Monitoring of Surveillance Quality Indicators of Measles in Iranian Districts: Analysis of Measles Surveillance System 2014-2016

Background: The elimination target for measles as an acute and contagious disease in Eastern Mediterranean Region (EMR) and Iran is planned by high-quality surveillance. We aimed to monitor the surveillance quality indicators of measles by in all districts of Iran during 2014-16. Study design: A cross-sectional study. Methods: Four quality surveillance indicators of measles including non measles discarded rate, percent of suspected cases with adequate investigation, percent of adequate blood specimen collection and percent with timely availability of laboratory results were assessed in Iran. Surveillance data of measles were extracted from the measles surveillance system and the risk point score for each district was calculated based on WHO Risk Assessment Tool by a function of four indicators. Results: Overall, 14312 suspected cases and 322 districts were assessed and the risk points of measles' quality surveillance showed that 92.8% of Iranian districts were categorized as low risk, 2.8% medium risk, 0.62% high risk and 3.73% very high-risk category. The appropriate non measles discarded rate indicator was 87.3%. The percent of suspected cases with adequate investigation (more than 2 per 100000 people) was 87.9%. Moreover, the average of percent adequate blood specimen collection and percent with timely availability of laboratory results was 85.16% and 85.71%, respectively in all Iranian districts. Conclusions: The surveillance quality indicators in Iran were good and higher than the WHO plans. Increasing the percentage of non-measles discarded rate could improve the poor quality in high risk and very high-risk districts.