Table 2.

Factors to consider when deciding on the extent of public health interventions during measles outbreaks in elimination settings.

What is the public health objective?

• Abort or modify the clinical course of the illness (e.g., post-exposure prophylaxis)

• Limit spread in the community (e.g., community-wide vaccination campaign, use of isolation, quarantining)

Considerations for tailoring response to the particular outbreak

• Feasibility of the intervention

○ Community engagement, acceptability

○ Healthcare infrastructure, public health capacity

○ Availability of resources (vaccine, cold chain, promotional materials)

○ Cost

• Risk of spread in affected (and surrounding) communities

○ Size of the community

○ Baseline vaccination coverage (within and surrounding the affected community)

○ Population density, rates of contact (rural vs. urban, closed populations)

○ Patterns of movement/travel

• Risk to persons prone to severe disease

○ Unvaccinated infants, susceptible pregnant women, severely immunocompromised individuals

Specifics of the intervention

• Timeliness: Prompt case recognition, reporting, investigation, and vaccination of susceptible contacts can limit spread

• Target coverage (e.g., vaccination of >80% of target population)

• Target age range:

○ Age groups with highest attack rates vs. all ages

○ If burden is high among infants <12 months of age, measles vaccination of infants as young as 6 months of age should be considered

• Selective versus non-selective:

○ Unvaccinated only vs. all, regardless of vaccination status

○ Exposed only vs. exposed and non-exposed

• Spatial scale

○ High-risk areas (households, healthcare institutions, schools/colleges, churches, border areas other populated/peri-urban settings) vs. entire community

• Outreach:

○ Referral to healthcare provider or local hospital for vaccination or immunoglobulin

○ Vaccination clinics at health departments

○ Community outreach (e.g., door-to-door vaccination)