Elimination of Rubella and Congenital Rubella Syndrome in the Americas

Pan American Health Organization, Washington, DC 20037, USA.
The Journal of Infectious Diseases (Impact Factor: 6). 09/2011; 204 Suppl 2(2):S571-8. DOI: 10.1093/infdis/jir472
Source: PubMed


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.

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    • "Since the 2010 earthquake, there was a large influx into Haiti of people from a number of countries, including some where measles and rubella are still endemic, for humanitarian aid and other support activities, putting the island nation at high risk of measles and rubella virus importation. PAHO recommends conducting periodic 'follow-up' SIAs to provide an additional opportunity to administer MR to children missed by the routine vaccination programme and to close immunity gaps, because the efficacy of a single measles vaccine dose is 85–95% (De Quadros et al. 2003; WHO 2009; Castillo-Sol orzano et al. 2011). From April to June 2012, the Haiti Ministry of Public Health and Population (French Acronym: MSPP) implemented several essential activities to verify and maintain measles, rubella and CRS elimination: (i) a nationwide MR SIA targeting children aged 9 months to 9 years regardless of previous vaccination history (oral polio vaccine, vitamin A and albendazole were also administered); (ii) active community-based and institutional searches for suspected measles, rubella and CRS cases; and (iii) a retrospective review of hospital records for CRS cases (PAHO 2012). "
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    ABSTRACT: Objectives We conducted a nationwide survey to assess measles containing vaccine (MCV) coverage among children aged 1–9 years in Haiti and identify factors associated with vaccination before and during the 2012 nationwide supplementary immunisation activities (SIA).Methods Haiti was stratified into five geographic regions (Metropolitan Port-au-Prince, North, Centre, South and West), 40 clusters were randomly selected in each region, and 35 households were selected per cluster.ResultsAmong the 7000 visited households, 75.8% had at least one child aged 1–9 years; of these, 5279 (99.5%) households consented to participate in the survey. Of 9883 children enrolled, 91% received MCV before and/or during the SIA; 31% received MR for the first time during the SIA, and 50.7% received two doses of MCV (one before and one during the 2012 SIA). Among the 1685 unvaccinated children during the SIA, the primary reason of non-vaccination was caregivers not being aware of the SIA (31.0%). Children aged 1–4 years had significantly lower MR SIA coverage than those aged 5–9 years (79.5% vs. 84.8%) (P < 0.0001). A higher proportion of children living in the West (12.3%) and Centre (11.2%) regions had never been vaccinated than in other regions (4.8–9.1%). Awareness, educational level of the mother and region were significantly associated with MR vaccination during and before the SIA (P < 0.001).Conclusions The 2012 SIA successfully increased MR coverage; however, to maintain measles and rubella elimination, coverage needs to be further increased among children aged 1–4 years and in regions with lower coverage.
    Full-text · Article · Jul 2014 · Tropical Medicine & International Health
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    • "The incidence of CRS has been reduced in many developed countries by effective vaccination programs [4]. Effective rubella vaccination programs as well as high-quality surveillance of rash/fever diseases have been implemented in the Americas and resulted in rubella and CRS elimination in those countries since 2010 [5,6]. However, rubella vaccination has not yet been introduced in many developing countries [7]. "
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    ABSTRACT: Background Epidemiological data about congenital rubella syndrome (CRS) are scarce and rubella vaccine is not yet included in the childhood immunization schedule in Sudan. This study aimed to identify and describe CRS cases among Sudanese infants with congenital eye or heart defects. Methods Between February and September 2010, paired oral fluid and dried blood spot samples were collected from 98 infants aged up to 12 months. These infants were enrolled during their visits to five hospitals in Khartoum, Sudan. Clinical samples were screened for rubella IgM and for ≥ 6 months old infants also for IgG antibodies by ELISA. The oral fluid of IgM and/or IgG positive patients was tested for rubella RNA by reverse transcriptase PCR. Results Our findings revealed that two children (2.0%) were IgM positive and another five children (5.1%) were positive for IgG antibodies. None of the five infants of which enough oral fluid was available for RNA investigation was PCR positive. Conclusions This study documented the presence of CRS in Sudan and highlighted the importance of rubella vaccine introduction for preventing future CRS cases in the country.
    Full-text · Article · Jun 2014 · BMC Infectious Diseases
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    • "The ROA goal of measles elimination, established in 1994, was achieved by 2002 [6]. In 2003, ROA countries adopted a goal for rubella elimination by 2010 and started implementing large, one-time 'speed-up' SIAs using combined measles-rubellacontaining (MR) vaccine targeting children and adults, generally up to 29 or 39 years of age [7]. The last endemic rubella case was reported in 2009 [8]. "
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    ABSTRACT: In seven southern African countries (Botswana, Lesotho, Malawi, Namibia, South Africa, Swaziland and Zimbabwe), following implementation of a measles mortality reduction strategy starting in 1996, the number of annually reported measles cases decreased sharply to less than one per million population during 2006-2008. However, during 2009-2010, large outbreaks occurred in these countries. In 2011, a goal for measles elimination by 2020 was set in the World Health Organization (WHO) African Region (AFR). We reviewed the implementation of the measles control strategy and measles epidemiology during the resurgence in the seven southern African countries. Estimated coverage with routine measles vaccination, supplemental immunization activities (SIA), annually reported measles cases by country, and measles surveillance and laboratory data were analyzed using descriptive analysis. In the seven countries, coverage with the routine first dose of measles-containing vaccine (MCV1) decreased from 80% to 65% during 1996-2004, then increased to 84% in 2011; during 1996-2011, 79,696,523 people were reached with measles vaccination during 45 SIAs. Annually reported measles cases decreased from 61,160 cases to 60 cases and measles incidence decreased to <1 case per million during 1996-2008. During 2009-2010, large outbreaks that included cases among older children and adults were reported in all seven countries, starting in South Africa and Namibia in mid-2009 and in the other five countries by early 2010. The measles virus genotype detected was predominantly genotype B3. The measles resurgence highlighted challenges to achieving measles elimination in AFR by 2020. To achieve this goal, high two-dose measles vaccine coverage by strengthening routine immunization systems and conducting timely SIAs targeting expanded age groups, potentially including young adults, and maintaining outbreak preparedness to rapidly respond to outbreaks will be needed.
    Full-text · Article · Feb 2014 · Vaccine
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