MEASLES, MUMPS & RUBELLA
-
Upload
mgmcricommunitymed -
Category
Healthcare
-
view
1.121 -
download
4
Transcript of MEASLES, MUMPS & RUBELLA
![Page 1: MEASLES, MUMPS & RUBELLA](https://reader034.fdocuments.in/reader034/viewer/2022042610/58a4db761a28ab34318b5d0f/html5/thumbnails/1.jpg)
1
Measles, Mumps &Rubella(MMR)
Dr Rajkumar PatilProfessor,Community Medicine
MGMCRI
![Page 2: MEASLES, MUMPS & RUBELLA](https://reader034.fdocuments.in/reader034/viewer/2022042610/58a4db761a28ab34318b5d0f/html5/thumbnails/2.jpg)
2
Learning objectives
At the end of the class student should be able to:
• Describe the important agent, host and environmental factors of Measles, Mumps and Rubella
• Describe the preventive and control measures Measles ,Mumps and Rubella
![Page 3: MEASLES, MUMPS & RUBELLA](https://reader034.fdocuments.in/reader034/viewer/2022042610/58a4db761a28ab34318b5d0f/html5/thumbnails/3.jpg)
3
Measles (Rubeola)
![Page 4: MEASLES, MUMPS & RUBELLA](https://reader034.fdocuments.in/reader034/viewer/2022042610/58a4db761a28ab34318b5d0f/html5/thumbnails/4.jpg)
4
Measles-Introduction
• Acute highly infectious disease of childhood caused by a specific virus (RNA paramyxovirus).
• Characterized by fever and respiratory symptoms followed by typical rash.
• Associated with high morbidity and mortality in developing countries.
• 2% of under 5 mortality in India (WHO 2014)
![Page 5: MEASLES, MUMPS & RUBELLA](https://reader034.fdocuments.in/reader034/viewer/2022042610/58a4db761a28ab34318b5d0f/html5/thumbnails/5.jpg)
5
Problem statement
• In 2014, there were 114900 measles deaths globally – about 314 deaths every day or 13 deaths every hour.
• Measles vaccination resulted in a 79% drop in measles deaths between 2000 and 2014 worldwide.
• Measles is still common in many developing countries – particularly in parts of Africa and Asia.
![Page 6: MEASLES, MUMPS & RUBELLA](https://reader034.fdocuments.in/reader034/viewer/2022042610/58a4db761a28ab34318b5d0f/html5/thumbnails/6.jpg)
6
Agent factors
• Agent- RNA virus (Paramyxo virus family, genus Morbillivirus)
• Can’t survive outside the human body
• Source of infection: case of measles (no carriers).
• No animal reservoir
![Page 7: MEASLES, MUMPS & RUBELLA](https://reader034.fdocuments.in/reader034/viewer/2022042610/58a4db761a28ab34318b5d0f/html5/thumbnails/7.jpg)
7
Agent factors• Infective material- Secretions of nose, throat and respiratory tract
• Virus remains active and contagious in the air or on infected surfaces for up to 2 hours.
• Period of communicability: 4 days before to 4 days after the appearance of rash
• Highly infectious during prodromal period and at the time of eruption.
• Secondary Attack Rate(SAR): > 80%
![Page 8: MEASLES, MUMPS & RUBELLA](https://reader034.fdocuments.in/reader034/viewer/2022042610/58a4db761a28ab34318b5d0f/html5/thumbnails/8.jpg)
Host factorsAge:• Commonly 6 months to 3 years in developing and
underdeveloped countries• More than 5 years in developed countriesSex: Incidence equal in both sexesImmunity:• No age is immune if there is no previous immunity• One attack-life long immunityNutrition: Malnourished children highly susceptible, mortality is more
8
![Page 9: MEASLES, MUMPS & RUBELLA](https://reader034.fdocuments.in/reader034/viewer/2022042610/58a4db761a28ab34318b5d0f/html5/thumbnails/9.jpg)
9
Environmental factors
• In tropical climate: Dry season
• In temperate climate: Winter season, over crowding
• In India: January to April
![Page 10: MEASLES, MUMPS & RUBELLA](https://reader034.fdocuments.in/reader034/viewer/2022042610/58a4db761a28ab34318b5d0f/html5/thumbnails/10.jpg)
10
Transmission:Droplet infection,droplet nucleiPortal of entry and exit: Respiratory tract, Minor- conjunctiva
Incubation period:10-14 days
![Page 11: MEASLES, MUMPS & RUBELLA](https://reader034.fdocuments.in/reader034/viewer/2022042610/58a4db761a28ab34318b5d0f/html5/thumbnails/11.jpg)
11
Clinical features
• Prodromal stage
• Eruptive stage
• Post-measles stage
![Page 12: MEASLES, MUMPS & RUBELLA](https://reader034.fdocuments.in/reader034/viewer/2022042610/58a4db761a28ab34318b5d0f/html5/thumbnails/12.jpg)
12
Prodromal stage
• From 10th day of infection to 14th day• 3 Cs (Cough, Coryza with sneezing and nasal
discharge & Conjunctivitis)• Lacrimation and photophobia• Fever for 4 days• May be- Vomiting or Diarrhoea • Koplik spots
![Page 13: MEASLES, MUMPS & RUBELLA](https://reader034.fdocuments.in/reader034/viewer/2022042610/58a4db761a28ab34318b5d0f/html5/thumbnails/13.jpg)
13
![Page 14: MEASLES, MUMPS & RUBELLA](https://reader034.fdocuments.in/reader034/viewer/2022042610/58a4db761a28ab34318b5d0f/html5/thumbnails/14.jpg)
14
Koplik’s spots
• Pathognomic sign
• 1-2 days before appearance of rash
• Small, bluish-white spots over a red base
• On buccal mucosa opposite the first and second lower molars
![Page 15: MEASLES, MUMPS & RUBELLA](https://reader034.fdocuments.in/reader034/viewer/2022042610/58a4db761a28ab34318b5d0f/html5/thumbnails/15.jpg)
15
KOPLIK SPOTSource: http://phil.cdc.gov/PHIL_Images/20040908/4f54ee8f0e5f49f58aaa30c1bc6413ba/6111_lores.jpg
![Page 16: MEASLES, MUMPS & RUBELLA](https://reader034.fdocuments.in/reader034/viewer/2022042610/58a4db761a28ab34318b5d0f/html5/thumbnails/16.jpg)
16
![Page 17: MEASLES, MUMPS & RUBELLA](https://reader034.fdocuments.in/reader034/viewer/2022042610/58a4db761a28ab34318b5d0f/html5/thumbnails/17.jpg)
17
Eruptive stage
• Dusky red, generalized, maculopapular, erythematous rash.
• Begins behind the ear and rapidly spreads to face, neck and extends down the body within 2-3 days.
• In the absence of complications, rash and fever disappears in 3-4 days.
• Rash fades in the order of appearance.
![Page 18: MEASLES, MUMPS & RUBELLA](https://reader034.fdocuments.in/reader034/viewer/2022042610/58a4db761a28ab34318b5d0f/html5/thumbnails/18.jpg)
18
Courtesy : This media comes from the Centers for Disease Control and Prevention's Public Health Image Library (PHIL), with identification number #3168
![Page 19: MEASLES, MUMPS & RUBELLA](https://reader034.fdocuments.in/reader034/viewer/2022042610/58a4db761a28ab34318b5d0f/html5/thumbnails/19.jpg)
19Courtesy : Adapted from Mims et al. Medical Microbiology, 1993, Mosby
![Page 20: MEASLES, MUMPS & RUBELLA](https://reader034.fdocuments.in/reader034/viewer/2022042610/58a4db761a28ab34318b5d0f/html5/thumbnails/20.jpg)
20
Post Measles Stage
Growth retardationSusceptibility to other infectionsComplications:• Pneumonia(20-80% in developing countries, less than 10% in developed)• Diarrhoea • Respiratory Infections• Otitis Media(5-15%)• Rarely Febrile convulsions, Encephalitis
![Page 21: MEASLES, MUMPS & RUBELLA](https://reader034.fdocuments.in/reader034/viewer/2022042610/58a4db761a28ab34318b5d0f/html5/thumbnails/21.jpg)
21
What is a probable case of Measles?
In the absence of a more likely diagnosis, an illness characterized by: Generalized rash lasting ≥3 days; andTemperature ≥101°F or 38.3°C; and
Cough, coryza, or conjunctivitis; and
No epidemiologic linkage to a confirmed case of measles; &Non-contributory or no serologic or virologic testing.
![Page 22: MEASLES, MUMPS & RUBELLA](https://reader034.fdocuments.in/reader034/viewer/2022042610/58a4db761a28ab34318b5d0f/html5/thumbnails/22.jpg)
22
What is a confirmed case of Measles?• Laboratory confirmation by any of the following:• Positive serologic test for measles IgM antibody;• Isolation of measles virus from a clinical specimen; or• Detection of measles-virus specific nucleic acid by polymerase chain
reaction (PCR)(Note: A lab-confirmed case does not have to have generalized rash lasting ≥3 days; temperature ≥101°F or 38.3°C; cough, coryza, or conjunctivitis. ) OR
An illness characterized by• Generalized rash lasting ≥3 days; and• Temperature ≥101°F or 38.3°C; and• Cough, coryza, or conjunctivitis; and• Epidemiologic linkage to a confirmed case of measles.
![Page 23: MEASLES, MUMPS & RUBELLA](https://reader034.fdocuments.in/reader034/viewer/2022042610/58a4db761a28ab34318b5d0f/html5/thumbnails/23.jpg)
23
Treatment of Measles
• Isolation for 7 days after the onset of rash
• No specific antiviral treatment.• Supportive care: good nutrition, adequate fluid intake and
treatment of dehydration.
• Antibiotics: to treat eye and ear infections, and pneumonia.
• All children diagnosed with measles should receive two doses of vitamin A supplements, given 24 hours apart.
Vitamin A can help prevent eye damage and blindness. (Vitamin A supplements reduces the deaths from measles by 50%)
![Page 24: MEASLES, MUMPS & RUBELLA](https://reader034.fdocuments.in/reader034/viewer/2022042610/58a4db761a28ab34318b5d0f/html5/thumbnails/24.jpg)
24
Prevention of MeaslesImmunization:• Eradication can be achieved by immunization rate of
atleast 96% under one year of age • Ongoing immunization against measles • Measles vaccination: live attenuated, subcutaneous,0.5
ml, at 9-12 months, life long immunity in 90-99%; Reactions: Mild fever
• MMR vaccine • Immunoglobulin(human):with in 3-4 days of exposure
![Page 25: MEASLES, MUMPS & RUBELLA](https://reader034.fdocuments.in/reader034/viewer/2022042610/58a4db761a28ab34318b5d0f/html5/thumbnails/25.jpg)
25
Measles outbreak control
• Isolation for 7 days after the onset of rash
• Active Immunization of contacts within 2 days of exposure (or passive immunization within 3-4 days)
• Prompt immunization at the beginning of outbreak
![Page 26: MEASLES, MUMPS & RUBELLA](https://reader034.fdocuments.in/reader034/viewer/2022042610/58a4db761a28ab34318b5d0f/html5/thumbnails/26.jpg)
26
Enhanced measles eradication strategy-WHO 1) Catch up: First, a one-time-only "catch-up" measles
vaccination campaign is conducted among children aged 9 months to 14 years.
2) Keep up: Efforts are then made to vaccinate through routine health services ("keep-up") at least 95% of each
newborn cohort at 12 months of age.
3) Follow up: Finally, to assure high population immunity among preschool-aged children, indiscriminate "follow-up" measles vaccination campaigns are conducted approximately every 4 years.
![Page 27: MEASLES, MUMPS & RUBELLA](https://reader034.fdocuments.in/reader034/viewer/2022042610/58a4db761a28ab34318b5d0f/html5/thumbnails/27.jpg)
27
Challenges for Measles elimination
• Weak immunization systems• High infectious nature of measles• Inaccessible population in certain areas• Refusal to immunization by some people • Changing epidemiology(adolescents and adults)• Catch up immunization to more than 130 million
children in India• Lack of human and financial resources
![Page 28: MEASLES, MUMPS & RUBELLA](https://reader034.fdocuments.in/reader034/viewer/2022042610/58a4db761a28ab34318b5d0f/html5/thumbnails/28.jpg)
28
Mumps
![Page 29: MEASLES, MUMPS & RUBELLA](https://reader034.fdocuments.in/reader034/viewer/2022042610/58a4db761a28ab34318b5d0f/html5/thumbnails/29.jpg)
29
Mumps-Introduction
• "to mump" (british word): grimace or grin (as a result of parotid gland swelling)
• Acute infectious disease due to “myxovirus parotiditis” ; RNA paramyxovirus (Genus Rubulavirus) affecting mainly glands and nervous system
• Mortality is negligible
![Page 30: MEASLES, MUMPS & RUBELLA](https://reader034.fdocuments.in/reader034/viewer/2022042610/58a4db761a28ab34318b5d0f/html5/thumbnails/30.jpg)
30
Source: Centers for Disease Control and Prevention's Public Health Image Library (PHIL), with identification number #130 Content Providers: CDC/NIP/Barbara Rice
![Page 31: MEASLES, MUMPS & RUBELLA](https://reader034.fdocuments.in/reader034/viewer/2022042610/58a4db761a28ab34318b5d0f/html5/thumbnails/31.jpg)
31
Agent factors
• Myxovirus parotidis –RNA virus
• Source of infection: Clinical and subclinical cases; mainly saliva; others:blood,urine,human milk,CSF
• Period of communicability: 4-6 days of onset of symptoms to 7 days after
(Maximum just before and at the onset of parotid swelling)• Secondary attack rate: 86%
![Page 32: MEASLES, MUMPS & RUBELLA](https://reader034.fdocuments.in/reader034/viewer/2022042610/58a4db761a28ab34318b5d0f/html5/thumbnails/32.jpg)
32
Host factors• Age: mostly 5-9 yrs, but can be seen in any age • Sex: females • Immunity: less than 6 months of age infants are immune,
life long immunity after one infection
Environmental factor • Any time but peak in winter and spring season • Overcrowding
Mode of transmission: droplet infection and direct contact with the infection personI.P.: 2-4 weeks
![Page 33: MEASLES, MUMPS & RUBELLA](https://reader034.fdocuments.in/reader034/viewer/2022042610/58a4db761a28ab34318b5d0f/html5/thumbnails/33.jpg)
Clinical features• One third cases: asymptomatic• Initial symptoms: ear ache on affected side, pain and
stiffness on opening the mouth
• Pain and swelling due to involvement of parotid, sublingual and submandibular glands,
• Swelling subsides in 1-2 weeks
• Can affect testes,pancreas,ovaries,prostate,CNS• Severe cases: Fever 3-5 days
33
![Page 34: MEASLES, MUMPS & RUBELLA](https://reader034.fdocuments.in/reader034/viewer/2022042610/58a4db761a28ab34318b5d0f/html5/thumbnails/34.jpg)
34
Source : Adapted from Mims et al. Medical Microbiology, 1993, Mosby
![Page 35: MEASLES, MUMPS & RUBELLA](https://reader034.fdocuments.in/reader034/viewer/2022042610/58a4db761a28ab34318b5d0f/html5/thumbnails/35.jpg)
35
Complications of MumpsFrequent but not serious:• Orchitis (25-40%): 7-10 days after parotitis,with high fever (Unilateral in 75% orchitis cases, Most common extra-salivary gland manifestation in adults)• Epididymitis• Pancreatitis(4%)• Mild form of meningitis• Thyroiditis, Neuritis, Hepatitis,Ovaritis,• Oophoritis (5% adult women)• Spontaneous abortion(25% in pregnancy)Rare:Hearing loss, Polyarthritis, Encephalitis, Cerebellar ataxia
![Page 36: MEASLES, MUMPS & RUBELLA](https://reader034.fdocuments.in/reader034/viewer/2022042610/58a4db761a28ab34318b5d0f/html5/thumbnails/36.jpg)
36
Management of Mumps
• Supportive
• Case should be isolated till symptoms subside
• Contacts should be kept under surveillance
![Page 37: MEASLES, MUMPS & RUBELLA](https://reader034.fdocuments.in/reader034/viewer/2022042610/58a4db761a28ab34318b5d0f/html5/thumbnails/37.jpg)
37
Prevention of Mumps
Immunization• Mumps vaccine: Live attenuated,0.5 ml, IM• MMR vaccine
![Page 38: MEASLES, MUMPS & RUBELLA](https://reader034.fdocuments.in/reader034/viewer/2022042610/58a4db761a28ab34318b5d0f/html5/thumbnails/38.jpg)
38
Rubella
(German measles)
![Page 39: MEASLES, MUMPS & RUBELLA](https://reader034.fdocuments.in/reader034/viewer/2022042610/58a4db761a28ab34318b5d0f/html5/thumbnails/39.jpg)
39
Introduction-Rubella
• Rubella (Latin term) means "little red."
• It is a generally mild disease caused by the rubella virus.
• Rubella is also known as German Measles or 3-day Measles.
• Typical course of rubella exanthema starts initially on the face and neck and spreads centrifugally to the trunk and extremities within 24 hours, It then begins to fade on the face on the second day and disappears throughout the body by the end of the third day.
![Page 40: MEASLES, MUMPS & RUBELLA](https://reader034.fdocuments.in/reader034/viewer/2022042610/58a4db761a28ab34318b5d0f/html5/thumbnails/40.jpg)
40
Agent factors
• Agent: RNA virus (Togo virus family) • Source of infection: majority subclinical cases, minor-
clinical cases • Infective material: Respiratory secretions, blood, CSF,
urine• Period of communicablity: A week before symptoms to a
week after the rash
![Page 41: MEASLES, MUMPS & RUBELLA](https://reader034.fdocuments.in/reader034/viewer/2022042610/58a4db761a28ab34318b5d0f/html5/thumbnails/41.jpg)
41
Host factors-Age: 3-10 yrs(developing countries) 15 years developed countriesImmunity: Life long after first attack, maternal immunity upto 6 months of age
Environmental factors- winter and spring season, with epidemics every 4-9 years
Transmission- droplet inf, droplet nuclei, vertical transmission, portal of entry: respiratoryIncubation period- 2 to 3 weeks (average 18 days)
![Page 42: MEASLES, MUMPS & RUBELLA](https://reader034.fdocuments.in/reader034/viewer/2022042610/58a4db761a28ab34318b5d0f/html5/thumbnails/42.jpg)
42
Clinical features
• 50-60% asymptomatic
• Symptoms: Prodromal phase(mild): coryza,sore thorat, low grade fever Lymphadenopathy: post auricular and posterior
cervical lymph nodes enlargement
![Page 43: MEASLES, MUMPS & RUBELLA](https://reader034.fdocuments.in/reader034/viewer/2022042610/58a4db761a28ab34318b5d0f/html5/thumbnails/43.jpg)
43
Rash:• Minute,discrete,pinkish,macular • Starts on face within 24 hours of the onset of the
prodromal symptoms,spreads to trunk and extremities, clears more rapidly,disappears in 3 days
• Rash absent (25% cases) in subclinical cases
Conjunctivitis may occur.
![Page 44: MEASLES, MUMPS & RUBELLA](https://reader034.fdocuments.in/reader034/viewer/2022042610/58a4db761a28ab34318b5d0f/html5/thumbnails/44.jpg)
44
Image in a 4-year-old girl with a 4-day history of low-grade fever, symptoms of an upper respiratory tract infection, and rash. Courtesy of Pamela L. Dyne, MD.
![Page 45: MEASLES, MUMPS & RUBELLA](https://reader034.fdocuments.in/reader034/viewer/2022042610/58a4db761a28ab34318b5d0f/html5/thumbnails/45.jpg)
45
Complications of Rubella
Rare:ArthralgiaThrombocytopenic purpura
Very rare:Encepahlaitis
![Page 46: MEASLES, MUMPS & RUBELLA](https://reader034.fdocuments.in/reader034/viewer/2022042610/58a4db761a28ab34318b5d0f/html5/thumbnails/46.jpg)
46
Diagnosis
• Virus isolation by throat swab culture
• ELISA for IgM antibody
![Page 47: MEASLES, MUMPS & RUBELLA](https://reader034.fdocuments.in/reader034/viewer/2022042610/58a4db761a28ab34318b5d0f/html5/thumbnails/47.jpg)
47
Congenital Rubella Syndrome(CRS)
• Due to Rubella infection in pregnancy
• It is a chronic infection of foetus
• First trimester infection- severe
• Foetal death and spontaneous abortion
![Page 48: MEASLES, MUMPS & RUBELLA](https://reader034.fdocuments.in/reader034/viewer/2022042610/58a4db761a28ab34318b5d0f/html5/thumbnails/48.jpg)
48
Clinical features of CRS
• Congenital malformations(Triad of Deafness,Cradiac malformations,cataract)
• Other defects: Glaucoma,retinopathy,microcephalus,cerebral palsy,IUGR,LBW,Heapto-splenomegaly,mental and motor retardation
![Page 49: MEASLES, MUMPS & RUBELLA](https://reader034.fdocuments.in/reader034/viewer/2022042610/58a4db761a28ab34318b5d0f/html5/thumbnails/49.jpg)
49
![Page 50: MEASLES, MUMPS & RUBELLA](https://reader034.fdocuments.in/reader034/viewer/2022042610/58a4db761a28ab34318b5d0f/html5/thumbnails/50.jpg)
50
Photo source: U.S. Centers for Disease Control and Prevention
![Page 51: MEASLES, MUMPS & RUBELLA](https://reader034.fdocuments.in/reader034/viewer/2022042610/58a4db761a28ab34318b5d0f/html5/thumbnails/51.jpg)
51
Salt and pepper retinopathy
Content Providers(s): CDC Creation Date: 1976
Courtesy http://phil.cdc.gov/phil_images/20030724/28/PHIL_4284_lores.jpg
http://www.kellogg.umich.edu/theeyeshaveit/congenital/retinopathy.html
Courtesy: Jonathan Trobe, M.D. - University of Michigan Kellogg Eye Center
![Page 52: MEASLES, MUMPS & RUBELLA](https://reader034.fdocuments.in/reader034/viewer/2022042610/58a4db761a28ab34318b5d0f/html5/thumbnails/52.jpg)
52
Prevention of Rubella
Immunization• Rubella vaccine: RA 27/3 strain,0.5 ml, SC,Life
long immunity in 95% • C/I for immunization: Pregnancy• Recipients of vaccine should be advised not to
become pregnant in 3 months after getting vaccine
• MMR vaccine
![Page 53: MEASLES, MUMPS & RUBELLA](https://reader034.fdocuments.in/reader034/viewer/2022042610/58a4db761a28ab34318b5d0f/html5/thumbnails/53.jpg)
53
Vaccination strategy for Rubella
• First protect women in 15-39 yr age• Second interrupt transmission by vaccinating
children aged 1-14 years• Third,all children at age 1
![Page 54: MEASLES, MUMPS & RUBELLA](https://reader034.fdocuments.in/reader034/viewer/2022042610/58a4db761a28ab34318b5d0f/html5/thumbnails/54.jpg)
54
MMR Vaccine
Live attenuated strains of:• Edmonston-Zagreb Measles virus• L-Zagreb Mumps virus • Wistar RA 27/3 Rubella virus
• The reconstituted vaccine contains, in single dose of 0.5 ml. not less than 1000 CCID50 of Measles virus 5000 CCID50 of Mumps virus 1000 CCID50 of Rubella virus.
![Page 55: MEASLES, MUMPS & RUBELLA](https://reader034.fdocuments.in/reader034/viewer/2022042610/58a4db761a28ab34318b5d0f/html5/thumbnails/55.jpg)
55
MMR vaccine contd…
• Diluent: Sterile water for injection. • MMR vaccine may be given after 12 months of age.
• After reconstitution the vaccine should be used immediately.
• Dose: 0.5 ml, deep SC in the upper arm. • If the vaccine is not used immediately then it should be
stored in the dark at 2°- 8°C for no longer than 8 hours.
![Page 56: MEASLES, MUMPS & RUBELLA](https://reader034.fdocuments.in/reader034/viewer/2022042610/58a4db761a28ab34318b5d0f/html5/thumbnails/56.jpg)
![Page 57: MEASLES, MUMPS & RUBELLA](https://reader034.fdocuments.in/reader034/viewer/2022042610/58a4db761a28ab34318b5d0f/html5/thumbnails/57.jpg)
![Page 58: MEASLES, MUMPS & RUBELLA](https://reader034.fdocuments.in/reader034/viewer/2022042610/58a4db761a28ab34318b5d0f/html5/thumbnails/58.jpg)
58
Global Measles and Rubella Strategic Plan 2012-2020In 2012, the M&R Initiative launched a new Global Measles and Rubella Strategic Plan which covers the period 2012-2020.
By the end of 2015 the plan aims:to reduce global measles deaths by at least 95% compared with 2000 levels;to achieve regional measles and rubella/congenital rubella syndrome (CRS) elimination goals.
By the end of 2020 the plan aims:to achieve measles and rubella elimination in at least 5 WHO regions.
![Page 59: MEASLES, MUMPS & RUBELLA](https://reader034.fdocuments.in/reader034/viewer/2022042610/58a4db761a28ab34318b5d0f/html5/thumbnails/59.jpg)
59
The strategy focuses on the implementation of 5 core components:
• achieve and maintain high vaccination coverage with 2 doses of measles- and rubella-containing vaccines;
• monitor the disease using effective surveillance, and evaluate programmatic efforts to ensure progress and the positive impact of vaccination activities;
• develop and maintain outbreak preparedness, rapid response to outbreaks and the effective treatment of cases;
• communicate and engage to build public confidence and demand for immunization; and
• perform the research and development needed to support cost-effective action and improve vaccination and diagnostic tools.
![Page 60: MEASLES, MUMPS & RUBELLA](https://reader034.fdocuments.in/reader034/viewer/2022042610/58a4db761a28ab34318b5d0f/html5/thumbnails/60.jpg)
60
Thank you