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The strongholds of measles are overcrowded India, SE Asia and subSahara Africa. These impoverished areas require vaccination campaigns if eradication is to be gained.
Bangladesh, India, Indonesia, Myanmar and Nepal continue to have cyclical measles outbreaks every 2-3 years, with the majority of cases occurring in children aged < 5 years. As the coverage increases, the time lag between outbreaks increases and a shift towards older age groups can be seen (Thailand, Sri Lanka). The number of susceptible children will continue to accumulate over time, leading to major outbreaks. Thailand has had epidemics every 4 years with the last one in 1994. Sri Lanka has not had a major outbreak since 1991, has maintained high coverage levels, but may experience an epidemic of measles in the near future.
Clean out the center that is most likely in the worst condition, and attempt to radiate virus-free areas from this eradtication.