Framework for verifying elimination of measles and rubella

The WHO Global Vaccine Action Plan for 2012–2020 has established as a target the elimination of measles and rubella in at least 5 WHO Regions by 2020.1 The working group on measles and rubella of the Strategic Advisory Group of Experts on Immunization (SAGE) has prepared revised guidance on how to monitor progress towards and verify elimination of measles and rubella, to ensure alignment between the activities of different WHO Regions. The framework for verifying the elimination of measles and rubella described below was endorsed by SAGE in November 2012. This framework builds on the experience gained in Regions and countries, and provides a description of the process of verification and definition of key terms and surveillance indicators, as well as an approach to the integration of rubella surveillance into measles and rubella elimination activities. The framework has been developed for set-tings where the aim is to interrupt transmission of both measles and rubella; the revisions to previous documents on this topic are tailored for that context. In settings where measles and/or rubella are still endemic, different definitions (e.g. for an outbreak) may be more appropriate.

Because not all countries will be able to measure all of the indicators provided below, alternative and complementary lines of evidence may be used to verify elimination of measles and rubella. The aim is to balance standardization against the need for flexibility to accommodate differences in national health systems.