Congenital rubella syndrome: a matter of concern.

Congenital rubella syndrome (CRS), an important cause of severe birth defects, remains a public health problem in a significant number of countries. Therefore, global health experts encourage use of rubella vaccination, with the primary aim of preventing CRS. While large-scale rubella vaccination during the last decade has drastically reduced or eliminated both the virus and CRS in Europe and the Americas, many countries in Africa, South-East Asia, the Eastern Mediterranean, and the Western Pacific have not yet incorporated any type of rubella-containing vaccine into their immunization schedule. As a result, through travel and migration, rubella has been imported into countries that had successfully eliminated the virus, leading to outbreaks and the reestablishment of endemic transmission. The objective of this study was to identify the key factors required for CRS elimination (prevalence reduction, vaccination strategies, and surveillance methods) by reviewing publications in PubMed on rubella and CRS (systematic reviews, country experiences, and position papers from the World Health Organization (WHO) and other intergovernmental organizations). Based on the results of the review, to eliminate rubella and CRS in endemic areas and reduce re-emergence in previously disease-free areas, all countries should carry out two types of mass rubella vaccination campaigns: 1) one single mass national immunization campaign targeting all men and women 5-39+ years old (with the upper age limit depending on the year in which the rubella-containing vaccine was introduced and the epidemiology of rubella in the country) and 2) incorporation of an rubella-containing vaccine in routine childhood immunization programs, including regular vaccination campaigns for 12-month-olds and measles follow-up campaigns. In addition to mass rubella immunization campaigns and routine childhood vaccination programs, the following measures should be taken to help fight rubella and CRS: 1) surveillance of the number of susceptible women of childbearing age, and the emergence of imported cases; 2) coverage of susceptible populations with "second-chance" ("catch-up") campaigns (vaccination of older children and adults who may have missed earlier immunization programs); 3) rapid response to outbreaks; 4) strengthening of CRS surveillance; 5) involvement of the private sector in awareness and vaccination campaigns; and 6) reduction of the number of false-positive laboratory test results.

Congenital rubella syndrome: a matter of concern / Síndrome de rubéola congénita: un motivo de preocupación

Congenital rubella syndrome (CRS), an important cause of severe birth defects, remains a public health problem in a significant number of countries. Therefore, global health experts encourage use of rubella vaccination, with the primary aim of preventing CRS. While large-scale rubella vaccination during the last decade has drastically reduced or eliminated both the virus and CRS in Europe and the Americas, many countries in Africa, South-East Asia, the Eastern Mediterranean, and the Western Pacific have not yet incorporated any type of rubella-containing vaccine into their immunization schedule. As a result, through travel and migration, rubella has been imported into countries that had successfully eliminated the virus, leading to outbreaks and the reestablishment of endemic transmission. The objective of this study was to identify the key factors required for CRS elimination (prevalence reduction, vaccination strategies, and surveillance methods) by reviewing publications in PubMed on rubella and CRS (systematic reviews, country experiences, and position papers from the World Health Organization (WHO) and other intergovernmental organizations). Based on the results of the review, to eliminate rubella and CRS in endemic areas and reduce re-emergence in previously disease-free areas, all countries should carry out two types of mass rubella vaccination campaigns: 1) one single mass national immunization campaign targeting all men and women 5-39+ years old (with the upper age limit depending on the year in which the rubella-containing vaccine was introduced and the epidemiology of rubella in the country) and 2) incorporation of an rubella-containing vaccine in routine childhood immunization programs, including regular vaccination campaigns for 12-month-olds and measles follow-up campaigns. In addition to mass rubella immunization campaigns and routine childhood vaccination programs, the following measures should be taken to help fight rubella and CRS: 1) surveillance of the number of susceptible women of childbearing age, and the emergence of imported cases; 2) coverage of susceptible populations with "second-chance" ("catch-up") campaigns (vaccination of older children and adults who may have missed earlier immunization programs); 3) rapid response to outbreaks; 4) strengthening of CRS surveillance; 5) involvement of the private sector in awareness and vaccination campaigns; and 6) reduction of the number of false-positive laboratory test results.

El síndrome de rubéola congénita (SRC), una causa importante de defectos congénitos graves, sigue siendo un problema de salud pública en un número significativo de países. Por consiguiente, los expertos mundiales en salud promueven el uso de la vacunación antirrubeólica con el objetivo primario de prevenir el SRC. Aunque, durante el último decenio, la vacunación antirrubeólica administrada a gran escala ha reducido drásticamente o eliminado tanto el virus como el SRC en Europa y la Región de las Américas, muchos países de África, Asia Sudoriental, el Mediterráneo Oriental y el Pacífico Occidental aún no han incorporado ningún tipo de vacuna con componente antirrubeólico en su calendario de vacunaciones. Como resultado, y a consecuencia de los viajes y las migraciones, la rubéola se ha importado a países que habían eliminado eficazmente el virus, provocando brotes y el restablecimiento de la transmisión endémica. El objetivo de este estudio fue determinar los factores clave requeridos para la eliminación del SRC (reducción de la prevalencia, estrategias de vacunación y métodos de vigilancia) mediante la revisión de publicaciones aparecidas en PubMed sobre la rubéola y el SRC (revisiones sistemáticas, experiencias de países y documentos de posición de la Organización Mundial de la Salud y otras organizaciones intergubernamentales). Con base en los resultados de la revisión, y con objeto de eliminar la rubéola y el SRC en las zonas endémicas y reducir su reaparición en las zonas previamente libres de la enfermedad, todos los países deben llevar a cabo dos tipos de campañas de vacunación antirrubeólica masivas: 1) una única campaña de vacunación masiva a escala nacional dirigida a todos los hombres y mujeres de 5 a 39 años de edad (el límite superior de edad depende del año de introducción de la vacuna con componente antirrubeólico y de la epidemiología de la rubéola en el país), y 2) la incorporación de una vacuna con componente antirrubeólico en los programas sistemáticos de vacunación infantil, incluidas las campañas regulares de vacunación dirigidas a lactantes de 12 meses de edad y las campañas de seguimiento de las enfermedades exantemáticas. Además de las campañas de vacunación masiva contra la rubéola y los programas sistemáticos de vacunación infantil, se deben aplicar las siguientes medidas para ayudar a combatir la rubéola y el SRC: 1) la vigilancia de las mujeres en edad fecunda susceptibles, y de la aparición de casos importados; 2) la cobertura de las poblaciones vulnerables mediante campañas de "segunda oportunidad" ("puesta al día") (vacunación de niños mayores y adultos a los que no hubieran alcanzado los programas de vacunación anteriores); 3) la respuesta rápida ante los brotes; 4) el fortalecimiento de la vigilancia del SRC; 5) la participación del sector privado en las campañas de concientización y vacunación; y 6) la reducción del número de resultados de pruebas de laboratorio falsamente positivos.

Identification of Serologic Markers for School-Aged Children With Congenital Rubella Syndrome.

BACKGROUND: Congenital rubella syndrome (CRS) case identification is challenging in older children since laboratory markers of congenital rubella virus (RUBV) infection do not persist beyond age 12 months. METHODS: We enrolled children with CRS born between 1998 and 2003 and compared their immune responses to RUBV with those of their mothers and a group of similarly aged children without CRS. Demographic data and sera were collected. Sera were tested for anti-RUBV immunoglobulin G (IgG), IgG avidity, and IgG response to the 3 viral structural proteins (E1, E2, and C), reflected by immunoblot fluorescent signals. RESULTS: We enrolled 32 children with CRS, 31 mothers, and 62 children without CRS. The immunoblot signal strength to C and the ratio of the C signal to the RUBV-specific IgG concentration were higher (P < .029 for both) and the ratio of the E1 signal to the RUBV-specific IgG concentration lower (P = .001) in children with CRS, compared with their mothers. Compared with children without CRS, children with CRS had more RUBV-specific IgG (P < .001), a stronger C signal (P < .001), and a stronger E2 signal (P ≤ .001). Two classification rules for children with versus children without CRS gave 100% specificity with >65% sensitivity. CONCLUSIONS: This study was the first to establish classification rules for identifying CRS in school-aged children, using laboratory biomarkers. These biomarkers should allow improved burden of disease estimates and monitoring of CRS control programs.

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.

Advocacy and resource mobilization for rubella elimination in Guatemala.

This review describes the advocacy efforts to mobilize resources for the campaign to vaccinate men and women aged 9-39 years, with a goal of eliminating rubella and congenital rubella syndrome in Guatemala. The country's investment in health has been historically low (0.9% of gross domestic product), and there has been a wide gap between the availability of economic resources and the need for economic resources for the immunization campaign. The review contains a summary of the investment made, the results of advocacy and resource mobilization, the vaccination coverage attained, and the campaign's impact on the disease.

Lessons learned from integrated surveillance of measles and rubella in the Caribbean.

The Caribbean subregion was one of the first areas to successfully integrate measles and rubella surveillance, and it can serve as an example to other subregions on how to achieve similar success. The integrated surveillance system, established through strong political commitment by Caribbean countries, is coordinated by the Caribbean Epidemiology Centre (CAREC). The system, which became operational in January 2000, is designed to detect and investigate patients with fever and rash illness, and also test a blood specimen from each case investigated. During over 9 years of operation, 3733 cases were reported and investigated. Laboratory tests identified 2 imported cases of measles, 27 cases of rubella, 309 cases of dengue, and 260 cases of human herpesvirus 6 (HHV-6) infection. The lessons learned from the success of this integrated system indicate that the following factors are critical: strong political commitment, strong technical oversight from all levels within the health-care system, the use of proven tools or systems and technology for data collection and analysis, integration with other surveillance activities, continuing training, and continuing review and evaluation.

Measles outbreak in Venezuela: a new challenge to postelimination surveillance and control?

The circulation of wild measles virus was interrupted in Venezuela in February 2007 after the catch-up vaccination (1994) and monitoring (1998) and in response to the measles outbreak in 2001. Traditionally, the routine coverage with measles-mumps-rubella vaccine does not exceed 85%. In February 2006, a measles outbreak started by importation in the State Miranda; this extended to 7 states and lasted 50 weeks with an intermediate period of 17 weeks without reported cases. New cases were reported in the States Guarico and Amazon. The pattern of circulation of the silent period was determined through the use of retrospective search for measles; this showed that 57% of suspected cases did not enter the surveillance system. Molecular epidemiology made it possible to identify B3 as only genotype, which also circulated in Spain. The epidemiological and clinical characteristics of measles have been modified; these determine outbreaks identified late, of slow expansion, silent, and with limited case-fatality, compared with classical outbreaks. The outbreak spread by that behavior was not recognized and the classical control measures did not result. The beginning of a broader and intense vaccination was delayed, partly by weaknesses in the sensitivity of the system. It is crucial to recognize the new behavior of measles and the effectiveness of the classical control measures, and especially to establish criteria for interruption of the circulation to control an outbreak in this stage of elimination.

Guidelines for the documentation and verification of measles, rubella, and congenital rubella syndrome elimination in the region of the Americas.

In the region of the Americas, goals for the elimination of endemic measles and rubella/congenital rubella syndrome (CRS) by the year 2000 and 2010, respectively were established. The successful implementation of measles elimination strategies in the region of the Americas resulted in the interruption of endemic measles transmission in 2002 and tremendous progress toward rubella and CRS elimination. In October 2007, the 27th Pan American Sanitary Conference adopted Resolution CSP27.R2 urging member states to begin documenting and verifying the interruption of endemic transmission of the measles and rubella viruses in the Americas. To ensure a standardized approach for the process of documentation and verification, the Pan American Health Organization/World Health Organization (PAHO/WHO) developed a regional plan of action to guide countries and their national commissions as they prepare and consolidate evidence of the interruption of endemic measles and rubella transmission. This article summarizes the plan of action including the essential criteria and components of the guidelines.

Approach to verify the status of measles, rubella, and congenital rubella syndrome elimination in Costa Rica.

Costa Rica introduced the measles-mumps-rubella (MMR) vaccine in 1986. The Ministry of Health adopted the goal of eliminating endemic measles in 1991 by achieving and maintaining high vaccine coverage through routine delivery, mass campaigns and outreach activities, and the strengthening of expanded program on immunization (EPI) surveillance. Measles and rubella immunization strategies shifted susceptibility to older age groups, leading to the introduction of MMR2 in 1992, administered at age 7 years. In 2000, the goal of accelerated rubella control and congenital rubella syndrome prevention was established, and a nationwide vaccination campaign targeting men and women aged 15-39 was implemented to immunize the population of reproductive age. The last endemic case of measles was confirmed in 1999, and at the end of 2001 Costa Rica reported the last endemic cases of rubella and congenital rubella syndrome. Imported cases of measles and rubella were detected in 2003 and 2005, with no secondary cases detected. In 2008, Costa Rica established a National Committee of Experts, supported by technical teams, to collect the evidence required to verify the interruption of endemic transmission of the measles and rubella viruses. The evidence includes information on trends and epidemiologic analysis, molecular epidemiology, population immunity, the quality of surveillance, and the sustainability of the EPI program.

Rubella vaccination of unknowingly pregnant women during mass campaigns for rubella and congenital rubella syndrome elimination, the Americas 2001-2008.

BACKGROUND: Due to the significant teratogenicity of rubella virus and the use of a live-attentuated vaccine, pregnancy is a contraindication of receipt of rubella vaccine (RCV). Data collected from several countries that have observed susceptible women who had received RCV during pregnancy documented that no infant with congenital rubella syndrome (CRS) has been born, so the risk is theoretical. As part of the regional initiative to eliminate rubella and CRS in the Americas, one of the key strategies was the vaccination of women of childbearing age. The implementation of mass vaccination campaigns targeting women of childbearing age in Argentina, Brazil, Costa Rica, Ecuador, El Salvador, and Paraguay provided an opportunity to further increase the body of knowledge on the safety of rubella vaccine if an unknowingly pregnant woman is vaccinated in early pregnancy. METHODS: Using a standard protocol, women who were unknowingly pregnant or become pregnant ≤ 30 days after receiving RCV were evaluated to determine immunity status (eg, susceptible, immune, and unknown) at the time of vaccination. Susceptible pregnant women were observed to determine the outcome of the pregnancy. For pregnancies that resulted in live births, serum samples were obtained from the newborn for rubella immunoglobulin (Ig) M antibody testing. If the newborn's serum sample was IgM positive, the infant was evaluated for manifestations of CRS. RESULTS: During the period 2001-2008, 48748253 women of childbearing age were vaccinated in the region of the Americas, 39542253 (81%) of whom were vaccinated in the 6 selected countries. Of these women, 30139 (0.07%) were pregnant or became pregnant ≤1 month after receiving vaccine and were followed up. On the basis of serological evaluation, 2894 (10%) women were classified as susceptible at the time of vaccination; of their pregnancies, 1980 (90%) resulted in a live birth. Sera from 70 (3.5%) of these infants were rubella IgM antibody positive, but none of the infants had features of CRS as a result of rubella vaccination. The maximum theoretical risk for CRS following rubella vaccination of susceptible pregnant women was 0.2%. Conclusions. The results of these studies from 6 select countries provides additional evidence showing an absence of risk of CRS associated with administering rubella vaccine shortly before or during pregnancy.

Congenital rubella syndrome surveillance as a platform for surveillance of other congenital infections, Peru, 2004-2007.

BACKGROUND: Rubella during pregnancy can cause serious fetal abnormalities and death. Peru has had integrated measles/rubella surveillance since 2000 but did not implement congenital rubella syndrome (CRS) surveillance until 2004, in accordance with the Pan American Health Organization recommendations for rubella elimination. The article describes the experience from the CRS sentinel surveillance system in Peru. METHODS: Peru has maintained a national sentinel surveillance system for reporting confirmed and suspected CRS cases since 2004. A surveillance protocol was implemented with standardized case definitions and instruments in the selected sentinel sites. Each sentinel site completes their case investigations and report forms and sends the reports to the Health Region Epidemiology Department, which forwards the data to the national Epidemiology Department. CRS surveillance data were analyzed for the period 2004-2007. RESULTS: During the period 2004-2007, 16 health facilities, which are located in 9 of the 33 health regions, representing the 3 main geographical areas (coast, mountain, and jungle), were included as sentinel sites for the CRS surveillance. A total of 2061 suspected CRS cases were reported to the system. Of these, 11 were classified as CRS and 23 as congenital rubella infection. Factors significantly associated with rubella vertical transmission were: (1) in the mother, maternal history of rash during pregnancy (odds ratio [OR], 12.0; 95% confidence interval [CI], 3.8-37.8); (2) and in the infant, pigmentary retinopathy (OR, 18.4; 95% CI, 3.2-104.6), purpura (OR, 14.7; 95% CI, 2.8-78.3), and developmental delay (OR, 4.4; 95% CI, 1.75-11.1). CONCLUSIONS: The surveillance system has been able to identify rubella vertical transmission, reinforcing the evidence that rubella was a public health problem in Peru. This system may serve as a platform to implement surveillance for other congenital infections in Peru.

Follow-up study of unknowingly pregnant women vaccinated against rubella in Brazil, 2001-2002.

BACKGROUND: Brazil conducted mass immunization of women of childbearing age in 2001 and 2002. Surveillance was initiated for vaccination of women during pregnancy to monitor the effects of rubella vaccination on fetal outcomes. METHODS: Women vaccinated while pregnant or prior to conception were reported to the surveillance system. Susceptibility to rubella infection was determined by anti-rubella immunoglobulin (Ig) M and IgG immunoassays. Susceptible women were observed through delivery. Live-born infants were tested for anti-rubella IgM antibody; IgM-seropositive newborns were tested for viral shedding and observed for 12 months for signs of congenital rubella syndrome. Incidence of congenital rubella infection was calculated using data from 7 states. RESULTS: A total of 22 708 cases of rubella vaccination during pregnancy or prior to conception were reported nationwide, 20,536 (90%) of which were from 7 of 27 states in Brazil. Of these, 2332 women were susceptible to rubella infection at vaccination. Sixty-seven (4.1%) of 1647 newborns had rubella IgM antibody (incidence rate, 4.1 congenital infections per 100 susceptible women vaccinated during pregnancy [95% confidence interval, 3.2-5.1]). None of the infants infected with rubella vaccine virus was born with congenital rubella syndrome. CONCLUSIONS: As rubella elimination goals are adopted worldwide, evidence of rubella vaccine safety aids in planning and implementation of mass adult immunization.

Measles elimination in the Americas: a comparison between countries with a one-dose and two-dose routine vaccination schedule.

BACKGROUND: The Region of the Americas eliminated measles in 2002 through high first-dose routine measles vaccine coverage and vaccination campaigns every 4-6 years; a second routine dose at school entry was added in some countries. The impact of this second routine dose on measles elimination was evaluated. METHODS: Data on socioeconomic factors, demographic characteristics, vaccination coverage, and the estimated proportion of children (<15 years of age) susceptible to measles were compiled. Countries were grouped using propensity score methods, and Kaplan-Meier curves were used to compare time to measles elimination between countries with a 1-dose schedule and those with a 2-dose schedule. RESULTS: One-dose (n = 14) and 2-dose (n = 7) countries did not differ with respect to median routine first-dose measles vaccine coverage, median coverage for 3 measles campaigns, or estimated percentage of susceptible children after routine first vaccination dose and campaigns. Compared with 1-dose countries, 2-dose countries had higher median gross national income per capita (P = .002), percentage of population living in urban areas (P = .04), and female literacy (P = .01), as well as lower infant mortality (P = .007); however, no differences in time to elimination were found. CONCLUSIONS: One-dose and 2-dose countries had similar times to measles elimination despite socioeconomic differences between their populations. A second routine dose might not have hastened measles elimination, because threshold immunity needed to eliminate measles was achieved with high first routine dose coverage and vaccination campaigns. Further research will be needed to determine the applicability of these findings to other regions.

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.

Global distribution of measles genotypes and measles molecular epidemiology.

A critical component of laboratory surveillance for measles is the genetic characterization of circulating wild-type viruses. The World Health Organization (WHO) Measles and Rubella Laboratory Network (LabNet), provides for standardized testing in 183 countries and supports genetic characterization of currently circulating strains of measles viruses. The goal of this report is to describe the lessons learned from nearly 20 years of virologic surveillance for measles, to describe the global databases for measles sequences, and to provide regional updates about measles genotypes detected by recent surveillance activities. Virologic surveillance for measles is now well established in all of the WHO regions, and most countries have conducted at least some baseline surveillance. The WHO Global Genotype Database contains >7000 genotype reports, and the Measles Nucleotide Surveillance (MeaNS) contains >4000 entries. This sequence information has proven to be extremely useful for tracking global transmission patterns and for documenting the interruption of transmission in some countries. The future challenges will be to develop quality control programs for molecular methods and to continue to expand virologic surveillance activities in all regions.

Confirmation of rubella within 4 days of rash onset: comparison of rubella virus RNA detection in oral fluid with immunoglobulin M detection in serum or oral fluid.

Rubella virus infection is typically diagnosed by the identification of rubella virus-specific immunoglobulin M (IgM) antibodies in serum, but approximately 50% of serum samples from rubella cases collected on the day of rash onset are negative for rubella virus-specific IgM. The ability to detect IgM in sera and oral fluids was compared with the ability to detect rubella virus RNA in oral fluids by reverse transcription-PCR (RT-PCR) by using paired samples taken within the first 4 days after rash onset from suspected rubella cases during an outbreak in Perú. Sera were tested for IgM by both indirect and capture enzyme immunoassays (EIAs), and oral fluids were tested for IgM by a capture EIA. Tests for IgM in serum were more sensitive for the confirmation of rubella than the test for IgM in oral fluid during the 4 days after rash onset. RT-PCR confirmed more suspected cases than serum IgM tests on days 1 and 2 after rash onset. The methods confirmed approximately the same number of cases on days 3 and 4 after rash onset. However, a few cases were detected by serum IgM tests but not by RT-PCR even on the day of rash onset. Nine RT-PCR-positive oral fluid specimens were shown to contain rubella virus sequences of genotype 1C. In summary, RT-PCR testing of oral fluid confirmed more rubella cases than IgM testing of either serum or oral fluid samples collected in the first 2 days after rash onset; the maximum number of confirmations of rubella cases was obtained by combining RT-PCR and serology testing.

Images that Inspire: The Mobilization of the Americas to Eliminate Measles and Rubella

[Preface]. Some 100 years ago, public health regularly began to include graphic arts among its armamentarium in the fight against diseases. It was an era of devastating epidemics and endemic infectious diseases, as health workers began to organize coordinated media campaigns that sought to mobilize the community and enlist its participation through striking posters, illustrated pamphlets, films, and other graphic materials. In its classical book, Rats, lice, and history, published in 1934, Hans Zinsser wrote: “infectious diseases are one of humankind’s great tragedies. They permanently struggle to exist through different ways of life.” This battle has sparked the imagination and creativity of many a graphic artist, who have variously depicted this ongoing saga in the course of time. / Es para mí un privilegio presentar Imágenes que inspiran: la movilización de las Américas para eliminar el sarampión y la rubéola, publicación que recoge los afiches utilizados por los Estados Miembros de la Organización Panamericana de la Salud (OPS) para la eliminación del sarampión y la rubéola en la Región de las Américas. Los afiches compilados aquí ofrecen un boceto del sistema visual e iconográfico que fue desarrollado para informar, persuadir, dar reconocimiento y motivar a los pueblos de las Américas a mantenerse fieles a su compromiso de eliminar estas dos enfermedades, promoviendo así la equidad. Desde una perspectiva histórica, estos afiches ofrecen mucho más de lo que originalmente se propusieron: son espejos que reflejan las percepciones, sesgos y actitudes de la cultura, sociedad y tiempo en que fueron creados. En ellos se unen el arte, la cultura, la ciencia, la religión y los valores en pro de la salud.

Imágenes que inspiran: la movilización de las américas para eliminar el sarampión y la rubéola

Esta publicación recoge los afiches utilizados por los Estados Miembros de la Organización Panamericana de la Salud (OPS) para la eliminación del sarampión y la rubéola en la Región de las Américas. Los afiches compilados aquí ofrecen un boceto del sistema visual e iconográfico que fue desarrollado para informar, persuadir, dar conocimientos y motivar a los pueblos de las Américas a mantenerse fieles a su compromiso de eliminar estas dos enfermedades, promoviendo así la equidad. Desde una perspectiva histórica, estos afiches ofrecen mucho más de lo que reflejan las percepciones, sesgos y actitudes de la cultura, sociedad y tiempo en que fueron creados. En ellos se unen el arte, la cultura, la ciencia, la religión y los valores en pro de la salud.