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 Rubella at 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
Partners HMIS
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 images © Shobhan Singh - Communica on Offi cer/WHO Country Offi ce for Timor-Leste
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 2018
Verifi cati on that Timor-Leste has met both goals:
endemic measles eliminated and rubella controlled
2011
Nati onwide measles SIA conducted to provide measles vaccine, Vitamin A and de-
worming tablets
2014
Mandatory reporti ng of measles and rubella cases begun
2006
SIA
conducted for children aged 6 months to 15 years
2003
Supplementary immunizati on acti viti es (SIAs) conducted for children aged 9 months to 5 years
2000
Limited 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
2015
Nati onal Measles Eliminati on Verifi cati on Committ ee formed;
rubella vaccine introduced; MR/OPV catch-up immunizati on campaign conducted
2016
MCV2 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 independen
t 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.
1 261 405
Total populati on
13
Municipaliti es65
Sub-districts442
villages (suco)1
Nati onal Referral Hospital5
Regional referral hospitals68
Community health centres at the sub-district levelTimor-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
100 90 80 70 60 50 40 30 20 10 0
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%) 900
800 700 600 500 400 300 200 100 0
100 90 80 70 60 50 40 30 20 10 0
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 Lautem
Baucau Viqueque Manufahi
Covalima Oecusse
Ainar
o
Manatuto
Ermer a Bobonaro
Liquisa
Aileu
317
Health posts at the village levelMCV: Measles-containing vaccine SIA: Supplementary immunizati on acti vity
MR: Measles–rubella
CRS: 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 Rubella at 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
Partners HMIS
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 images © Shobhan Singh - Communica on Offi cer/WHO Country Offi ce for Timor-Leste
