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We examined rubella vaccination trends, rubella surveillance, and disease patterns for the Americas, Mexico, and the United States, to evaluate the impact of hemispheric rubella control on rubella elimination in the United States during 1997-2004. In 1997, 130,375 rubella cases were reported in the Americas, with 38,042 reported in Mexico. Over the next 7 years, a rubella control initiative resulted in the administration of approximately 110 million rubella-containing vaccine doses in Latin America, with 77.7 million doses administered within Mexico. By 2004, the number of reported rubella cases had declined to 3103 in the Americas and 698 in Mexico. Concurrently, the number of rubella cases in the United States fell from 817 during 1997-1999 to <25 cases/year from 2001 onward, with loss of seasonality and geographic clustering, despite no change in vaccination rates. Implementation of rubella control strategies in the Americas, particularly in Mexico, appears to have facilitated rubella elimination in the United States.

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Se calcula que cada año nacen en el mundo más de 100 000 niños con síndrome de rubéola congénita (SRC). La Organización Mundial de la Salud (OMS) estandarizó en 1998 las definiciones de casos para la vigilancia del SRC y de la rubéola. En 2001, 123 países o territorios notificaron 836 356 casos de rubéola y se espera que el número de países se incremente a medida que se desarrolla, bajo la coordinación de la OMS, una red mundial de laboratorios para la detección del sarampión y la rubéola. Se están realizando investigaciones para mejorar la vigilancia de esta última enfermedad, entre ellas algunos proyectos encaminados a echar a andar la vigilancia y a comparan métodos diagnósticos, así como estudios de epidemiología molecular para lograr entender más a fondo los patrones de circulación del virus de la rubéola en el mundo. En 1996 una encuesta efectuada por la OMS reveló que 78 (36 per ciento) de los 214 países o territorios que habían notificado casos de la enfermedad aplicaban la vacuna contra la rubéola como parte de su régimen de vacunación estándar. Para fines de 2002 un total de 124 de esos 214 (58 per ciento) países o territorios aplicaban la vacuna antirrubeólica cuyo uso depende del nivel de desarrollo económico: 100 per ciento en países industrializados, 71 per ciento en países con economías en transición y 48 per ciento en países en desarrollo. Se dispone de una vacuna inocua y eficaz y se ha demostrado la eficacia de algunas estrategias de vacunación para la prevención de la rubeóla y el SRC. En un trabajo de posición de la OMS se ofrece orientación acerca de lo que entraña, desde el punto de vista programático, emprender la vacunación antirrubeólica. Se trata de una medida cuya efectividad y beneficios superan su costo, pero que exige un continuo fortalecimiento de los servicios de vacunación y sistemas de vigilancia habituales.

Worldwide, it is estimated that there are more than 100 000 infants born with congenital rubella syndrome (CRS) each year. In 1998, standard case definitions for surveillance of CRS and rubella were developed by the World Health Organization (WHO). In 2001, 123 countries/territories reported a total of 836 356 rubella cases. In the future more countries are expected to report on rubella as a global measles/rubella laboratory network is further developed under the coordination of the WHO. Operational research is being conducted to improve rubella surveillance. This includes projects on initiating CRS surveillance, comparative studtes on diagnostic laboratory methods, and molecular epidemiology research to expand the global understanding of patterns of rubella virus circulation. In 1996 a WHO survey found that 78 of 214 reporting countries/territories (36%) were using rubella vaccine in their routine immunization services. By the end of 2002 a total of 124 of the 214 counties/territories (58%) were using rubella vaccine. Rubella vaccine use varies by stage of economic development: 100% for industrialized countries, 71% for countries with economies in transition, and 48% for developing countries. A safe and effective rubella vaccine is available, and there are proven vaccination strategies for preventing rubella and CRS. A WHO position paper provides guidance on programmatic aspects of rubella vaccine introduction. The introduction of rubella vaccine is cost-effective and cost-beneficial but requires ongoing strengthening of routine immunization services and surveillance systems

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OBJECTIVES: This article describes the effort to eliminate measles from Jamaica and its impact on measles incidence. METHODS: In addition to routine measles vaccination, the Jamaican Ministry of Health implemented a strategy of a 1-time only catch-up vaccination campaign, conducted in 1991, and periodic follow-up campaigns, the first of which occurred in 1995. RESULTS: Since 1991, despite careful surveillance, no serologically confirmed indigenous cases of measles have occurred in Jamaica. CONCLUSIONS: Measles virus circulation has been interrupted in Jamaica. The Jamaican experience provides further evidence that global measles eradicaion is achievable.(AU)

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OBJECTIVES: This article describes the effort to eliminate measles from Jamaica and its impact on measles incidence. METHODS: In addition to routine measles vaccination, the Jamaican Ministry of Health implemented a strategy of a 1-time-only catch-up vaccination campaign, conducted in 1991, and periodic follow-up campaigns, the first of which occurred in 1995. RESULTS: Since 1991, despite careful surveillance, no serologically confirmed indigenous cases of measles have occurred in Jamaica. The Jamaican experience provides further evidence that global measles eradication is achievable (Au)

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La vacuna antisarampionosa se empezó a usar en Cuba en 1971. En los años setenta se implantó una estrategia inicial para el control del sarampión, y a ella le siguieron iniciativas adicionales a principios de los años ochenta. Pese a haberse mejorado el programa de control, siguieron produciéndose brotes de la enfermedad. En 1986, después de revisar las experiencias recogidas a partir de las iniciativas de control ya establecidas, se adoptó una nueva estrategia de vacunación antisarampionosa. Con el tiempo, la nueva estrategia de vacunación contra el sarampión llegó a tener tres componentes principales: primero, una campaña única de vacunación de "puesta al día" dirigida a niños de 1 a 14 años de edad. Segundo, se procuró lograr y mantener una alta cobertura con la vacuna mediante el ofrecimiento de servicios de vacunación obligatoria para niños de 12 meses de edad ("vacunación de mantenimiento"). Por último, se llevaron a cabo periódicamente campañas de "seguimiento" para niños de 2 a 6 años de edad. Con el fin de monitorear el territorio recorrido hacia le eliminación del sarampión, se ha hecho un esfuerzo por fortalecer la vigilancia de la enfermedad, de la cual forma parte la investigación de casos sospechados. Tanto la campaña general de "puesta al día" como la de "seguimiento" alcanzaron coberturas de más de 98% en los grupos de edad a los que fueron dirigidas. El programa de vacunación de rutina también ha mantenido una alta cobertura. La alta inmunidad poblacional contra el sarampión lograda mediante estas estrategias de vacunación dio por resultado una rápida reducción de la incidencia de la enfermedad. De 1989 a 1992, se notificaron menos de 20 casos anuales confirmados por laboratorios. En Cuba, el último caso confirmado por pruebas serológicas se presentó en julio de 1993. La estrategia para la eliminación del sarampión que se ha aplicado en Cuba ha interrumpido la transmisión de la enfermedad y ha impedido la circulación...

The vaccine against measles came into use in Cuba in 1971. During the seventies, a new early strategy for measles control was established, and it was followed by further efforts in the early eighties. Despite improvements to the control program, disease outbreaks continued to occur. In 1986, after examining the experience acquired through the control initiatives that were already in place, a new measles vaccination strategy was adopted. In time, the new vaccination strategy against measles came to have three main components: first, a single vaccination "catching-up" campaign targeting children 1 to 14 years of age. Second, efforts were made to achieve and maintain high vaccine coverage through mandatory vaccination services for 12-month-old children ("maintenance vaccination"). Finally, periodic "follow-up" campaigns were carried out for children 2 to 6 years of age. Steps were taken, for the purpose of monitoring the progress made so far toward eliminating measles, to strengthen disease surveillance systems, including the screening of suspected cases. The "catching-up" and "follow-up" campaigns both achieved greater than 98% coverage within targeted age groups. The routine vaccination program has also maintained high coverage. The high population immunity against measles that has been attained through these vaccination strategies has resulted in a rapid decrease in the incidence of the disease. From 1989 to 1992, less than 20 laboratory-confirmed cases were reported annually. In Cuba, the last case confirmed through serologic screening was reported in July 1993. Cuba's strategy for measles elimination has interrupted disease transmission and kept the causal virus from circulating on the island. Cuba's experience with measles elimination suggests that if an appropriate vaccination strategy is applied, measles can be globally eradicated.

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Rubella is a viral disease with minor morbidity and few complications unless it is contracted by a pregnant woman. Rubella infection during the first trimester of pregnancy often leads to fetal death or severe congenital defects (congenital rubella syndrome, CRS). Rubella remains endemic in many countries of Latin America and the Caribbean. It has been estimated that 20000 or more infants are perhaps born with CRS each year in Latin American and Caribbean countries. While the inclusion of rubella vaccination into routine childhood immunization will decrease rubella virus circulation among young children, it will not have immediate impact on the transmission of rubella among adults or the occurrence of CRS. A one-time mass campaign targeting both males and females 5 to 39 years of age with measles-mumps-rubella or measles-rubella vaccine followed by the use of measles-mumps-rubella vaccine in routine early childhood vaccination will prevent and control both rubella and CRS promptly. In April 1988, the Ministers of Health of the English-speaking Caribbean targeted rubella for elimination by the end of the year 2000 using the vaccination strategy outlined above. The rubella elimination experience of these countries will provide useful information for the eventual elimination of rubella virus from the Americas.

La rubéola es una enfermedad vírica que produce poca morbilidad y pocas complicaciones, a no ser que la contraiga una mujer embarazada. La infección con rubéola durante el primer trimestre del embarazo a menudo termina en muerte fetal o en deformidades congénitas graves (síndrome de anomalías congénitas por rubéola, o SCR). La rubéola sigue siendo endémica en muchos países de América Latina y el Caribe. Se estima que quizá 20 000 niños o más nacen cada año con SCR en países latinoamericanos y caribeños. Si bien la adición de la vacuna contra la rubéola a los programas de inmunización infantil de rutina disminuirá la circulación del virus entre los niños pequeños, no tendrá un impacto inmediato sobre la transmisión de la rubéola entre los adultos o sobre la frecuencia de SCR. Una campaña única dirigida a toda la población de hombres y mujeres de 5 a 39 años de edad en que se aplique la vacuna triple contra el sarampión, la parotiditis y la rubéola, o la vacuna doble contra el sarampión y la rubéola seguida de la vacuna triple como parte de la inmunización rutinaria de niños pequeños servirá para controlar y prevenir de manera inmediata tanto la rubéola como el SCR. En abril de 1988, los Ministros de Salud de países del Caribe angloparlante establecieron la meta de eliminar la rubéola para fines del año 2000 mediante la aplicación de la estrategia de vacunación aquí descrita. La experiencia que han tenido estos países en sus actividades de eliminación de la rubéola será fuente de información provechosa para la eliminación futura del virus de la rubéola de todo el territorio americano.

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Rubella is a viral disease with minor morbidity and few complications unless it is contacted by a pregnant woman. Rubella infection during the first trimester of pregnancy often leads to fetal death or severe congenital defects (congenital rubella syndrome, CRS). Rubella remains endemic in many countries of Latin America and the Caribbean. It has been estimated that 20,000 or more infants are perhaps born with CRS each year in Latin American and Caribbean countries. While the inclusion of rubella vaccination into routine childhood immunization decrease rubella virus circulation among young children, it will not have immediate impact on the transmission of rubella amongst adults or the occurrence of CRS. A one-time mass compaign targeting both males and females 5 to 39 years of age with measles-mumps-rubella vaccination or measles-rubella vaccine followed by the use of measles-mumps-rubella vaccine in routine early childhood vaccination will prevent and control both rubella and CRS promptly. In April 1988, the Ministers of Health of the English-speaking Caribbean countries targeted rubella for elimination by the end of year 2000 using the vaccination strategy outlined above. The rubella elimination experience of these countries will provide useful information for the eventual elimination of rubella virus from the Americas.(AU)

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Tiene por objeto hacer un repaso de la epidemiología de la enfermedad en territorio cubano y describir la estrategia especial para la eliminación del sarampión que se creó y puso en marcha en el país.(AU)

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