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

Thrombocytopenic purpura and neonatal hepatitis

Congenital Rubella Syndrome

• 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

HELEN KELLER:

Blindness separates us from things, but deafness separates us from people.

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

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Tracking campaigns

Rubella elimination in The Americas1980-2010

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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

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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

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60

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Global AFR AMR EMR

EUR SEAR WPR

After 2015: 90%

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1982

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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.

COPA MUNDIAL FIFA SUB-2029 de Julio

20 de Agosto

COPA MUNDIAL FIFA SUB-17

18 de Junio – 10 de Julio

COPA MUNDIAL FEMENINADE LA FIFA 26 de Junio17 de Julio

Deafblind International

World Conference Sao Paulo 26 – 01 Oct

2011

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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.

Partners for the elimination of measles, rubella and CRS

Thanks a million!