Let's Work Together to Beat Measles

After preliminary research into overseas measles elimination campaigns, existing levels of measles immunity in Australia, and the cost and practicality of various options, the Measles Elimination Advisory Committee (MEAC) developed a strategy. The first step was to recommend to the National Health and Medical Research Council (NHMRC) that the second dose of the Measles, Mumps, Rubella (MMR) vaccine be brought forward from 10-16 years of age to 4-5 years. (The first dose of MMR remained scheduled at 12 months of age.) This was done to shorten the interval between the two MMR doses to three years, thereby reducing the risk of an epidemic outbreak. With this change to the schedule, a vaccination campaign was designed to ensure that children aged 5-12 years received their second dose. The components of the programme included a 'mop-up' approach (providing the MMR vaccine - based on parental consent - to all children in primary schools throughout Australia); a 'catch-up' campaign (encouraging all parents and physicians of preschool-age children to ensure that this cohort received at least one dose of the MMR vaccine); and a campaign to encourage parents of high-school age children to ensure that their children had received two doses of measles vaccine by age 12.

The main component of the campaign was a school-based vaccination programme that offered a dose of the MMR vaccine to primary-school-age children. A key strategy involved increasing parental awareness of the school-based programme and encouraging parents to give consent for their children to be vaccinated. Preschool-aged children were reached through letters to parents asking them to ensure that their child had received their first dose of MMR vaccine. In addition, principals of high schools were encouraged to provide information to students and their parents to ensure that the two-dose measles vaccination schedule had been completed.

To support the implementation of the campaign, a social marketing strategy featuring community participation was developed. Research was conducted and workshops were organised with parents, teachers, and school principals from various communities in Australia to help develop and evaluate campaign materials like the consent form. Focus testing was also conducted. Mass media advertising included direct marketing to parents and school principals, as well as advertising on television and in women's and parents' magazines. For example, two 60-second television advertisements communicated the seriousness of vaccine-preventable diseases and magazine advertisements outlined the full immunisation schedule. In addition, information booklets for parents, teachers, and principals outlined the benefits and risks of vaccination.

Health care service providers were involved in the campaign in various ways. A poster was distributed to doctors' offices and health centres. Immunisation Days were held at selected health centres across the country. Measures were taken to increase service providers' knowledge and skills and to encourage the active promotion and provision of full age-appropriate child vaccination. A multicultural marketing strategy addressed 12 language groups. For instance, separate consent forms were developed by and for some Aboriginal and Torres Strait Islander communities. One Community Health Centre in the Northern Territory developed a video that explained the Campaign, narrated by an Aboriginal Health Worker in the local language.

An evaluation strategy for the communication component of the campaign was developed. Specifically, a benchmark survey was conducted before the implementation of the campaign, daily continuous tracking surveys were conducted over the five weeks of campaign activity, and a final evaluation survey was conducted.

Health, Immunisation & Vaccines, Children.

In all, 1.7 million primary school children were vaccinated as part of the campaign, preventing an estimated 17,500 children from contracting measles. The campaign is the first stage of a long-term strategy to eliminate measles from Australia.

Organisers claim that the introduction of a measles-containing vaccine to Australia in 1968 had a dramatic impact on the number of measles cases, but that immunisation levels were not high enough to prevent episodic outbreaks across Australia. More than 16,000 cases of measles were reported in Australia between 1988 and 1998. There was an epidemic of measles in 1993-1994, and local projections suggested that another epidemic was likely in 1998. A measles control programme with a two-dose vaccination schedule has operated since late 1994. Very high vaccination coverage levels are needed, especially in closed settings such as schools where contact rates are high. Uniformity of coverage is also important, because pockets of people who are susceptible to measles can perpetuate endemic transmission.