Measles control programmes in emergency settings - both refugee and internally displaced camps – have two major components:

• Measles prevention through routine immunization.
• Measles outbreak response.

For all elective and emergency mass campaigns it is recommended that auto-disable syringes and safety boxes be used.

It is important to involve the national immunization programme from the start in any plan or activity. A measles immunization programme should be an early priority of emergency relief programmes.

Such a programme will require:

trained personnel, vaccine, cold chain equipment (refrigerators, freezers, cold boxes, vaccine carriers, ice-packs etc.), other supplies (auto-disable syringes, safety boxes, monitoring forms: vaccination cards, tally sheets etc.), vaccine administration sites, surveillance system, other activities (e.g. nutritional supplementation and Vitamin A, treatment of complications), health education and social promotion materials.

In the event of an outbreak the main strategy should be:

• To ensure proper case management;
• To immunize the population at risk as soon as possible.

The presence of several cases of measles in an emergency setting does not preclude a measles immunization campaign. Even among individuals who have already been exposed to, and are incubating the natural virus, measles vaccine, if given within three days of infection, may provide protection or modify the clinical severity of the illness. Isolation is not indicated and children should not be withdrawn from feeding programmes.

All children aged nine months to five years should be immunized against measles once they are in a refugee or internally displaced persons camp.

Coverage: It is essential that high coverage (more than 85%) be achieved.

Age: If very high coverage with measles vaccine has already been achieved in the community experiencing the emergency, and there is no evidence of circulation of the virus, it may be decided that supplementary immunization is unnecessary. An active surveillance system is essential in this situation to ensure their detection, should suspected measles cases occur. With this exception, the age range should be extended in emergencies:

The lower age limit should be reduced to 6 months of age. A child who receives the first dose before 9 months of age should receive another dose as soon as possible after reaching nine months of age, respecting the four-week interval between doses.

The upper age limit should be extended depending on local circumstances. If the population comes from a situation where there has been high measles transmission and low measles vaccine coverage, there is no need to immunize beyond 5 years of age. Similarly, if the population has already been exposed to measles within the previous 3-5 years, there may not be a need to immunize beyond 5 years of age. If, on the other hand, the population is drawn from isolated communities dispersed over a wide area (where there may have been little measles transmission), it will be necessary to extend the age of immunization up to 15 years of age.

If cases occur in children older than 5 years of age, consideration should be given to extending the age range. Although the risk of a child’s dying from complications of measles diminishes with age, measles transmission can occur from older to younger children. Thus, any older children who are thought to be under-immunized should be regarded as a potential risk for measles and be included in the target group for immunization.

In countries with a vitamin A deficiency problem the provision of prophylactic high-dose vitamin A supplements every 4–6 months gives protection against blindness and reduces the risk of all-cause mortality by 23%.

In order to promote overall improvements in child health, measles vaccination should be used as an opportunity to administer vitamin A prophylaxis in areas where vitamin A deficiency is prevalent. Opportunities for the provision of vitamin A supplements occur:

• at the time of routine measles vaccination (e.g. at nine months of age);
• during national immunization days (NIDs);
• during measles supplementary campaigns.

For all elective and emergency mass campaigns it is recommended that auto-disable syringes and safety boxes be used and that these should be disposed of by incineration or burning.

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