Abstract
Measles is a highly transmissible infectious disease that causes serious illness and death worldwide. Efforts to eliminate measles through achieving high immunization coverage, well-performing surveillance systems, and rapid and effective outbreak response mechanisms while strategically engaging and strengthening health systems have been termed a diagonal approach. In March 2015, a large nationwide measles epidemic occurred in Mongolia, 1 year after verification of measles elimination in this country. A multidisciplinary team conducted an outbreak investigation that included a broad health system assessment, organized around the Global Health Security Agenda framework of Prevent-Detect-Respond, to provide recommendations for evidence-based interventions to interrupt the epidemic and strengthen the overall health system to prevent future outbreaks of measles and other epidemic-prone infectious threats. This investigation demonstrated the value of evaluating elements of the broader health system in investigating measles outbreaks and the need for using a diagonal approach to achieving sustainable measles elimination.
Highlights
Measles, a highly transmissible infectious disease that causes serious illness and death worldwide, is often referred to as a public health “canary in the coalmine” because it can be used as both a signal of weak health systems and a driver for strategies and policies to strengthen health systems [1]
55 (9%) occurred in healthcare worker (HCW); 220 (36%) occurred in infants >9 months of age who were eligible for routine measles vaccination; and 448 (74%) occurred in infants >6 months of age who were eligible for postexposure or outbreak response measles vaccination
The National Standard on Measles Surveillance Guidelines from 2003 recommended routine contact tracing of measles cases and, where appropriate, administration of measles-containing vaccine (MCV) or immunoglobulin as postexposure prophylaxis (PEP) [26]
Summary
A highly transmissible infectious disease that causes serious illness and death worldwide, is often referred to as a public health “canary in the coalmine” because it can be used as both a signal of weak health systems and a driver for strategies and policies to strengthen health systems [1]. A WHO member state in the Western Pacific Region (WPR), participates in the GHSA [16] and has received support to strengthen IHR 2005 capabilities and response capacity for public health events of international concern. The government of Mongolia requested that WHO and the US Centers for Disease Control and Prevention, in collaboration with the Ministry of Health and Sports (MOHS), conduct an outbreak investigation to assess factors contributing to ongoing transmission and provide recommendations for outbreak response and elimination strategies. In addition to identifying risk factors for transmission and evaluating the response vaccination activities and strategies, we used the measles outbreak as an opportunity to conduct a broader evaluation of the health system and emergency response strategies, following the GHSA framework, to prevent future outbreaks in Mongolia. We reviewed surveillance data, standard operating procedures (SOPs), and practices, and evaluated national emergency preparedness activities and response processes during the outbreak
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
