The Pan American Health Organization/World Health Organization (PAHO/WHO) has announced that the Americas region has become the first in the world to be declared free of endemic transmission of rubella, a contagious viral disease that can cause multiple birth defects as well as fetal death when contracted by women during pregnancy.
This achievement culminates a 15-year effort that involved widespread administration of the vaccine against measles, mumps and rubella (MMR) throughout the western hemisphere. The announcement comes as 45 countries and territories of the Americas are participating in the 13th annual Vaccination Week in the Americas starting from April 25 to May 2.
The declaration of elimination, made by an international expert committee during a meeting at the Pan American Health Organization/World Health Organization (PAHO/WHO) last week, makes rubella and congenital rubella syndrome (CRS), the third and fourth vaccine-preventable diseases to be eliminated from the Americas, following the regional eradication of smallpox in 1971 and the elimination of polio in 1994.
"The elimination of rubella from the Americas is a historic achievement that reflects the collective will of our region's countries to work together to achieve ambitious public health milestones," said PAHO/WHO director Carissa F Etienne.
"Ours was the first region to eradicate smallpox, the first to eliminate polio, and now the first to eliminate rubella. All four achievements prove the value of immunisation and how important it is to make vaccines available even to the remotest corners of our hemisphere."
"Three years ago, governments agreed a Global Vaccine Action Plan. One of the plan's targets is to eliminate rubella from two WHO regions by end-2015. I congratulate the Americas region for being the first region to achieve this," said Dr Margaret Chan, director general of the World Health Organization.
Rubella, also known as German measles, caused widespread outbreaks throughout the Americas before the introduction of the MMR vaccine. Although the virus usually causes mild or asymptomatic infections in children and adults, when contracted by women early in pregnancy, it can cause miscarriage or CRS, a constellation of birth defects that often includes blindness, deafness, and congenital heart defects.
Before mass-scale rubella vaccination, an estimated 16,000 to more than 20,000 children were born with CRS each year in Latin America and the Caribbean, while more than 158,000 rubella cases were reported in 1997 alone. In the United States, 20,000 infants were born with CRS during the last major rubella outbreak in 1964-65.
Following the widespread adoption of the MMR vaccine in the region's national immunisation programmes, PAHO/WHO member countries in 1994 set the target of eliminating measles by 2000 and then in 2003 set the goal of eliminating rubella by 2010.
In the late 1990s, the English-speaking Caribbean countries pioneered the use of mass rubella vaccination campaigns targeting adolescents and adults. With support from PAHO/WHO and its Revolving Fund for Vaccine Procurement, which helps countries procure vaccines at lower cost, some 250 million adolescents and adults in 32 countries and territories were vaccinated against rubella between 1998 and 2008.
As a result of these efforts, the last endemic (local origin) cases of rubella and CRS were reported in the Americas in 2009. Because the virus continues to circulate in other parts of the world, imported cases have continued to be reported by countries including Canada, Argentina, and the United States.
In its meeting last week, the International Expert Committee for Measles and Rubella Elimination in the Americas reviewed epidemiological evidence provided by PAHO/WHO and its member countries and concluded that there was no evidence of endemic transmission of rubella or CRS for five consecutive years, exceeding the three-year requirement for declaring the disease eliminated. The committee noted that in the near future, it hopes to be able to declare the region free of measles as well.
"The fight against rubella has taken more than 15 years, but it has paid off with what I believe will be one of the most important Pan American public health achievements of the 21st century," said Etienne. "Now it's time to roll up our sleeves and finish the job of eliminating measles as well."
Key partners in rubella as well as measles elimination have included the ministries of health of PAHO/WHO member countries, the US Centres for Disease Control and Prevention (CDC), the US Department of Health and Human Services (HHS), Health Canada, the Canadian International Development Agency (CIDA), the Spanish Development Agency (AECID), the Sabin Vaccine Institute, the Serum Institute of India, the March of Dimes, the Church of Jesus Christ of Latter Day Saints, and the Measles-Rubella Initiative, a coalition of global partners including the International Federation of Red Cross/Red Crescent Societies, the UN Foundation, CDC, UNICEF and WHO.
This week (April 25 to May 2) marks the 13th annual Vaccination Week in the Americas, the largest international health initiative in the western hemisphere. Vaccination Week's main goals are to raise awareness of the importance of immunisation and to take vaccines to marginal and hard-to-reach groups such as those living in urban fringe areas or border communities. Since it began in 2003, Vaccination Week has reached more than 519 million people with vaccines against more than 20 diseases, including rubella, measles, diphtheria, tetanus, pertussis and others.
The PAHO/WHO-coordinated effort has also helped to strengthen countries' national immunisation programmes. Vaccination Week in the Americas inspired the creation of World Immunisation Week, which is celebrating its fourth year in 2015.
PAHO, founded in 1902, is the oldest international public health organization in the world. It works with its member countries to improve the health and the quality of life of the people of the Americas. It also serves as the regional office for the Americas of WHO.