Progress in the Elimination of Measles, Rubella and Congenital
Rubella Syndrome in the Americas
XV DbI Conference Sao Paulo, September 27th, 2011
Dr. Salvador Garcia-Jimenez Immunization Unit
PAHO-WHO
• Congenital deafness: hearing loss• Ocular blindness: congenital cataracts• Neurological disorders: severe mental
impairment• Congenital heart disease• Intrauterine growth retardation,
hepatosplenomegaly, and / or blood disorders• Pneumonitis
Most common manifestations
Deafblindness banishes those who suffer from a world of loneliness and isolation of human solidarity which only can rescue them.Blessed are those who, with his humanism make bearable the exile.
Salvador Garcia-Ximenez
PAHO David Salisbury, TAG, 1997(Technical Advisory Group on Vaccine Preventable Diseases)
20,000
WHO Cutts & VynnyckyJour.Int. Epid. 1999;28:1176-84
16,000
(4,500-36,000)
CRS cases expected per year in the Americas without the control actions
Adult rubella vaccination results in the Americas 1998-2005
Caribbean - English Speaking 1998-2001
2.16 millions of men and women
Chile 1999
2.5 millions of women
Costa Rica 2001
1.6 millions of men and women
Brasil 2001-2002
29 millions of women
Honduras 2002
3.3 millions of men and women
El Salvador 2004
2.8 millions of men and women
Ecuador 2004
4.8 millions of men and women
Paraguay 2005
3.7 millions of men and women
0
20.000
40.000
60.000
80.000
100.000
120.000
140.000
82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 2010
0
20
40
60
80
100
Casos Cobertura de rutina
Tracking campaigns
Rubella elimination in The Americas1980-2010
Routine C
overage(%
)C
onfir
me
d C
ases
Accelerated campaigns
43 of 44 countries of the Americas introduced the MMR vaccine in routine services.
Source: Report to PAHO country. * Data as of September /2010 .1C
Fin
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All countries of the Americas are firmly committed to measles, rubella and congenital rubella syndrome elimination as part of a Regional strategy.
Number of people vaccinated in the region by each strategy:
Catch-up(<15yr)
Follow-up(1-4 yr)
Speed-up(adol/adult)
140 million 60 million 250 million
Estimated vaccination coverage with measles-rubella vaccine by WHO region, 1980-2009
1619 20
3741
47 46
53
6268
7369 69 70 71 73 73 71 71 70 71 72 73 74 76 78 80 81 82 82
0
20
40
60
80
1001
98
01
98
11
98
21
98
31
98
41
98
51
98
61
98
71
98
81
98
91
99
01
99
11
99
21
99
31
99
41
99
51
99
61
99
71
99
81
99
92
00
02
00
12
00
22
00
32
00
42
00
52
00
62
00
72
00
82
00
9
MC
V c
ove
rag
e (
%)
Global AFR AMR EMR
EUR SEAR WPR
After 2015: 90%
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
2008
2010
N0 C
ases
Rubella
Measles
Strengthened surveillance
Outbreak control
Measles Elimination
Reported Measles and Rubella Cases, the Americas, 1980-2010
*Data until EW 52/2010.Source: EPI tables (1999-2003) and country reports to PAHO/WHO (since 2004).
2003 & 2006 Directing Council Rubella Resolutions Calls Member States to:(g) “ eliminate rubella and congenital rubella syndrome from their countries by the year 2010”
44th DC, September 2003
(a) “implement policies and operational strategies to meet the rubella and CRS elimination target by 2010”
47th DC, September 2006
Starting in 2001, in a horizon of 15 years, it has been estimated that the initiative to eliminate rubella and CRS will save $ 3 Billion and will prevent more than 112,500 cases of CRS in Latin America and the Caribbean
Rubella cases: 135,947The Americas, 1998
Impact of Rubella Elimination Strategies, the Americas, 1998–2010
1 dot = 1 case
Source: Country reports to PAHO.* Data until EW 52/2010
Import-associated Rubella cases: 15** -7 CAN, 1 FGU and 7 USA
25 months without confirmed endemic
rubella cases
Close monitoring of…SeasonalityVirus excretion from confirmed CRS cases
Last endemic rubella cases
EW 5/2009
French Guinea =1
United States 2010 = 72011 = 4
1 dot = 1 case
TOTAL2010 = 17cases2011 = 4 cases
Reported cases of rubella in the Americas, 2010-2011
Source: Country Reports to PAHO / WHO
Note: The cases were imported, associated with importation or unknown.
Canada 2010 = 7
Recent cases of Measles/Rubella and CRS
Measles:Venezuela / 16 November, 2002
Measles/Rubella/CRS:Brasil/ 26 August, 2009
RubellaArgentina/ February,2009
> 8 years without endemic measles transmission
> 8 years without endemic measles transmission
> 2 years without endemic rubella transmission
> 2 years without endemic rubella transmission
Source: Country Reports PAHO/WHO
Updated estimate of the CRS disease burden, global * † in 1996 and 2008
Regions 1996 2008
Number Range Number Range
Africa 31, 133 6,127- 71,017 42,440 9,130- 97,228
Americas 9,701 2,605- 19,274 24 0- 301
East Mediterranean
9,265 3,054- 22,287 5,895 69- 20,384
European 9,509 5,742-13,240 243 12-1,949
Southeast Asia 50,637 3,644-141,432 52,643 3,418-149,274
Western Pacific 10,098 3,495-17,839 10,641 3,741-18,618
GLOBAL 120,342 252,45-285,089 111,888 16,369-287,754
*unpublished, Adams E, Vynnycky E†All member states
Use of rubella vaccine by WHO Region, 1996 vs. 2010
Region 1996No. of countries (%)
2010No. of countries (%)
AFR 2 (4%) 3 (7%)
AMR 21 (60%) 35 (100%)
EMR 9 (43%) 15 (71%)
EUR 39 (74%) 53 (100%)
SEAR 2 (20%) 4 (36%)
WPR 10 (37%) 21 (78%)
Global 83 (43%) 131 (68%)
Source: WHO
Goals for the control of rubella by WHO Region, 2011
AMR-Rubella
Elimination2010
EUR-Rubella Elimination 2015
EMR-National CRS Prevention
WPR-Accelerated Rubella Controland CRS Prevention
Source: WHO
Challenges for the maintenance of the elimination of measles, rubella and CRS in the
Americas (1)Risk of importation of the virus from other regions
Prevention and rapid response to outbreaks
Prevent or limit secondary cases of imports (in some countries)
Reaching the subject through the second chance / campaigns tracking high quality
Alerts to prevent / limit imports of measles and rubella in the Americas in 2011
Given the numerous upcoming athletic and cultural celebrations that
will be held in various countries in the Americas, PAHO/WHO particularly recommends that all people planning to
travel internationally should be vaccinated against measles, rubella,
poliomyelitis, and other vaccine-preventable diseases regardless of the reason for travel, country of origin, or
geographic area of destination.
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Deafblind International
World Conference Sao Paulo 26 – 01 Oct
2011
D6
last
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D9
last
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2001 2002 2003
GenotypeD4D5D6D8D9B3H1Unknown / other
2004 2005 2006 2007 2008 2009 2010
Measles Elimination in the Americas, 2001-2010
•Imports caused limited outbreaksGenotypes did not continue the transmission
Source: Report from country to the Global Measles and Rubella Laboratory.
Reasons for non-vaccination: United States, 2011 *
Born before 1957 (3%).Born outside the United States (1%).Medical contraindications (1%). Intentionally delayed vaccination (1%).Age were not vaccinated.Personal or religious reasons (53%).
* Data: Up to Sept 24, 2011 Source: CDC Report to PAHO / WHO.