Health workers share measles outbreak experiences at Teach to Reach 9

# Health workers share measles outbreak experiences in global learning exchange During the October 13, 2023 session of Teach to Reach 9, immunization professionals from India, Nigeria, Pakistan, and Uganda exchanged specific experiences responding to measles outbreaks. The session focused not on technical guidelines, which participants already implement through their national programs, but on the practical challenges and solutions they have developed in their local contexts. ## Field experiences and local innovations Dr. Isha Goyal, WHO surveillance officer in India, described analyzing outbreak data that revealed 90% of cases concentrated in a single community. Despite engaging religious and community leaders, vaccination coverage remained at 60-70% post-outbreak. She noted that the same community consistently refused vaccines across different immunization programs, raising questions about current engagement approaches. In Nigeria, Mudassir Abdullahi from Skano State Hospital outlined how response teams mapped affected settlements and conducted household assessments that revealed missed vaccinations. The team combined awareness activities with vaccination services, leading to reduced cases in previously affected areas. Dr. Bala Ganesh Kumar, WHO medical officer in South India, shared a systematic response protocol initiated by a hospital case notification: - Sample collection for laboratory confirmation - Formation of epidemic response teams at district and block levels - House-to-house surveys in affected areas and schools - Line listing of fever/rash cases from previous 90 days - Catch-up vaccination for children with immunity gaps Dr. Kamran Khan described Pakistan's 2021 nationwide campaign strategies that achieved 95% coverage: - Public vaccination of policymakers' children - School-based outreach covering 70% of target population - Direct engagement with hesitant parents through schools - Coordinated media management for adverse events ## Implementation challenges identified Participants shared several common challenges: 1. Data and tracking: - Mobile population movement during investigations - Incomplete vaccination records for second doses - Limited data sharing between facilities 2. Vaccine delivery: - Supply chain disruptions - Reluctance to open multi-dose vials - Geographic access barriers 3. Community engagement: - Persistent vaccine hesitancy in specific groups - Limited success with traditional approaches - Need for new strategies for consistently refusing communities ## Analysis and recommendations Lora Shimp synthesized three key approaches from the shared experiences: 1. Data utilization: "Using data to really help us identify where we have missed infants or younger children who may have received one dose of measles, but not two doses." 2. Health system operations: "Working with the health system to address these problems, to better communicate how to get, not to turn people away, what are the best ways to organize these services." 3. Campaign duration: "That campaign shouldn't just stop the day we're doing vaccination... planning for four weeks so that you also follow up with those communities that have been missed." ## Next steps The session highlighted several areas requiring further examination: - Analysis of patterns in vaccine refusal across programs - Development of new approaches for consistently refusing communities - Improved systems for vaccination record keeping - Strengthened preparedness planning Participants continued discussions through networking sessions to explore specific challenges in more detail. Note: Names have been transcribed from the session recording. Their spelling therefore may be inaccurate.