While measles and rubella are ongoing public health threats worldwide, the Democratic People’s Republic of Korea (DPR Korea) achieved measles elimination in 2018 and was in 2023 officially declared as also having eliminated endemic rubella virus. Both public health achievements were verified by the Southeast Asia Regional Verification Commission for Measles and Rubella Elimination. This latest critical milestone was achieved under the strong leadership of the Government of the DPR Korea who have collaboratively worked with WHO, UNICEF and Gavi, the Vaccine Alliance to accelerate considerable improvements to the country’s measles and rubella surveillance system while ensuring a sustained high level of population immunity against the disease.
Ensuring high levels of population immunity against rubella
The Ministry of Public Health (MoPH), DPR Korea had introduced measles-rubella (MR) vaccine into the National Immunization Programme since November 2019; immediately after the implementation of a wide-age range MR immunization campaign targeting 9 months to 15 years children and 16 to 18 years old women in October 2019. Through this MR supplementary immunization activity (SIA) achieving more than 99.8% coverage in the almost 6 million target, the country had built large population immunity for rubella within one month, even though there had been no local transmission of rubella since 2009.
For the successful implementation of this MR SIA, MoPH ensured best practices of MR vaccine management and immunization safety, while systematically implementing supportive supervision, monitoring and evaluation for quality EPI services to achieve high and equitable immunization coverage through the routine introduction of MR vaccine. All trained supervisors were proactive in supporting the effective implementation of the MR SIA.
The MoPH conducted a wide range of activities in communication and social mobilization; to ensure high uptake of the vaccine. All household doctors disseminated key messages of the benefits of MR vaccine to their catchment areas for better acceptance. IEC materials such as posters on measles and rubella were displayed and some media presented relevant information. Special measures were taken to reach the high risk/ hard to reach target children (children of orphanages, institutions, of families working in factories, mines, camps etc.) using name-based registration prepared during the MR SIA implementation.
Approximately 11,600 vaccination teams, after having undergone specific MR SIA training, carried out immunization sessions in 7237 vaccination sites within one month and targeting about 5.4 million children aged 9 months to 15 years and 0.5 million women aged 16-18 years. After the MR SIA, MoPH has made concerted efforts to successfully implement the routine immunization programme of MR vaccine, ensuring continued high levels of population immunity against rubella.
Photo credit: WHO DPR Korea
Improving rubella surveillance
DPR Korea has a unique household doctor (HHD) system for health service delivery which provides integrated first line preventive and curative services for approximately 130 households per household doctor including the people working in factories and other enterprises, students in nurseries, kindergartens, and schools in their catchment areas. This HHD system provides for the well-functioning and good operations of a field-based service delivery system, ensuring that no child will be left uncounted and unvaccinated. It is also supporting high-quality surveillance; sensitive and specific enough to detect all suspected cases.
Case-based, laboratory-confirmed rubella surveillance has been implemented nation-wide since 2006. The MoPH has strengthened a sensitive and timely “acute fever and rash” and congenital rubella syndrome surveillance system through regularized refresher training on vaccine preventable disease (VPD) surveillance, ensuring all suspected fever and rash cases of any age are reported and availability of test kits to perform serological tests for these cases.
Earlier this year, DPR Korea restructured its robust nationwide disease prevention and control network guided by a newly reformed National Center for Disease Prevention and Control, while strengthening the capacity of Provincial and County Institutes for Disease Prevention and Control for disease surveillance, prevention, and control of newly emerging diseases, with particular focus on VPD laboratories.