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RUBELLA ERADICATION IN WEST INDIES: THE COUNTDOWN BEGINS

Since the start of the Expanded Program on Immunization in the early 1970s, 2 diseases have been eliminated from the countries of the Caribbean Community (CARICOM). Poliomyelitis in 1982 and measles in 1991. In order to measure the impact of the campaign and to ensure elimination, a sensitive and active surveillance system was implemented. An effective system requires at least 80% weekly reporting from over 600 sites in the countries, at least 80% suspected cases being investigated within 48 hours, and at least 80% of reported cases being completely investigated, including the collection of adequate blood specimens.

During the period 1991-1997, no indigenous case of measles was confirmed, although 3125 blood samples from suspected measles cases were tested for IgM antibodies at Caribbean Epidemiology Centre (CAREC). However, it was discovered that rubella, characterised by fever and rash, occurred in epidemic proportions in some countries. Since the implementation of a special pilot surveillance system for CRS in 1996, over 30 confirmed cases have been detected and notified. Even so, Congenital Rubella Syndrome (CRS) cases with only mild hearing deficits or minimal mental retardation which manifest in the post-neonatal manifestations has equalled the no. of cases with deficits detected in the neonatal period.

It has been predicted that absence of a rubella control program could lead to around 100 CRS cases yearly. The average cost of care and rehabilitation of a single CRS case has been estimated to be about US $ 40,000 and thus for 1,500 CRS cases to be approx. US$ 60 million. This estimate does not include the loss of economic productivity due to the disease.

Mass vaccination of a susceptible population is a well documented strategy for interrupting viral transmission. The rubella elimination program mass vaccination campaign targeting both males and females 1-30 years of age emerges as a logical sequel to the elimination of measles. The programs complement each other since a measles/rubella containing vaccine is being utilized for the campaign and in the vaccination of childhood population through routine health services. The full implementation of this strategy targeting approx. 2 million persons in the CARICOM countries will cost around US$ 4.5 million.

Abstracted from : West Indian Med Journal 1998, 47 (3) 75-76