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WHO
Collaborative Programme
Measles
Elimination
Back
Situation analysis:
Measles is an endemic disease in Lebanon. Since its launching in 1987, the national EPI programme has adopted an immunization schedule that includes a first dose of measles vaccine at 9 months and a second dose at 15 months. Since January 1997, MMR replaced the second dose of measles. A second dose of MMR was added at the age of 5 years. The private medical sector accounts for more than 50 percent of vaccination services; it continues to give measles vaccine at the age of 15 months.
Measles is a notifiable disease reported on a monthly basis. However, if an outbreak occurs, reporting becomes immediate. Surveillance system needs further support in order to include private physicians as well.
Two measles outbreaks have occurred in Lebanon since 1992. The first was between October 1992 and October 1993, where 383 cases of measles were reported from 300 health centers distributed all over Lebanon.
The second outbreak started in November 1997 and ended in April 1998 and occurred in the north governorate (717 cases were reported); 31 cases occurred in November and December 1997 and 686 cases up to April 1998. The majority of these cases were above the age of 5 years (67.9%) with 46% unvaccinated and 56.8% admitted to the hospitals in the north. The epidemic curve showed that peak occurrence was in February 1998. The case-fatality rate was 0.4 %, and the major cause of deaths was septicaemia. A campaign targeting children 9 months to 18 years in the northern areas affected by the outbreak delivered about 60,000 doses.
There is no reliable national data on the age distribution of reported cases. Because some children in school age already have two doses of MMR and school attendance appears to be high, a school-based campaign could be very effective for school age children. A non-selective campaign for pre-school children should also be conducted simultaneously.
A national workshop for measles elimination and AFP/Polio Surveillance was held in July 1999. WHO enhanced the mobilization of external resources from extrabudgetary funds to support the implementation of the plan of action for measles elimination.
In April 2001, a national Measles Elimination Campaign was conducted, targeting school children. Despite the active participation of NGOs and the lengthy preparations, the campaign reached around 60 % of its target population, essentially due to the unknown (and uncontrollable) participation of the Private sector, and refusal of some private schools to join in the campaign.
Another Measles campaign is recommended to account for the remaining percentage of the population that was not reached.
WHO support would be essential in development of a Plan of action as well as direct support to the related activities.
A national vaccination campaign against measles and rubella was conducted from 15 March till 15 May 2001. The total number of vaccinated children was 747 743 from the 981370 targeted (children between 1 and 14 years of age). A follow-up campaign will be conducted in specific schools, during the month of October 2001, for the missing children (children who were not vaccinated during the national campaign)
Objectives:
Elimination of measles.
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