Health Leaders Applaud Measles Efforts, Back New Vaccine Push
Second Vaccination Week in the Americas Set for April 2004

At the meeting of the 44th Directing Council of the Pan American Health Organization (PAHO), held in Washington, D.C., Sept. 22–26, the health leaders also agreed to step up vaccination of the region's children against other vaccine-preventable diseases and, in particular, to intensify efforts to eliminate rubella.

PAHO Director Mirta Roses Periago announced on the meeting's opening day that since November 2002 no indigenous transmission of measles has been reported anywhere in the continent.

"We at PAHO are very excited to have this opportunity to celebrate with you the successful elimination of measles in the Americas," she said at a news conference. "This remarkable achievement is the result of the hard work done by all health workers in the Americas, led by the ministers of health assembled here this week."

During the week-long policymaking meeting, the ministers called on countries throughout the Americas to participate in a hemisphere-wide Ibero-American Vaccination Week, modeled on the June 1–8 Vaccination Week in the Americas, involving 19 Latin American and Caribbean countries. That effort was judged an overwhelming success by health leaders meeting in Lima, Peru, in early September. Planning for an April 2004 vaccination week is already under way.

Battling rubella
Participants in the Washington meeting also agreed to speed up efforts to eliminate rubella (known as German measles) from the region, saying this could be achieved by 2010. They called on PAHO member countries to develop national plans of action toward that goal within the next 12 months.

The Americas currently have the lowest rates of mortality due to vaccine-preventable diseases of any region of the world. Other vaccine-preventable diseases of priority to the region include yellow fever and neonatal tetanus. But the region's countries are focusing considerable public health efforts on eliminating measles and rubella.

Health leaders believe they can capitalize on the success so far in fighting measles to eliminate rubella as well. "Efforts against measles have been very successful, and they provide a good model for eliminating rubella," Jon Andrus, the new head of PAHO's Immunizations Unit, said in an interview. "By integrating the two efforts, we can advance the elimination of both diseases."

Measles and rubella are both highly contagious viral diseases. Measles is a more acute disease that can cause complications with long-lasting effects. Rubella causes generally mild symptoms but is a significant threat in pregnant women, as it can cause serious birth defects when contracted during the first three months of pregnancy. An estimated 20,000 babies born in the Americas each year suffer from congenital rubella syndrome, or CRS.

Andrus noted that both diseases are good candidates for elimination because there is a vaccine for each and neither has an animal reservoir. Moreover, there is widespread political will for banishing the diseases.

Recent progress
A report prepared for the Directing Council meeting highlights recent progress achieved by several countries against rubella and CRS. Costa Rica, Honduras and the countries of the Englishspeaking Caribbean have carried out mass vaccination campaigns of heterogeneous populations, including men, women and adolescents. Brazil carried out mass rubella vaccination campaigns in 2001 and 2002 that reached some 28 million women. Dramatic reductions of CRS have been seen in Chile, the English-speaking Caribbean and Cuba.

In the news conference with PAHO Director Roses, Walter Orenstein, director of the U.S. National Immunization Program of the Centers for Disease Control and Prevention (CDC), said that the United States is fully committed to the 2010 target. "We are proud to work in close partnership with PAHO on this honorable goal," he said.

Both Roses and Orenstein cautioned, however, that immunization must remain a top priority if the progress already achieved is to be maintained.

"The absence of a disease does not mean the absence of the threat of that disease. We must not be lulled into a false sense of security when case numbers are low," said Orenstein. "Measles virus still circulates in much of the world. We are all vulnerable to importations of virus."

Despite the absence of local transmission, measles continues to be imported from other regions. As of late August, 87 imported cases had been confirmed in Canada, Chile, Mexico and the United States during 2003. Experts agree that to prevent measles' reintroduction, countries need to maintain high levels of vaccination coverage—ideally at least 95 percent—and must target high-risk populations with increased coverage and surveillance.

"We are working together to achieve and maintain high immunization coverage, using safe, effective and affordable vaccines. PAHO sees this as a unique opportunity to achieve equity in health," said Roses.