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

From: Measles outbreaks in displaced populations: a review of transmission, morbidity and mortality associated factors

  Potential risk factors involved Possible solutions
1 Overcrowded and high density camps [4, 8, 20, 37] Improve camp planning and shelter
2 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
3 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.
4 Narrow target age group for vaccination campaign [7, 8, 11, 20, 37, 47] Extension of population target to >15 years old
5 Primary vaccination failure due to vaccination in lower age group [7, 8] Revaccinate at 9 months
6 Lower vaccination coverage in high risk group [11] Increase coverage in high risk age group guided by good quality of surveillance data
7 One time measles vaccination strategy [3] Routine vaccination plus supplemental vaccination
8 Frequent visit of refugees between camps [3, 8] Restriction of refugees movement during outbreak period
9 Frequent movement of refugees in the neighbouring community and in other camps [3, 11] Restriction measures for visit from surrounding communities during outbreak period
10 Malnutrition and famine [4, 8, 20, 37, 47, 56] Consideration of vitamin A provision
11 Insecurity and inaccessibility to target zones [56] Re-establish the routine vaccination service after the security situation is normalized.
12 No or limited surveillance system [4, 37, 47] Improving surveillance approach for early case detection
13 Lack of laboratory confirmation of suspect cases[35] Establishing appropriate laboratory testing
14 Association with other diseases [20, 37] Implementation of integrated management of childhood illness (IMCI)
  1. IMCI = integrated management of childhood illness