An outbreak of paralytic poliomyelitis occurred in the Dominican Republic (13 confirmed cases) and Haiti (8 confirmed cases, including 2 fatal cases) during 2000-2001. All but one of the patients were either unvaccinated or incompletely vaccinated children, and cases occurred in communities with very low (7 to 40%) rates of coverage with oral poliovirus vaccine (OPV). The outbreak was associated with the circulation of a derivative of the type 1 OPV strain, probably originating from a single OPV dose given in 1998-1999. The vaccine-derived poliovirus associated with the outbreak had biological properties indistinguishable from those of wild poliovirus.

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Cartagena, Colombia, was one of the last cities in the Americas known to have endemic poliomyelitis. After 3 cases were identified in 1991, two approaches for detecting continued silent transmission of wild polioviruses within a high-risk community were used: stool surveys of healthy children and virologic analysis of community sewage. Wild type 1 polioviruses were isolated from 8% of the children studied and from 21% of sewage samples. The proportions of wild polioviruses, vaccine-related polioviruses, and nonpolio enteric viruses were similar for both approaches. Wild poliovirus sequences were also amplified directly from processed sewage samples by the polymerase chain reaction using primer pairs specific for the indigenous type 1 genotype. The last reported cases associated with wild polioviruses in the Americas occurred in Colombia (8 April 1991) and Peru (23 August 1991). Direct sampling for wild polioviruses in high-risk communities can provide further evidence that eradication of the indigenous wild polioviruses has been achieved in the Americas.

In 2003, the Pan American Health Organization (PAHO) adopted a resolution calling for rubella and congenital rubella syndrome (CRS) elimination in the Americas by the year 2010. To accomplish this goal, PAHO advanced a rubella and CRS elimination strategy including introduction of rubella-containing vaccines into routine vaccination programs accompanied by high immunization coverage, interruption of rubella transmission through mass vaccination of adolescents and adults, and strengthened surveillance for rubella and CRS. The rubella elimination strategies were aligned with the successful measles elimination strategies. By the end of 2009, all countries routinely vaccinated children against rubella, an estimated 450 million people had been vaccinated against measles and rubella in supplementary immunization activities, and rubella transmission had been interrupted. This article describes how the region eliminated rubella and CRS.

Since 1994, when the goal of interrupting indigenous measles transmission was adopted, important progress has been made toward the control of measles in the Americas. Thirty-nine (95%) of 41 countries reporting to the Pan American Health Organization (PAHO) conducted catch-up vaccination campaigns during 1989-1995 and follow-up measles campaigns every 4 years. Routine (keep-up) vaccination coverage in the Region increased from 80% in 1994 to 94% in 2000. Measles vaccination coverage ranged between 75% and 99% in 2000 and between 53% and 99% in 2001. As a result, in 2001, the total number of confirmed measles cases reached a record low of 537, 99% lower than the number reported in 1990. In 2002, only Venezuela and Colombia had known indigenous transmission. As of January 2003, no known indigenous measles transmission had occurred in the Region since November 2002. This is due to high political commitment and implementation of PAHO's recommendations, including strengthened supervision and monitoring to improve accountability at the local level.

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Data from the regional measles surveillance system have documented widespread rubella virus circulation in many different countries in the Americas. In response to the ongoing endemic incidence of the disease and the potential for a major rubella epidemics in the region, the Pan American Health Organization Technical Advisory Group on Vaccine Preventable Diseases recommended the implementation of a regional initiative to strengthen rubella and congenital rubella syndrome (CRS) preventive efforts in 1997. This article summarizes and highlights the progress toward accelerated rubella control and CRS prevention in the English-speaking Caribbean and in Chile, Costa Rica, and Brazil. Useful knowledge is being generated for the adaptation of similar rubella strategies elsewhere. The findings also document the feasibility of implementing the recommended strategies and their rapid impact on disease burden.Rubella, usually a mild febrile rash illness in children and adults, can produce devastating consequences when a woman becomes infected in early pregnancy. The sequels of infection during pregnancy include miscarriage, stillbirth, and a series of birth defects known as congenital rubella syndrome (CRS). Since 1969, rubella-containing vaccines have been shown to be safe and effective in preventing rubella and CRS.Data generated by a regional measles surveillance system developed by the Pan American Health Organization (PAHO) document widespread rubella virus circulation in many countries in the Americas. Some countries also have CRS cases. In the Western Hemisphere, an estimated 20,000 infants with CRS are born annually-even in the absence of major epidemics [1].In response to the ongoing rubella virus circulation and the potential for major rubella epidemics in the region, the PAHO Technical Advisory Group on Vaccine Preventable Diseases recommended in 1997 that a regional initiative be implemented to strengthen rubella and CRS prevention efforts. To achieve this initiative, PAHO developed a rubella control and CRS strategy [2] that includes the introduction of rubellacontaining vaccines into routine childhood immunization programs, vaccination of women at childbearing age, development of specific vaccination strategies for accelerated rubella control and CRS prevention, support to countries in the development of integrated surveillance systems for measles and rubella, implementation of a CRS surveillance system, and rubella virus isolation. Here we summarize the progress made toward rubella control and CRS prevention with emphasis on experience gained in the accelerated control of rubella in the English-speaking Caribbean and in Chile, Costa Rica, and Brazil. METHODSData from an integrated measles-rubella surveillance system and a CRS surveillance system were analyzed to assess the burden of rubella and CRS disease. Coverage

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