Assessing Measles Risk Transmission in Iran: A Utilization of the World Health Organization's Programmatic Risk Assessment Tool,2022

Abstract

Abstract Background According to a study conducted in Iran, despite the country’s successful effort to eliminate measles, imported cases of the disease continue to be reported due to the endemic of measles in neighboring countries like Afghanistan and Pakistan. This research aims to evaluate the risk of measles transmission in different regions of Iran. Methods Utilizing data from the Measles case-based surveillance of the Expanded Program of Immunization spanning 31 provinces and 463 districts from 2019 to 2021, the research employed the WHO Measles Programmatic Risk Assessment tool. This tool evaluated the risk of disease transmission across four domains: population immunity, surveillance quality, program delivery performance, and threat assessment. The resulting scores were categorized as low, medium, high, or very high risk. Results During the years 2019–2021, the average incidence of measles was 1.9 per 1 million people، Sistan and Baluchestan had the highest provincial incidence rates (12.5 per one million population), Chabahar exhibited the highest district-level rates (76 per one million population). Conversely, Yazd and Mashhad demonstrated the lowest provincial (0.1 per one million population) and district-level (0.6 per one million population) incidence rates, respectively. Conclusion Although in the assessment of the risk of measles transmission at the provincial and district levels, all regions were placed at a low level of the risk of disease transmission, this tool is not able to assess the risk at the level of the rural sector or peripheral sectors such as comprehensive health service centers. Therefore, the evaluation of the risk of measles disease transmission for low levels can have more than one weakness. Emphasize the strength of the surveillance and immunization system of the country. The indicators used in this tool are the same for all countries with different epidemiological features (elimination, endemic). Sensitivity analysis can optimize the use of this tool for countries with different disease conditions.