Essential health services – child health standard 1: Prevention of vaccine-preventable diseases
Children aged 6 months to 15 years have immunity against measles and access to routine Expanded Programme on Immunization (EPI) services once the situation stabilised.
Key actions (to be read in conjunction with the guidance notes)
Make an estimation of measles vaccination coverage of children aged 9 months to 15 years at the outset of the disaster response, to determine the risk of outbreaks (see guidance note 1).
When measles vaccination coverage is <90 per cent or unknown, conduct a mass measles vaccination campaign for children aged 6 months to 15 years, including the administration of Vitamin A to children aged 6–59 months (see guidance notes 1–2).
Ensure that all infants vaccinated between 6–9 months of age receive another dose of measles vaccine upon reaching 9 months (see guidance note 3).
For mobile or displaced populations, establish an ongoing system to ensure that at least 95 per cent of newcomers to a camp or community aged between 6 months and 15 years receive vaccination against measles.
Re-establish the EPI as soon as conditions permit to routinely immunise children against measles and other vaccine-preventable diseases included in the national schedule (see guidance note 4).
Key indicators (to be read in conjunction with the guidance notes)
Upon completion of measles vaccination campaign:
at least 95 per cent of children aged 6 months to 15 years have received measles vaccination
at least 95 per cent of children aged 6–59 months have received an appropriate dose of Vitamin A.
- at least 95 per cent of children aged 6 months to 15 years have received measles vaccination
Once routine EPI services have been re-established, at least 90 per cent children aged 12 months have had three doses of DPT (diphtheria, pertussis and tetanus), which is the proxy indicator for fully immunised children.
- Measles vaccination coverage: Determine measles vaccination coveragein the affected population through review of immunisation coverage data. Based on this review, determine if routine measles immunisation coverage has been ≥90 per cent for the preceding five years and/or if a measles vaccination campaign conducted in the preceding 12 months has reached ≥90 per cent of children aged 9 months to 5 years. If measles vaccination coverage is <90 per cent, unknown or doubts remain regarding the coverage estimates, the campaign should be carried out on the assumption that the coverage is inadequate to prevent outbreaks.
- Age ranges for measles vaccination: Some older children may have escaped both previous measles vaccination campaigns and measles disease. These children remain at risk of measles and can serve as a source of infection for infants and young children who are at higher risk of dying from the disease. This is the reason for the recommendation to vaccinate up to the age of 15 years. In resource-poor settings, it may not be possible to vaccinate all children aged 6 months to 15 years. In these settings, priority should be given to children aged 6–59 months. All children in the target age group should be immunised against measles regardless of their previous immunisation status.
- Repeat measles vaccination for children aged 6–9 months: All children aged 6–9 months who received the measles vaccine should receive an additional dose of measles vaccine upon reaching 9 months of age, with at least one month between the two doses.
- Re-establishment of the national EPI programme: At the same time as the preparation of the mass vaccination campaign against measles, plans should begin to re-establish the EPI programme in coordination with national authorities. The prompt re-establishment of EPI vaccination not only protects children directly against diseases such as measles, diphtheria and pertussis, but has the added value of reducing the risk of respiratory infections.