Progress Toward Rubella Elimination - World Health Organization South-East Asia Region, 2013-2021.

During 2013, the 11 countries of the World Health Organization (WHO) South-East Asia Region* (SEAR) adopted the goals of measles elimination and rubella and congenital rubella syndrome (CRS) control† by 2020. During 2019, SEAR countries declared a broader goal for eliminating both measles and rubella§ by 2023 (1). Before 2013, only five SEAR countries had introduced rubella-containing vaccine (RCV). This report updates a previous report and describes progress toward rubella elimination in SEAR during 2013-2021 (2). During 2013-2021, six SEAR countries introduced RCV; all countries in the Region now use RCV in routine immunization. Routine immunization coverage with the first dose of a rubella-containing vaccine (RCV1) increased >600%, from 12% during 2013 to 86% during 2021, and an estimated 515 million persons were vaccinated via RCV supplementary immunization activities (SIAs)¶ during 2013-2021. During this time, annual reported rubella incidence declined by 80%, from 5.5 to 1.1 cases per million population. Maldives and Sri Lanka are verified as having achieved rubella elimination; Bhutan, North Korea, and Timor-Leste have halted endemic transmission of rubella virus for >36 months. SEAR has made substantial progress toward rubella elimination; however, intensified measures are needed to achieve elimination.

Update on polio eradication in the World Health Organization South-East Asia Region, 2013.

There has been a tremendous amount of progress toward polio eradication in the World Health Organization South-East Asia Region particularly over the past 4 years. In 1988, there were >25,000 reported cases of wild poliovirus infection in the South-East Asia Region, and because of substantial underreporting the estimated polio burden was probably 10-fold higher. Following the initiation of mass polio immunization campaigns in the mid-1990s and years of intense effort, the 11 countries of the South-East Asia Region reported no cases of wild poliovirus infection in 2012. With India reporting the last wild poliovirus case in the region, on 13 January 2011, and its subsequent removal from the list of polio-endemic countries, in February 2012, the South-East Asia Region is firmly on track for polio-free certification in early 2014.

Progress and challenges in measles and rubella elimination in the WHO European Region.

INTRODUCTION: Despite availability of safe and cost-effective vaccines to prevent it, measles remains one of the significant causes of death among children under five years of age globally. The World Health Organization (WHO) European Region has seen a drastic decline in measles and rubella cases in recent years, and a few of the once common measles genotypes are no longer detected. Buoyed by this success, all Member States of the Region reconfirmed their commitment in 2010 to eliminating measles and rubella, and made this a central objective of the European Vaccine Action Plan 2015-2020 (EVAP). Nevertheless, sporadic outbreaks continue, recently affecting primarily adolescents and young adults with no vaccination or an incomplete vaccination history. The European Regional Verification Commission for Measles and Rubella Elimination was established in 2011 to evaluate the status of measles and rubella elimination based on documentation submitted annually by each country's national verification committee. DISCUSSION: Each country's commitment to eliminate measles and rubella is influenced by competing health priorities, and in some cases lack of capacity and resources. All countries need to improve case-base surveillance for both measles and rubella, ensure documentation of each outbreak and strengthen the link between epidemiology and laboratory data. Achieving high coverage with measles- and rubella-containing vaccines will require a multisectoral approach to address the root causes of lower uptake in identified communities including service delivery challenges or vaccine safety concerns caused by circulating myths about vaccination. CONCLUSIONS: The WHO European Region has made steady progress towards eliminating measles and rubella and over half of the countries interrupted endemic transmission of both diseases by 2015. The programmatic challenges in disease surveillance, vaccination service delivery and communication in the remaining endemic countries should be addressed through periodic evaluation of the strategies by all stakeholders and exploring additional opportunities to accelerate the ongoing elimination activities.

Evolution of archosaurian body plans: skeletal adaptations of an air-sac-based breathing apparatus in birds and other archosaurs.

Living birds represent the only extant sauropsid group in which pulmonary air sacs pneumatize the postcranial skeleton. Notable in this regard is an extraordinary degree of variability, ranging from species that are completely apneumatic to those characterized by air within the entire postcranial skeleton. Although numerous factors (e.g., body size) have been linked with "relative" pneumaticity, comparative studies examining this system remain sparse. This project sought to (1) characterize whole-body patterns of skeletal pneumaticity in distantly related neognath birds and (2) evaluate putative relationships among relative pneumaticity, body size and locomotor specializations. Pneumaticity profiles were established for 52 species representing 10 higher-level groups. Although comparisons reveal relatively conserved patterns within most lower-level clades, apparent size- and locomotor-thresholds do impart predictable deviations from the clade norm. For example, the largest flying birds (vultures, pelicans) exhibit hyperpneumaticity (i.e., pneumaticity of distal limb segments) relative to smaller members of their respective clades. In contrast, skeletal pneumaticity has been independently lost in multiple lineages of diving specialists (e.g., penguins, auks). The application of pneumaticity profiling to extinct archosaurs reveals similar trends in body size evolution, particularly when examining patterns of pneumaticity in a size-diverse assemblage of pterosaurs (flying "reptiles"). As a fundamental organizing system, skeletal pneumaticity may play a role in relaxing constraints on body size evolution by allowing volumetric increases without concomitant increases in body mass. Not only might this be critical for taxa (birds, pterosaurs) exploiting the energetically costly aerial environment, but could be beneficial for any large-bodied terrestrial vertebrates such as the dinosaurs.