Table I.
Maximum Risk Points by Component of the World Health Organization (WHO) Measles Programmatic Assessment Tool for Risk of Measles Virus Transmission
| Components | Points | Cut-Off Criteria (Risk Points) |
|---|---|---|
| Population Immunity | (40) | |
| District MCV1 coveragea | 8 | ≥95% (+0);90–94% (+2); 85–89% (+4); 80–84% (+6); <80% (+8) |
| Proportion of neighboring districts with <80% MCV1 | 4 | <50% (+0); 50–74% (+2); ≥75% (+4) |
| District MCV2 coveragea | 8 | Same as MCV1 coverage |
| Measles SIA conducted within the past three yearsb | 8 | Yes: ≥95% coverage (+0); 90–94% coverage (+2); 85–89% coverage (+4); <85% coverage (+6); No coverage data (+6); No SIA (+8) |
| Target age group of measles SIA conducted within the past three years | 2 | Wide age group (+0); Narrow age group (+2); No SIA (+2) |
| Years since the last measles SIA | 4 | ≤1 year (+0); 2 years (+2); ≤3 years (+4) |
| Proportion of suspected cases who are unvaccinated or have unknown vaccination status | 6 | <20% (+0); ≥20% (+6) |
| Surveillance Quality | (20) | |
| Nonmeasles discarded rate | 8 | ≥2 per 100,000 (+0); <2 per 100,000 (+4); <1 per 100,000 (+8) |
| Proportion of measles cases with adequate investigation | 4 | ≥80% (+0); <80% (+4) |
| Proportion of measles cases with adequate specimens collection | 4 | ≥80% (+0); <80% (+4) |
| Proportion of measles cases with laboratory results available in a timely manner | 4 | ≥80% (+0); <80% (+4) |
| Program Performance | (16) | |
| Trends in MCV1 coverage | 4 | Increasing or same (+0); ≤10% decline (+2); >10% decline (+4) |
| Trends in MCV2 coverage | 4 | Same as MCV1 trend |
| MCV1-MCV2 drop-out rate | 4 | ≤10% (+0); >10% (+4) |
| DPT1-MCV1 drop-out rate | 4 | Same as MCV1-MCV2 dropout rate |
| Threat Assessment | (24) | |
| ≥1 measles case reported among children <5 years | 4 | No (+0); Yes (+4) |
| ≥1 measles case reported among persons 5–14 years | 3 | No (+0); Yes (+3) |
| ≥1 measles case reported among persons ≥15 years | 3 | No (+0); Yes (+3) |
| Population density | 4 | 0-50/km2 (+0); 51–100/km2 (+1); 101–300/km2 (+2); 301–1000/km2 (+3); > 1000/km2 (+4) |
| ≥1 measles case reported in a bordering district within the past 12 months | 2 | No (+0); Yes (+2) |
| Presence of vulnerable groupsc | 8 | No vulnerable groups (+0); One risk point for each vulnerable group present (up to maximum of +8) |
| Total possible points | (100) |
DPT1 = first dose in series for diphtheria, pertussis, and tetanus vaccination; MCV1 = first dose in series for measles-containing vaccination; MCV2 = second dose in series for measles-containing vaccination; SIA = supplemental immunization activity.
Vaccination coverage estimates from surveys if conducted within past three years and includes birth cohorts of recent three years can be used to replace administrative coverage.
Outbreak response immunization (ORI) campaign coverage data can be considered if an SIA was not conducted within the past three years and if the ORI targeted a geographical area that included the entire district.
Presence of vulnerable groups includes any of the following: (1) migrant population, internally displaced population, slums, or tribal communities; (2) communities resistant to vaccination (e.g., religious, cultural, philosophical reasons); (3) security and safety concerns; (4) areas frequented by calamities/disasters; (5) poor access to health services due to terrain/transportation issues; (6) lack of local political support; (7) high-traffic transportation hubs/major roads or bordering large urban areas (within and across countries); (8) areas with mass gatherings (i.e., trade/commerce, fairs, markets, sporting events, high density of tourists).