title: Development of the World Health Organization Measles Programmatic Risk Assessment Tool Using Experience from the 2009 Measles Outbreak in Namibia.
abstract: In the World Health Organization (WHO) African region, reported measles cases decreased by 80% and measles mortality declined by 88% during 2000-2012. Based on current performance trends, however, focused efforts will be needed to achieve the regional measles elimination goal. To prioritize efforts to strengthen implementation of elimination strategies, the Centers for Disease Control and Prevention and WHO developed a measles programmatic risk assessment tool to identify high-risk districts and guide and strengthen program activities at the subnational level. This article provides a description of pilot testing of the tool in Namibia using comparisons of high-risk districts identified using 2006-2008 data with reported measles cases and incidence during the 2009 outbreak. Of the 34 health districts in Namibia, 11 (32%) were classified as high risk or very high risk, including the district of Engela where the outbreak began in 2009. The district of Windhoek, including the capital city of Windhoek, had the highest overall risk score-driven primarily by poor population immunity and immunization program performance-and one of the highest incidences during the outbreak. Other high-risk districts were either around the capital district or in the northern part of the country near the border with Angola. Districts categorized as high or very high risk based on the 2006-2008 data generally experienced high measles incidence during the large outbreak in 2009, as did several medium- or low-risk districts. The tool can be used to guide measles elimination strategies and to identify programmatic areas that require strengthening.
authors.affiliation: Centers for Disease Control and Prevention (CDC), Center for Global Health, Global Immunization Division, Atlanta, GA, USA.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Kriss
authors.affiliation: World Health Organization (WHO), Office of the WHO Representative in Namibia, Windhoek, Namibia.
authors.forename: Roselina J
authors.initials: RJ
authors.lastname: De Wee
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: WHO, Regional Office for Africa, InterCountry Support Team (IST) East and Southern Africa, Harare, Zimbabwe.
authors.forename: Reinhard
authors.initials: R
authors.lastname: Kaiser
authors.affiliation: WHO, Regional Office for Africa, InterCountry Support Team (IST) East and Southern Africa, Harare, Zimbabwe.
authors.forename: Messeret E
authors.initials: ME
authors.lastname: Shibeshi
authors.affiliation: Ministry of Health and Social Services, Windhoek, Namibia.
authors.forename: Emmy-Else
authors.initials: EE
authors.lastname: Ndevaetela
authors.affiliation: Ministry of Health and Social Services, Windhoek, Namibia.
authors.forename: Clementine
authors.initials: C
authors.lastname: Muroua
authors.affiliation: Ministry of Health and Social Services, Windhoek, Namibia.
authors.forename: Nicholaus
authors.initials: N
authors.lastname: Shapumba
authors.affiliation: WHO, Regional Office for Africa, Brazzaville, Congo.
authors.forename: Balcha G
authors.initials: BG
authors.lastname: Masresha
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: D002487:Centers for Disease Control and Prevention, U.S.; D060740:Disease Eradication / Q000379:methods*; D004196:Disease Outbreaks / Q000517:prevention & control*; D005843:Geography; D006801:Humans; D017589:Immunization Programs / Q000379:methods*; D015994:Incidence; D007223:Infant; D008457:Measles / Q000453:epidemiology* / Q000517:prevention & control*; D008458:Measles Vaccine; D009276:Namibia / Q000453:epidemiology; D011159:Population Surveillance; D018570:Risk Assessment / Q000379:methods*; D014481:United States; D014611:Vaccination; D014944:World Health Organization
chemical_list: D008458:Measles Vaccine
keywords: Elimination; Namibia; measles; outbreak; risk assessment