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Progress in the Elimination of Measles, Rubella and Congenital Rubella Syndrome in the Americas

Progress in the Elimination of Measles, Rubella and Congenital Rubella Syndrome in the Americas. Dr. Salvador Garcia-Jimenez Immunization Unit PAHO-WHO. XV DbI Conference Sao Paulo, September 27th, 2011. Congenital Rubella Syndrome. Thrombocytopenic purpura and neonatal hepatitis.

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Progress in the Elimination of Measles, Rubella and Congenital Rubella Syndrome in the Americas

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  1. Progress in the Elimination of Measles, Rubella and Congenital Rubella Syndrome in the Americas Dr. Salvador Garcia-Jimenez Immunization Unit PAHO-WHO XV DbI Conference Sao Paulo, September 27th, 2011

  2. Congenital Rubella Syndrome Thrombocytopenic purpura and neonatal hepatitis

  3. Most common manifestations • 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

  4. HELEN KELLER: Blindness separates us from things, but deafness separates us from people.

  5. 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

  6. CRS cases expected per year in the Americas without the control actions

  7. 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

  8. Rubella elimination in The Americas1980-2010 Accelerated campaigns Tracking campaigns Confirmed Cases Routine Coverage(%) 1G Final Transmisión Last case Rub. 2B SE 5/2009 1C Final Transmisión 43 of 44 countries of the Americas introduced the MMR vaccine in routine services. Source: Report to PAHO country. * Data as of  September /2010 .

  9. 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:

  10. Estimated vaccination coverage with measles-rubella vaccine by WHO region, 1980-2009 After 2015: 90%

  11. Outbreak control Strengthened surveillance Measles Elimination Reported Measles and Rubella Cases, the Americas, 1980-2010 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 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 *Data until EW 52/2010. Source:EPI tables (1999-2003) and country reports to PAHO/WHO (since 2004).

  12. Impact of Rubella Elimination Strategies, the Americas, 1998–2010 Rubella cases: 135,947 The Americas, 1998 25 months without confirmed endemic rubella cases Last endemic rubella cases EW 5/2009 Close monitoring of… • Seasonality • Virus excretion from confirmed CRS cases Import-associated Rubella cases: 15** -7 CAN, 1 FGU and 7 USA 1 dot = 1 case Source: Country reports to PAHO. * Data until EW 52/2010

  13. Reported cases of rubella in the Americas, 2010-2011 French Guinea =1 Canada 2010 = 7 United States 2010 = 7 2011 = 4 TOTAL 2010 = 17cases 2011 = 4 cases 1 dot = 1 case Note: The cases were imported, associated with importation or unknown. Source: Country Reports to PAHO / WHO

  14. Recent cases of Measles/Rubella and CRS Measles: Venezuela / 16 November, 2002 > 8 years without endemic measles transmission Measles/Rubella/CRS:Brasil/ 26 August, 2009 > 2 years without endemic rubella transmission RubellaArgentina/ February,2009 Source: Country Reports PAHO/WHO

  15. Updated estimate of the CRS disease burden, global * † in 1996 and 2008 *unpublished, Adams E, Vynnycky E †All member states

  16. Use of rubella vaccine by WHO Region, 1996 vs. 2010 Source: WHO

  17. Goals for the control of rubella by WHO Region, 2011 EUR-Rubella Elimination 2015 WPR-Accelerated Rubella Control and CRS Prevention AMR- Rubella Elimination 2010 EMR-National CRS Prevention Source: WHO

  18. 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

  19. Alerts to prevent / limit imports of measles and rubella in the Americas in 2011 COPA MUNDIAL FIFA SUB-20 29 de Julio 20 de Agosto COPA MUNDIAL FIFA SUB-17 18 de Junio – 10 de Julio Deafblind International World Conference Sao Paulo 26 – 01 Oct 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 FEMENINA DE LA FIFA 26 de Junio 17 de Julio

  20. Measles Elimination in the Americas, 2001-2010 • Imports caused limited outbreaksGenotypes did not continue the transmission Genotype D6 last ftransmisión D9 last transmisión D4 D5 D6 D8 D9 B3 H1 Unknown / other 2008 2003 2009 2010 2006 2007 2001 2002 2004 2005 Source: Report from country to the Global Measles and Rubella Laboratory.

  21. 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.

  22. Partners for the elimination of measles, rubella and CRS

  23. Thanks a million!

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