Timor-Leste has met the criteria for measles elimination and control of rubella and congenital rubella syndrome. To sustain these achievements,

it is important to implement the post-elimination sustainability plan, including the outbreak preparedness and response plan; enhance

capacity to strengthen outbreak investigation and response; further strengthen routine immunization for MCV1 and MCV2; enhance local

capacity to strengthen VPD surveillance with focus on measles and rubella; strengthen cross-border initiatives; strengthen and ensure

functioning of surveillance and laboratory system.

What made Timor-Leste successful in eliminating measles and controlling

rubella?

Strong politi cal commitment Functi oning health system Strengthened routi ne immunizati on coverage Enhanced surveillance Regular review of programme implementati on at

nati onal and subnati onal levels Intersectoral collaborati on Moti vated workforce Community parti cipati on Strengthened laboratory networks Strong technical assistance Coordinated partner support

Measles and Rubellaat a Glance Timor-Leste, 2018

Flow chart of immunization service delivery system

Mother and Child Health Department

Community Health Service

Health Posts Private Clinic

Na onal Director for Public Health

Director General for Service Delivery

HMISPartners

Partners District Health Service Hospital

Laboratory

Community Outreach Services

Na onal EPI Program

Immunization coverage at subnational level, 2017

Aileu

Ainaro

Bobonaro

Baucau

Dili

Covalima

Ermera

Lautem

Liquisa

Manatuto

Manufahi

Oecusse

Viqueque

0 30 60 90 120 150

Coverage of 1st dose (%) Coverage of 2nd dose (%)

Servisu Integrado Saude Communitario (Integrated

Community Health Services)

Programa Nasional Saudena Familia (The Na onal Program of Health in the

Family – Domiciliary Visits)

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Immunization coverage and no. of measles cases (2002-2016)

Map of risk assessment for measles and rubella transmission

Immunization coverage and no. of rubella cases (2002-2018)

Significant events 2018Verifi cati on that Timor-Leste has met both goals: endemic measles eliminated and rubella controlled

2011Nati onwide measles SIA conducted to provide measles vaccine, Vitamin A and de-worming tablets

2014Mandatory reporti ng of measles and rubella cases begun

2006SIA conducted for children aged 6 months to 15 years2003

Supplementary immunizati on acti viti es (SIAs) conducted for children aged 9 months to 5 years

2000Limited immunizati on services re-established following disrupti on surrounding the struggle for restorati on of independence

1989 MCV1 introduced 2009

SIA conducted for children aged 9 months to 5 years; measles and rubella case surveillance started

2015Nati onal Measles Eliminati on Verifi cati on Committ ee formed; rubella vaccine introduced; MR/OPV catch-up immunizati on campaign conducted

2016MCV2 introduced; CRS surveillance started; 2 imported cases of measles reported

Legend says that Timor-Leste was formed out of a crocodile who remembered the kindness of a boy when he saved its life. As a token of grati tude, it fulfi lled the boy’s wish of exploring the world as it carried him on its back, and they travelled the oceans and followed the sun for years. Aft er the crocodile’s death, its rigid back grew to form the mountains and its scales the hills of Timor, becoming the home of the kind boy and his children – the people of Timor-Leste.

In August 2018, Timor-Leste was verifi ed by the

Regional Verifi cati on Commission, an independent

body of experts, for eliminati ng measles and

certi fi ed for control of rubella and congenital

rubella syndrome, two years ahead of the target

year 2020. No cases of indigenous virus were

reported for more than three years. This has been

possible due to self-fi nancing of immunizati on

programme, supplementary immunizati on

acti viti es, improved routi ne immunizati on coverage,

enhanced surveillance and strengthened

laboratory networks.

1 261 405Total populati on

13Municipaliti es65

Sub-districts

442villages (suco)

1Nati onal Referral Hospital

5Regional referral hospitals

68Community health centres at the sub-district level

Timor-Leste: An overview

Measles-SIA 6 months to

14 years (40%)

Measles-SIA 9-59 months

(76%)

Measles-SIA 6 months to

14 years (92%)

Measles-rubella-SIA 9 months to 14 years (96%)

Measles-rubella-SIA 9 months to <5 years

(99.5%)

Measles-SIA 9-59 months

(99%)

900

800

700

600

500

400

300

200

100

0

1009080706050403020100

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

2013

2014

2015

2016

2017

2018

Measles cases Routine coverage MCV-1 Routine coverage MCV-2 SIA coverage

Measles-rubella-SIA 9 months to 14 years (96%)

Measles-rubella-SIA 9 months to <5 years (99.5%)

900800700600500400300200100

0

1009080706050403020100

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

2013

2014

2015

2016

2017

2018

Rubella cases Routine coverage RCV-1 Routine coverage RCV-2 SIA coverage

96 99

78

4

1

9

Risk status Number of districts Popula on propor on

1. Very high risk 0 0

2. High risk 1 (Ainaro) 5%

3. Medium risk 2 (Dili & Viqueque) 30%

4. Low risk 10 65%

High Risk

Medium Risk

Low Risk

Unknown

Dili LautemBaucau

Viqueque

Manufahi

CovalimaOecusse

Ain

aro

Manatuto

Erm

era

Bobonaro

LiquisaAileu

317Health posts at the village level

MCV: Measles-containing vaccineSIA: Supplementary immunizati on acti vityMR: Measles–rubellaCRS: Congenital rubella syndrome

Timor-Leste has met the criteria for measles elimination and control of rubella and congenital rubella syndrome. To sustain these achievements,

it is important to implement the post-elimination sustainability plan, including the outbreak preparedness and response plan; enhance

capacity to strengthen outbreak investigation and response; further strengthen routine immunization for MCV1 and MCV2; enhance local

capacity to strengthen VPD surveillance with focus on measles and rubella; strengthen cross-border initiatives; strengthen and ensure

functioning of surveillance and laboratory system.

What made Timor-Leste successful in eliminating measles and controlling

rubella?

Strong politi cal commitment Functi oning health system Strengthened routi ne immunizati on coverage Enhanced surveillance Regular review of programme implementati on at

nati onal and subnati onal levels Intersectoral collaborati on Moti vated workforce Community parti cipati on Strengthened laboratory networks Strong technical assistance Coordinated partner support

Measles and Rubellaat a Glance Timor-Leste, 2018

Flow chart of immunization service delivery system

Mother and Child Health Department

Community Health Service

Health Posts Private Clinic

Na onal Director for Public Health

Director General for Service Delivery

HMISPartners

Partners District Health Service Hospital

Laboratory

Community Outreach Services

Na onal EPI Program

Immunization coverage at subnational level, 2017

Aileu

Ainaro

Bobonaro

Baucau

Dili

Covalima

Ermera

Lautem

Liquisa

Manatuto

Manufahi

Oecusse

Viqueque

0 30 60 90 120 150

Coverage of 1st dose (%) Coverage of 2nd dose (%)

Servisu Integrado Saude Communitario (Integrated

Community Health Services)

Programa Nasional Saudena Familia (The Na onal Program of Health in the

Family – Domiciliary Visits)

All i

mag

es ©

Sho

bhan

Sin

gh -

Com

mun

ica

on

Offi

cer/

WH

O C

ount

ry Offi

ce fo

r Tim

or-L

este