This User Guide describes how to use the Pan American Health Organization (PAHO) Measles and Rubella Risk Assessment Tool, breaking the process into several steps to foster user-friendliness. The Guide also includes a section on the most common dilemma issues and troubleshooting. The PAHO Measles and Rubella Risk Assessment Tool identifies at-risk municipalities to prioritize the implementation of corrective measures to close the surveillance and immunity gaps detected, and therefore, sustain the hard-won elimination gains. In addition, the tool will contribute with strengthening local capacities in the use and analysis of surveillance and immunization data. The risk is assessed as the sum of indicator scores that fall into five main categories: population immunity, surveillance quality, program delivery performance, threat probability assessment and rapid response. The scoring for each indicator was based on expert consensus. There are two versions of the PAHO Risk Assessment Tool for outbreak and non-outbreak scenarios. The tool is intended to be used every year, if possible, by managers of both immunization and surveillance programs. The tool is not meant to be used for predicting outbreaks, but rather for preventing virus spread if an importation occurs. Results can be shown by maps with municipalities color-coded by risk category. In addition, municipalities risk scores can be displayed by category, allowing for easy interpretation of results and better understanding of what programmatic weaknesses are driving the risk. Finally, the tool automatically generates a report displaying the main variables for each of the five categories through maps and tables.
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