This report presents the strategies used to eradicate rubella in the Caribbean region and the challenges faced by that effort.
Using the surveillance system for measles cases that was instituted in ...all countries in the Caribbean Community (CARICOM), 12 countries confirmed cases of rubella between 1992 and 1996. Rubella infections occurred in epidemic proportions in 6 countries during that period.
On the basis of the rubella prevalence data, rubella-congenital rubella syndrome (CRS) cost-benefit analysis, and cost-effectiveness of the mass campaign, the Council for Human and Social Development of CARICOM resolved, on April 21, 1998, that every effort would be made to eradicate rubella, as well as to prevent the occurrence of new cases of CRS by the end of 2000. Using the Pan American Health Organization's template for measles eradication, CARICOM proposed and implemented the main strategies for rubella and CRS eradication, and rubella mass campaigns were conducted in 18 countries. The target population, which included males and females (aged 20-40 years), was approximately 2.2 million.
The major challenges for rubella eradication are attaining high vaccine coverage in the adult population and maintaining an effective surveillance system able to detect rubella activity.
The purpose of this paper is to discuss methods recommended and used by the Pan American Health Organization (PAHO) to monitor the interruption of indigenous measles transmission in the Region of the ...Americas. The methods used include house‐to‐house monitoring of vaccination coverage as a supervisory tool during both campaigns and routine vaccination; thoroughly investigating all measles outbreaks; performing routine surveillance, including weekly reporting from at least 80% of reporting units; and validating routine surveillance through active‐case searches at health care institutions and schools and in the community. The strategies described have helped PAHO to increase the authority and accountability of vaccine program managers at the local, provincial, and national levels. Their efforts have permitted the Region of the Americas to reduce to three the number of countries with indigenous measles transmission and to reach a record low of 503 measles cases in 2001.
In May 1985, the Pan American Health Organization proposed the goal of interruption of wild poliovirus transmission in the Western Hemisphere. An important component of the polio eradication strategy ...was conducting surveillance for cases of acute flaccid paralysis. Reported cases were thoroughly investigated, including the collection of stool samples for testing for the presence of wild poliovirus. The last patient with poliomyelitis due to wild poliovirus in the Americas had onset of paralysis on 23 August 1991 in Peru. Since then, >9000 cases of acute flaccid paralysis have been reported and thoroughly investigated; none has been confirmed as paralytic poliomyelitis due to wild poliovirus. On 29 September 1994, the International Commission for the Certification of Poliomyelitis Eradication declared the Americas to be polio-free.
In 1988, the Ministers of Health in the Caribbean Community resolved to eliminate cases of indigenous measles. Specific performance indicators were developed to regularly monitor the program. In ...1998, selected countries in the Caribbean elected to accelerate rubella control. As a first step, surveillance for both measles and rubella was integrated, using the measles eradication system as a template. Between 1995 and 2000, 98%–99% of the surveillance sites reported weekly. During that time, the number of suspected measles and rubella cases that were disqualified by laboratory testing remained relatively constant at 94%–99%; however, the indicator for suspected cases investigated within 48 h improved from 89% in 1996 to 95% in 2000. This integrated surveillance system has thus proven to be as effective and efficient as the measles surveillance system alone. Limited changes were made to the initial measles system, and the transition was relatively smooth. The integrated system has been crucial to the control of rubella and for the maintenance of measles elimination in the Caribbean.
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