TABLE 2. Cut-off points and scores of the indicators by category.

Indicator	Justification	Cut-off point (score)
Vaccination
Measles vaccination coverage, %	A crucial indicator for assessing immunization, identifying low vaccination coverage, and evaluating the effectiveness of vaccination strategies	≥ 95 (+0) 90–94 (+2) 85–89 (+4) 80–84 (+6) < 80 (+8)
Threat assessment
≥ one case of measles in children younger than 5 years	Indicates additional transmission risk	No (+0) Yes (+4)
≥ one case of measles reported in the age group 5–14 years	Indicates additional transmission risk	No (+0) Yes (+3)
≥ one case of measles reported in a neighboring municipality	Transmission in border municipalities increases the risk of importation	No (+0) Yes (+2)
Population density (inhabitants/km²)	Higher risk of transmission or spread in densely populated areas	0–50 (+0) 51–100 (+1) 101–300 (+2) 301–1000 (+3) > 1000 (+4)
Quality of health services
Infant mortality rate, deaths per 1000 live births	A high infant mortality rate may indicate a weakened health care system, with potential deficiencies in prevention, diagnosis, and treatment	≥ 12 (+1) > 20 (+2)
Percentage of live births that had at least seven prenatal care visits during pregnancy	This number indicates better access to health care services. During prenatal care visits, pregnant women receive information about the importance of measles immunization	≥ 90 (+0) < 90 (+1) < 50 (+2)
Living conditions
Percentage of resident mothers without complete elementary education and with at least one child younger than 15 years	May indicate a potential lack of access to health information, including the importance of measles immunization. The lower the educational attainment, the higher the vulnerability	> 16 (+1)
Percentage of extremely poor individuals, per capita household income up to 1/4 of the minimum wage	Indicates precarious socioeconomic conditions and social vulnerability	1.5–3.6 (+1) > 3.6 (+4)
Percentage of individuals aged 15 to 24 years who are neither in school nor employed in households vulnerable to povertya	Indicates socioeconomic vulnerability. This can result in financial difficulties, limitations in access to basic services, and increased exposure to social and health risks.	> 33 (+1) < 33 (+0)
Percentage of individuals living in households with inadequate water supply and sanitation	Indicates housing vulnerability	> 3.2 (+1)
Percentage of people residing in areas with inadequate garbage collection	Indicates housing vulnerability	> 8.5 (+1)

^aHouseholds vulnerable to poverty have per capita household income of up to 1/2 of the minimum wage.

Source: Adapted by the authors from Lam et al., 2017 (6).