Elimination of rubella and congenital rubella syndrome in the Americas.

In 2003, the Pan American Health Organization (PAHO) adopted a resolution calling for rubella and congenital rubella syndrome (CRS) elimination in the Americas by the year 2010. To accomplish this goal, PAHO advanced a rubella and CRS elimination strategy including introduction of rubella-containing vaccines into routine vaccination programs accompanied by high immunization coverage, interruption of rubella transmission through mass vaccination of adolescents and adults, and strengthened surveillance for rubella and CRS. The rubella elimination strategies were aligned with the successful measles elimination strategies. By the end of 2009, all countries routinely vaccinated children against rubella, an estimated 450 million people had been vaccinated against measles and rubella in supplementary immunization activities, and rubella transmission had been interrupted. This article describes how the region eliminated rubella and CRS.

The Americas: paving the road toward global measles eradication.

BACKGROUND: The Region of the Americas set a goal of interrupting endemic measles virus transmission by the end of 2000. This decision was primarily based on rapid decreases in measles disease burden in pioneering countries that implemented Pan American Health Organization-recommended vaccination and surveillance strategies. Review of these strategies may inform measles elimination efforts in other regions. METHODS: Results from the implementation of the measles elimination strategy in the Americas were compiled and analyzed over a 30-year period, which was divided into 4 phases: the early years of the Expanded Program on Immunization (1980-1986); the start-up phase for elimination (1987-1994); the elimination phase (1995-2002); and the postelimination phase (2003-2010). Factors that contributed to elimination and the challenges confronted during the postelimination phase are discussed. RESULTS: An analysis of vaccination strategies over time highlights the transition from monovalent measles vaccine to the incorporation of measles-mumps-rubella vaccine administered in the routine program. Regional vaccination coverage increased during the period 1987-2010, sustained at ≥90% since 1998. Measles elimination efforts led to the implementation of 157 national vaccination campaigns, vaccinating a total of 440 million persons. Endemic measles virus transmission was interrupted in 2002. After elimination, measles importations and associated outbreaks occurred. Measles incidence has remained at <1 case per 1 million population since 2002. CONCLUSIONS: The success of measles elimination strategies in the Americas suggests that global measles eradication is attainable.

Measles and rubella elimination initiatives in the Americas: lessons learned and best practices.

Countries in the World Health Organization Region of the Americas successfully interrupted endemic measles virus transmission 8 years after setting a regional measles elimination goal and have sustained this achievement since 2002. The vast experience from the region clearly demonstrates that measles elimination can be accomplished and maintained over time. This brief report summarizes the lessons learned and the best practices that evolved in the Americas during 3 measles elimination phases (ie, preelimination, elimination, and postelimination phases), as well as the contribution of rubella elimination to strengthening and maintaining measles elimination. The effective measures that have been implemented and adapted by the countries of the Americas to eliminate endemic measles and rubella will serve as an example to other countries and regions embarking on this endeavor.