Table 4 Review of contributing risk factors for measles Morbidity and Mortality in displaced populations, 1979--2005

Overcrowded and high density camps [4, 8, 20, 37]

Improve camp planning and shelter

Poor vaccination status due to the continuous arrival of new refugees in camps [4, 7, 8, 11, 47, 56]

Vaccination of refugees on arrival in camps

Poor vaccination status in the surrounding community [11]

Coordination of vaccination campaign in camps and in the surrounding community in collaboration with local public health authorities.

Narrow target age group for vaccination campaign [7, 8, 11, 20, 37, 47]

Extension of population target to >15 years old

Primary vaccination failure due to vaccination in lower age group [7, 8]

Revaccinate at 9 months

Lower vaccination coverage in high risk group [11]

Increase coverage in high risk age group guided by good quality of surveillance data

One time measles vaccination strategy [3]

Routine vaccination plus supplemental vaccination

Frequent visit of refugees between camps [3, 8]

Restriction of refugees movement during outbreak period

Frequent movement of refugees in the neighbouring community and in other camps [3, 11]

Restriction measures for visit from surrounding communities during outbreak period

Malnutrition and famine [4, 8, 20, 37, 47, 56]

Consideration of vitamin A provision

Insecurity and inaccessibility to target zones [56]

Re-establish the routine vaccination service after the security situation is normalized.

No or limited surveillance system [4, 37, 47]

Improving surveillance approach for early case detection

Lack of laboratory confirmation of suspect cases[35]

Establishing appropriate laboratory testing

Association with other diseases [20, 37]

Implementation of integrated management of childhood illness (IMCI)