Evaluation of the Measles Surveillance System in the Border Districts of Surin and Buriram Provinces, Thailand, 2023

Abstract

The World Health Organization (WHO) set a target for measles elimination by 2023; however, Thailand has not yet achieved this goal, particularly in border areas. This study aimed to evaluate the measles surveillance system in seven community hospitals located in the border districts of Surin and Buriram provinces. A descriptive study was conducted from January 1 to December 31, 2023, using a combination of a medical record review of 1,845 patients with measles-related diagnoses based on ICD-10 codes (quantitative) and interviews with 62 relevant stakeholders (qualitative). The findings revealed that a total of 75 patients met the measles case definition, but only two cases were reported to the ME Online surveillance system, representing a system sensitivity of 2.67%. The system sensitivity was 4.44% in Surin Province, whereas no cases were reported to the system in Buriram Province. All reported cases met the standard case definition and were reported within seven days, resulting in 100% diagnostic accuracy and timeliness. However, because only two cases were reported to the surveillance system, the surveillance data were not representative of the epidemiological characteristics of all eligible patients in the study area. Furthermore, the qualitative assessment revealed that the system comprises multiple procedural steps requiring outbreak investigation findings and laboratory confirmation, resulting in low flexibility. Additionally, the system lacks stability due to the frequent turnover of responsible personnel. While the system is generally accepted by administrators and laboratory staff, most operational personnel still lack knowledge and understanding of the system. Moreover, there was no concrete evidence that the surveillance data were utilized for disease surveillance, prevention, and control in the study area. The ME Online surveillance system in the study area demonstrated low sensitivity and exhibited limitations in flexibility, stability, and data utilization. Therefore, active case-finding mechanisms should be developed, case reporting and communication of reporting guidelines for operational staff should be improved, and laboratory confirmation should be promoted for patients presenting with fever and rash, including those with a history of measles vaccination, to support the achievement of measles elimination goals.