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Appraisal of measles elimination indicators in Qassim region.


In 2009, the Kingdom of Saudi Arabia joined with other members of the Eastern Mediterranean Region to commit its Measles Elimination Program (MEP) to be successful by the end of 2015. In early 2011, an unexpectedly large number of Measles cases were reported from Qassim region and at the request of local health authorities; a team from the Saudi Field Epidemiology Training Program evaluated the current status of performance of the MEP in the region.


A comprehensive list of 15 indicators covering different aspects of MEP was identified. Four data extraction forms were designed to audit all the record pertaining to MEP which included 157 measles case investigation forms, 360 monthly target coverage forms, 1440 weekly surveillance reporting forms, vaccination status of 5717 children registered at PHCs. Study period was defined as 1st January 2010 to 30th June, 2011. All the required record was reviewed by the investigators.


From January 2010 until end of June 2011, 157 suspected measles cases were reported from Qassim region and 69 were confirmed by lab. Regarding outbreak investigation indicators, targets for timing of investigation (84.1%), timing of notification (97.5%), age documentation (99.4%), identification of source of infection (89.6%) and adequacy of serology sample (98.7%) were achieved; while targets for timing of serology sampling (15.9%) and timing of availability of laboratory results (10.8%) were not achieved. Regarding routine surveillance performance indicators, targets for the reporting rate of non-Measles cases for both 2010 (3.8/100,000) and 2011 (1.3/100,000) were achieved. Targets for suspected cases discarded after laboratory testing for both 2010 (74.6%) and 2011 (42.4%) and timeliness of weekly reporting for both 2010 (63.9%) and 2011 (75.2%) were not achieved. Regarding vaccination program outcome indicators, among children 12-23 months of age targets for Measles vaccine at 9 months (90.8%) and MMR at 12 months (82.6%) were not achieved; while for children 72-83 months of age target for MMR at 12 months (96.1%) was achieved.


Timely vaccination of children, timing of serology sampling, and availability of laboratory results and timeliness of weekly surveillance reports need improvement through training of staff, better coordination and improved supervision