Measles and Rubella Risk Assessment Final Report — {#Value ref_country_name#}

Measles and Rubella Risk Assessment Profile — {#Value ref_country_name#}

{#Value rep_label_date_completed#}

Contents

Background:	3

Section 1: Overall Measles/Rubella Risk Profile	5

Section 2: Population Immunity	6

Section 3: Surveillance Quality	8

Section 4: Program Delivery	9

Section 5: Threat Assessment	10

Section 6: Rapid Response to Imported Cases	11

Appendix: Global Variables	12

Background:

The Pan American Health Organization (PAHO) Measles and Rubella Programmatic Risk Assessment tool identifies areas not meeting measles and rubella programmatic targets for the implementation of the corrective measures. Therefore, the results from this tool will guide and strengthen measles and rubella sustainability activities and reduce the risk of virus spread following an importation. This tool assesses programmatic risk as the sum of indicator scores in five categories: 1) population immunity; 2) surveillance quality; 3) program performance; 4) threat assessment; and 5) rapid response.

Each {#Value rep_label_admin2_name#} in a country is assigned to a programmatic risk category of low, medium, high, or very high risk based on the overall risk score. Scoring for each indicator was developed based on expert consensus. The range of possible scores goes from 0 to 100 risk points following the table below:

Table 1: Risk Scoring Assigned at the Municipality Level

Risk categories	Total risk points
Low risk	Less than 26 points
Medium risk	Between 26 and 50 points
High risk	Between 51-75 points
Very high risk	Between 76-100 points

Risk categories

Population immunity: Assesses measles susceptibility using administrative vaccination coverage data for the first and second doses of the measles-mumps-rubella containing vaccine (MMR1 and MMR2 respectively) and coverage achieved during follow-up campaigns. This indicator also includes the proportion of suspected measles and rubella cases with unknown vaccination status or who were not vaccinated. (Total possible points = {#Value ref_Max_RP_PI#})

Surveillance quality: Evaluates the ability of a {#Value rep_label_admin2_name#} to detect and confirm cases rapidly and accurately. These indicators include the annual measles and rubella suspected reporting rate by 100,000 population; the proportion of suspected measles and rubella cases with adequate investigation (investigation within 48 hours of notification and inclusion of eight of 11 core variables); the proportion of cases with adequate specimen collection in <30 days of rash onset and the proportion of blood specimens received in laboratory in <5 days. (Total possible points = {#Value ref_Max_RP_SQ#})

Program performance: Assesses specific aspects of routine immunization services, including indicators for trends in MMR1 and MMR2 coverage, dropout rates from MMR1 to MMR2 and from the first dose of pentavalent vaccine (diphtheria, tetanus and pertussis, vaccine ([DTP], Hepatitis B and Haemophilus influenzae to MMR1 based on administrative vaccination coverage data. (Total possible points = {#Value ref_Max_RP_PDP#})

Threat assessment: Accounts for factors that might influence the risk for measles and rubella virus exposure and transmission in the population. The indicators include reported measles cases among specific age groups, population density and presence of vulnerable groups. (Total possible points = {#Value ref_Max_RP_TA#})

Rapid Response: Accounts for the presence of a rapid response to imported measles and rubella cases. The indicators are measured at the subnational level and include the presence of a trained team for rapid response and the proportion of hospitals trained to do triage and isolation of highly suspicious measles and rubella cases. (Total possible points = {#Value ref_Max_RP_RR#})

The tool can be used periodically by national immunization program managers, surveillance, and laboratory areas to monitor implementation of measles and rubella sustainability strategies within a country. The tool requires readily available and routinely collected data from the immunization and surveillance programs. Results are shown in table and map formats, with {#Value rep_label_admin2_name_plural#} color-coded by risk category. In addition, {#Value rep_label_admin2_name#} risk scores can be displayed by each indicator category, highlighting the programmatic weaknesses that are driving the overall risk score.

Section 1: Overall Measles/Rubella Risk Profile

Of the {#Value ref_num_admin2#} {#Value rep_label_admin2_name_plural#} in {#Value ref_country_name#}, {#Value rep_label_num_admin2_VHR#} ({#Value TEXT(rep_label_pct_admin2_VHR,"0.0%")#}) were categorized as very high risk, {#Value rep_label_num_admin2_HR#} ({#Value TEXT(rep_label_pct_admin2_HR,"0.0%")#}) were categorized as high risk, {#Value rep_label_num_admin2_MR#} ({#Value TEXT(rep_label_pct_admin2_MR,"0.0%")#}) were categorized as medium risk, and {#Value rep_label_num_admin2_LR#} ({#Value TEXT(rep_label_pct_admin2_LR,"0.0%")#}) were categorized as low risk (Table 1 and Figure 1).

Table 1a: Risk Profile – Number of {#Value rep_label_admin2_name_plural#} by {#Value rep_label_admin1_name#}

{#Table table_report_risk_profile_country#}

Figure 1a: Measles/Rubella Risk Assessment, {#Value ref_country_name#}, {#Value ref_assessment_years#}

{#Shape shp_Map_OVERALL_RISK#}

{#Shape shp_Legend_OVERALL_RISK#}

Table 1b: Risk Scores for Very High Risk {#Value rep_label_admin2_name_plural#}

{#Table table_report_VHR#}

Figure 1b: Map of Risk Scores for Very High Risk {#Value rep_label_admin2_name_plural#}

{#Shape shp_Map_VHR#}

{#Shape shp_Legend_VHR#}

Figure 1c: Map of Risk Scores for High Risk {#Value rep_label_admin2_name_plural#}

{#Shape shp_Map_HR#}

{#Shape shp_Legend_HR#}

Section 2: Population Immunity

{#Table table_report_population_immunity_country#}

Figure 2a: Risk Assessment for Immunity Profile

{#Shape shp_Map_PI#}

{#Shape shp_Legend_PI#}

Figure 2b: Coverage of Measles and Rubella Follow-up Campaign

{#Shape shp_Map_FOLLOW_UP_COVERAGE#}

{#Shape shp_Legend_FOLLOW_UP_COVERAGE#}

Figure 2c: MMR1 Coverage for {#Value ref_first_data_year#}

{#Shape shp_Map_MMR1_YEAR_1#}

{#Shape shp_Legend_MMR1_YEAR_1#}

Figure 2d: MMR1 Coverage for {#Value ref_first_data_year+1#}

{#Shape shp_Map_MMR1_YEAR_2#}

{#Shape shp_Legend_MMR1_YEAR_2#}

Figure 2e: MMR1 Coverage for {#Value ref_first_data_year+2#}

{#Shape shp_Map_MMR1_YEAR_3#}

{#Shape shp_Legend_MMR1_YEAR_3#}

Figure 2f: MMR1 Coverage for {#Value ref_first_data_year+3#}

{#Shape shp_Map_MMR1_YEAR_4#}

{#Shape shp_Legend_MMR1_YEAR_4#}

Figure 2g: MMR1 Coverage for {#Value ref_first_data_year+4#}

{#Shape shp_Map_MMR1_YEAR_5#}

{#Shape shp_Legend_MMR1_YEAR_5#}

Figure 2h: MMR2 Coverage for {#Value ref_first_data_year#}

{#Shape shp_Map_MMR2_YEAR_1#}

{#Shape shp_Legend_MMR2_YEAR_1#}

Figure 2i: MMR2 Coverage for {#Value ref_first_data_year+1#}

{#Shape shp_Map_MMR2_YEAR_2#}

{#Shape shp_Legend_MMR2_YEAR_2#}

Figure 2j: MMR2 Coverage for {#Value ref_first_data_year+2#}

{#Shape shp_Map_MMR2_YEAR_3#}

{#Shape shp_Legend_MMR2_YEAR_3#}

Figure 2k: MMR2 Coverage for {#Value ref_first_data_year+3#}

{#Shape shp_Map_MMR2_YEAR_4#}

{#Shape shp_Legend_MMR2_YEAR_4#}

Figure 2l: MMR2 Coverage for {#Value ref_first_data_year+4#}

{#Shape shp_Map_MMR2_YEAR_5#}

{#Shape shp_Legend_MMR2_YEAR_5#}

Section 3: Surveillance Quality

{#Table table_report_surveillance_quality_country#}

Figure 3a: Risk Assessment for Surveillance Quality

{#Shape shp_Map_SQ#}

{#Shape shp_Legend_SQ#}

Figure 3b: Annual Rate of Suspected Measles and Rubella Cases per 100,000 population

{#Shape shp_Map_SMARCR#}

{#Shape shp_Legend_SMARCR#}

Figure 3c: Percentage of Suspected Cases with Adequate Investigation

{#Shape shp_Map_PCT_CASES_ADEQ_INVEST#}

{#Shape shp_Legend_PCT_CASES_ADEQ_INVEST#}

Figure 3d: Percentage of Cases with Adequate Specimen Collection

{#Shape shp_Map_SQ_ADQ_COL#}

{#Shape shp_Legend_SQ_ADQ_COL#}

Figure 3e: Percentage of Blood Specimens Sent to the Laboratory in <= 5 Days

{#Shape shp_Map_SQ_BLOOD_REC_LAB#}

{#Shape shp_Legend_SQ_BLOOD_REC_LAB#}

Section 4: Program Delivery Performance

{#Table table_report_program_delivery_performance_country#}

Figure 4a: Risk Assessment for Program Delivery Performance

{#Shape shp_Map_PDP#}

{#Shape shp_Legend_PDP#}

Figure 4b: MMR1 Trend

{#Shape shp_Map_PP_MMR1_TREND#}

{#Shape shp_Legend_PP_MMR1_TREND#}

Figure 4c: MMR2 Trend

{#Shape shp_Map_PP_MMR2_TREND#}

{#Shape shp_Legend_PP_MMR2_TREND #}

Figure 4d: Drop-out Rate between MMR1- MMR2

{#Shape shp_Map_DROPOUT_MMR1_MMR2#}

{#Shape shp_Legend_DROPOUT_MMR1_MMR2#}

Figure 4e: Drop-out Rate between Penta1- MMR1

{#Shape shp_Map_DROPOUT_DTP1_MMR1#}

{#Shape shp_Legend_DROPOUT_DTP1_MMR1#}

Section 5: Threat Assessment

{#Table table_threat_assessment_country#}

Figure 5a: Risk Assessment for Threat Assessment

{#Shape shp_Map_TA#}

{#Shape shp_Legend_TA#}

Figure 5b: Confirmed Measles and / or Rubella Cases in the Past Year

{#Shape shp_Map_MEASLES_CASES#}

{#Shape shp_Legend_MEASLES_CASES#}

Figure 5c: Population Density

{#Shape shp_Map_TA_POP_DENSITY#}

{#Shape shp_Legend_TA_POP_DENSITY#}

Figure 5d: Presence of Vulnerable Population

{#Shape shp_Map_TA_VUL_GROUPS#}

{#Shape shp_Legend_TA_VUL_GROUPS#}

Section 6: Rapid Response to Imported Cases

{#Table table_rapid_response_country#}

Figure 6a: Risk Assessment for Rapid Response to Imported Cases

{#Shape shp_Map_RR#}

{#Shape shp_Legend_RR#}

Figure 6b: Presence of a Trained Rapid Response Team

{#Shape shp_Map_RR_TEAM#}

{#Shape shp_Legend_RR_TEAM#}

Figure 6c: Percentage of Hospitals Trained in Triage and Isolation

{#Shape shp_Map_RR_HOSPITAL#}

{#Shape shp_Legend_RR_HOSPITAL#}

Appendix: Global Variables

{#Table tbl_step1_global_ref_data#}

{#Table tbl_step1_calc_fields#}

{#Table tbl_step1_geo_data#}

When a municipality has less than 100,000 habitants and has reported at least 1 suspected case during the most recent year, the tool will assign 0 risk points. If the municipality was epidemiologically silent (did not report any cases), the tool will assign maximum risk score (8 points).