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Elimination of Rubella and Congenital Rubella Syndrome in the Americas:
Progress Report
140th Session of the Executive Committee Washington, D.C., 25-29 June, 2007
2004
Pan AmericanHealthOrganization
2003 & 2006 Directing Council Resolutions
44th DC, September 2003
(g) “eliminate rubella and congenital rubella syndrome from their countries by the year 2010…”;
47th DC, September 2006
(a) “implement policies and operational strategies to meet the rubella and CRS elimination target by 2010…”;
Calls Member States to:
2004
Pan AmericanHealthOrganization
English-speaking Caribbean 1998–2001Chile 1999
Costa Rica 2001Brazil 2001-2002Honduras 2002
El Salvador 2004Ecuador 2004
Nicaragua 2005Paraguay 2005Colombia 2005
Bolivia 2006Argentina 2006
Peru 2006Dominican Republic 2006
Guatemala 2007
TOTAL: 116 million vaccinated
Adult Vaccination Campaigns for Rubella Elimination, The Americas, 1998–2007
2004
Pan AmericanHealthOrganization
Keys to Success in Rubella Elimination Mass Vaccination Campaigns
• Political commitment and participation at the highest level
• Strong presence in the mass media
• Intensive social mobilization and local micro-planning
• Involvement of scientific societies, other social actors, and the media
• Timely and sustained technical support
2004
Pan AmericanHealthOrganization
*Vaccination of men and women Vaccination of women only
82
98 98 99 99 97 99 99 98 99 99 969899
0
20
40
60
80
100
CAR COR HON ELS PAR COL NIC BOL PER DOR ARG* GUT CHI BRA
Source: Country reports.*Vaccination of women and groups of men considered at high risk only.
Cov
erag
e (%
)Rubella Vaccination Coverage in Selected
Countries of the Americas,1998-2007
2004
Pan AmericanHealthOrganization
0
50,000
100,000
150,000
200,000
250,000
300,000
1980
1982
1984
1986
1988
1990
1992
1994
1996
1998
2000
2002
2004
2006
N0 C
ases
oN0
Rubella
Measles
% Reduction(1998 to 2006)
Rubella = 97.9%Rubella Elimination
Source: Country reports.* Includes rubella and measles cases reported to PAHO as of epidemiological week 33/2007.
Accelerated rubella control
Measles Elimination
Impact of Rubella and Measles Elimination Strategies The Americas, 1980–2007*
2004
Pan AmericanHealthOrganization
92 90 90
61
8378 77
61
8279 81
91
68
77
59
8489
74
85 80
63
8687
59
86
0
20
40
60
80
100
% sitesreporting
% cases withadequate
investigation
% cases withadequatesample
% samples inlaboratories <=5
days
% lab resultsreported <=4
days
Perc
enta
ge
2003 2004 2005 2006 2007
Source: Country reports.* Data reported until epidemiological week 33/2007.
Integrated Measles-Rubella Surveillance Indicators, Region of the Americas, 2003-2007*
2004
Pan AmericanHealthOrganization
Budgetary Implications of Rubella Initiative, 2003-2010
53%47%
ExecutedTotal:
US$100.4
PendingTotal:
US$112.5
Estimated initial cost (2003-2010): US$ 210 million
PAHO/ WHO 24%
National 85%
External 15%
Total Financing: $212.9 million
Regular Budget
Source: Rubella and CRS Elimination in the Americas: Plan of Action 2004-2010
National 76%
Extra budgetary
2004
Pan AmericanHealthOrganization
Partners for Rubella and CRS Elimination
2004
Pan AmericanHealthOrganization
• Strengthens health services for newborns, children, and adult men and women
• Reduces inequities in maternal health outcomes • Fosters a culture of prevention• Generates lessons learned which have
implications for the introduction of future vaccines • Provides essential experiences to facilitate the
transition from child to family immunization• Consistent with MDGs (#4 and #5)
Added Value of the Rubella and CRS Elimination Initiative
2004
Pan AmericanHealthOrganization
Next Steps…
Document the interruption of
endemic rubella virus
transmission
Determine what are the necessary data requirements for countries to document rubella and measles elimination*
Considering:
Epidemiological data for rubella and CRS
Population immunity (vaccine coverage, routine, follow-up campaigns, adolescent and adult campaigns, post partum vaccination (post campaign)
Evaluation of rubella and CRS surveillance systems
Molecular epidemiology
Formation of an international expert committee to independently verify the interruption of endemic transmission in the Americas
*Workshop held in San José, COR (May ’07) to begin development of protocol to document elimination
2004
Pan AmericanHealthOrganization
THANK YOU!
http://www.paho.org/immunization/
