Eugene
authors.initials: E
authors.lastname: Lam
authors.affiliation: World Health Organization (WHO), Western Pacific Regional Office, Manila, Philippines.
authors.forename: W William
authors.initials: WW
authors.lastname: Schluter
authors.affiliation: WHO, Regional Office for Africa, Brazzaville, Congo.
authors.forename: Balcha G
authors.initials: BG
authors.lastname: Masresha
authors.affiliation: WHO, Eastern Mediterranean Regional Office, Cairo, Egypt.
authors.forename: Nadia
authors.initials: N
authors.lastname: Teleb
authors.affiliation: WHO, Pan American Health Organization, Washington, DC, USA.
authors.forename: Pamela
authors.initials: P
authors.lastname: Bravo-Alcántara
authors.affiliation: WHO, European Regional Office, Copenhagen, Denmark.
authors.forename: Abigail
authors.initials: A
authors.lastname: Shefer
authors.affiliation: WHO, European Regional Office, Copenhagen, Denmark.
authors.forename: Dragan
authors.initials: D
authors.lastname: Jankovic
authors.affiliation: WHO, Southeast Asia Regional Office, New Delhi, India.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: McFarland
authors.affiliation: WHO, Eastern Mediterranean Regional Office, Cairo, Egypt.
authors.forename: Eltayeb
authors.initials: E
authors.lastname: Elfakki
authors.affiliation: World Health Organization (WHO), Western Pacific Regional Office, Manila, Philippines.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Takashima
authors.affiliation: WHO, Headquarters, Geneva, Switzerland.
authors.forename: Robert T
authors.initials: RT
authors.lastname: Perry
authors.affiliation: WHO, Headquarters, Geneva, Switzerland.
authors.forename: Alya J
authors.initials: AJ
authors.lastname: Dabbagh
authors.affiliation: WHO, Headquarters, Geneva, Switzerland.
authors.forename: Kaushik
authors.initials: K
authors.lastname: Banerjee
authors.affiliation: WHO, Headquarters, Geneva, Switzerland.
authors.forename: Peter M
authors.initials: PM
authors.lastname: Strebel
authors.affiliation: Centers for Disease Control and Prevention (CDC), Center for Global Health, Global Immunization Division, Atlanta, GA, USA.
authors.forename: James L
authors.initials: JL
authors.lastname: Goodson
mesh_terms: D002648:Child; D002675:Child, Preschool; D060740:Disease Eradication / Q000379:methods*; D005843:Geography; D014943:Global Health; D006801:Humans; D017589:Immunization Programs; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008457:Measles / Q000453:epidemiology / Q000517:prevention & control*; D008458:Measles Vaccine / Q000627:therapeutic use*; D009276:Namibia; D010679:Philippines; D011159:Population Surveillance; D018570:Risk Assessment; D012675:Senegal; D014944:World Health Organization
chemical_list: D008458:Measles Vaccine
keywords: Elimination; measles; outbreak; risk assessment