Immunization, Vaccines and Biologicals

Measles Programmatic Risk Assessment Tool

The World Health Organization (WHO) measles programmatic risk assessment tool was developed to help national programmes to identify areas not meeting measles programmatic targets, and based on the findings, guide and strengthen measles elimination program activities and reduce the risk of outbreaks. This Excel-based tool assesses subnational programmatic risk as the sum of indicator scores in four categories: population immunity, surveillance quality, program performance, and threat assessment. Each subnational area 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.

  • Population immunity: Assesses measles susceptibility using subnational vaccination coverage data administered through routine services for first-dose (MCV1) and second-dose (MCV2) measles-containing vaccine and coverage achieved during measles supplemental immunization activities (SIAs) conducted within the past three years. This indicator also includes the proportion of suspected measles cases with unknown vaccination status or who were unvaccinated.
  • Surveillance quality: Evaluates the ability of a subnational area to detect and confirm cases rapidly and accurately. These indicators include the non-measles discarded rate; the proportion of suspected measles cases with adequate investigation (investigation within 48 hours of notification and inclusion of 10 core variables); the proportion of cases with adequate specimen collection (within 28 days of rash onset); and the proportion of cases for whom laboratory results were available in a timely manner.
  • Program performance: Assesses specific aspects of routine immunization services, including indicators for trends in MCV1 and MCV2 coverage, dropout rates from MCV1 to MCV2 and from first dose of diphtheria, pertussis, and tetanus containing vaccine (DPT1) to MCV1 based on administrative vaccination coverage data.
  • Threat assessment: Accounts for factors that might influence the risk for measles virus exposure and transmission in the population. The indicators include reported measles cases among specific age groups, recent measles cases reported in a bordering subnational areas, population density, and presence of vulnerable groups.

To ensure programmatic utility of the tool, it is intended to be used annually by national program managers to monitor implementation of measles elimination strategies within a country. The required data inputs include readily-available and routinely collected data from the immunization and surveillance programs. Results are shown in table and map formats, with subnational areas color-coded by risk category. In addition, subnational risk scores can be displayed by indicator category, facilitating better understanding of programmatic weaknesses that are driving the overall risk score. Country reports can be created directly from the tool.

Please follow the user guide to understand how to use the tool. The user guide and the tool are available in English and in French.

For any questions please email In the subject line, please write Measles Risk Assessment Tool.

Last updated: 21 June 2017