VI: REGIONAL AND COUNTRY EXPERIENCES, MEASLES ELIMINATION IN THE REGION OF THE AMERICAS

Tuesday, 28th of June 2011

 

VI: REGIONAL AND COUNTRY EXPERIENCES, AMERICAN REGION

 

The Americas: Paving the Road Toward Global Measles Eradication

1. 1.   Carlos Castillo-Solorzano C1, Cuauhtémoc Ruiz Matus1, Brendan Flannery2,

Christina Marsigli1, Gina Tambini1 and  Jon Kim Andrus1 

+ Author Affiliations

1. 1.    ¹Pan American Health Organization, Washington, District of Columbia
2. 2.    ²Pan American Health Organization, Brasilia, Brazil
3. Correspondence: Carlos Castillo-Solórzano, MPH, Regional Advisor, Comprehensive Family Immunization, Pan American Health Organization, Washington, DC 20037 (castilsc@paho.org).

Abstract

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.

http://jid.oxfordjournals.org/content/204/suppl_1/S270.abstract

 

 

 

 

Measles and Rubella Elimination Initiatives in the Americas: Lessons Learned and Best Practices

1. 1.   Carlos Castillo-Solorzano, Christina Marsigli, M.Carolina Danovaro-Holliday,

Cuauhtémoc Ruiz-Matus, Gina Tambini and Jon Kim Andrus 

+ Author Affiliations

1. 1.    Pan American Health Organization, Washington, DC
2. Correspondence: Christina Marsigli, MPH, Comprehensive Family Immunization Project, Pan American Health Organization, Washington, DC marsiglc@paho.org.

Abstract

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.

http://jid.oxfordjournals.org/content/204/suppl_1/S279.abstract

 

 

The Caribbean Experience in Maintaining High Measles Vaccine Coverage

1. 1.   Beryl Irons1,2,  James G. Dobbins1,2 and  the Caribbean Vaccine Managersa 

+ Author Affiliations

1. 1.    ¹Pan American Health Organization, Family Immunization Program, Washington, DC
2. 2.    ²Caribbean Epidemiology Center, Expanded Programme on Immunization, Port of Spain, Trinidad and Tobago
3. Correspondence: Beryl Irons, Caribbean Epidemiology Centre, 16–18 Jamaica Blvd, Federation Park, Port of Spain, Trinidad and Tobago (ironsber@carec.paho.org).

Abstract

The Caribbean subregion was the first area of the world to eliminate measles. From 1991 through 2010, the 21 countries of the subregion were remarkably successful in maintaining their measles-free status despite importations of the virus from areas where it continues to circulate. This task has been accomplished by ensuring that each country in the subregion maintains measles vaccine coverage of ≥95%. The absence of measles is the result of a collaboration between the various national authorities and the Pan American Health Organization in ensuring vaccination campaigns to deliver the second dose of a measles-containing vaccine, estimating and validating vaccine coverage for both the first and second doses of measles vaccine for all local populations; developing detailed plans of action to improve coverage in those populations where coverage is <95%; providing technical assistance for the implementation of the plan; and performing follow-up to confirm that all aspects of the plans were in fact implemented and that the target vaccination level was achieved.

These efforts have been extremely successful in maintaining high vaccine coverage and, therefore, in keeping the virus from circulating on those occasions when it has been reintroduced into the subregion. Although sophisticated statistical methods have been used to identify weaknesses in national vaccine programs, the program is basically quite simple and can be systematically implemented in any country that has the desire to eliminate measles from its population.

http://jid.oxfordjournals.org/content/204/suppl_1/S284.abstract