Global measles & rubella strategic plan

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 Review of data from the field and from unpublished studies on the duration of measles outbreaks and effectiveness of interventions with non-selective vaccination.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.Abbreviations and acronyms -- Acknowledgements -- Part I: Introduction -- A. Development of the Guidelines -- B. Rationale and public-health importance -- C. Goals of measles outbreak response -- D. Target audience -- E. Strategies for measles prevention and control: current recommendations -- F. Rationale for use of measles vaccine to control outbreaks -- Part II: Definitions -- A. Case definitions for measles surveillance and outbreak investigation -- B. Definition of a measles outbreak -- Part III: Confirming, investigating and managing an outbreak -- A. Laboratory confirmation of a measles outbreak -- B. Ensuring adequate clinical case management -- C. Intensifying surveillance and notification -- D. Assessing the risk of a large outbreak with high morbidity and mortality -- E. Investigating a confirmed measles outbreak -- F. Implementing control and preventive measures -- G. Ensuring effective community involvement and public awareness -- Part IV: Learning lessons from the outbreak -- Annex 1: Laboratory procedures -- Annex 2: The outbreak coordination committee -- Annex 3: Formulae -- Annex 4: Generic line-list for use during measles outbreaks -- Annex 5: References."WHO/IVB/09.03."This document has been jointly prepared1 by the Departments of Immunization, Vaccines and Biologicals and Epidemic and Pandemic Alert and Response at the World Health Organization in consultation with the Centers for Disease Control and Prevention of the United States Health and Human Services Department, the United Nations Children's Fund, the Me\ucc?decins Sans Frontie\ucc\u20acres, and Epicentre