Monitoring Measles Eradication in the Region of the Americas: Critical Activities and Tools

Abstract

The purpose of this paper is to discuss methods recommended and used by the Pan American Health Organization (PAHO) to monitor the interruption of indigenous measles transmission in the Region of the Americas. The methods used include house-to-house monitoring of vaccination coverage as a supervisory tool during both campaigns and routine vaccination; thoroughly investigating all measles outbreaks; performing routine surveillance, including weekly reporting from at least 80% of reporting units; and validating routine surveillance through active-case searches at health care institutions and schools and in the community. The strategies described have helped PAHO to increase the authority and accountability of vaccine program managers at the local, provincial, and national levels. Their efforts have permitted the Region of the Americas to reduce to three the number of countries with indigenous measles transmission and to reach a record low of 503 measles cases in 2001.

Measles Virus Infection in Adults Induces Production of IL-10 and Is Associated with Increased CD4+CD25+ Regulatory T Cells

“…Enormous progress toward measles elimination has been made worldwide, including China, in large part due to the availability of a safe and effective vaccine (1)(2)(3)(4)(5). However, measles infections still cause 500,000 deaths annually, mostly due to subsequent opportunistic infections associated with immunosuppression (3).…”

Rapid monitoring in vaccination campaigns during emergencies: the post-earthquake campaign in Haiti

“…repeat mass vaccination -should be implemented in targeted geographical locations. 5,6 In nonemergency settings, mop-up vaccination is generally implemented as soon as a single unvaccinated child is identified among a convenience sample of children from 20 households Problem The earthquake that struck Haiti in January 2010 caused 1.5 million people to be displaced to temporary camps. The Haitian Ministry of Public Health and Population and global immunization partners developed a plan to deliver vaccines to those residing in these camps.…”

“…The population of such an area may have difficult access to a health clinic, be underserved by the health service or have a history of low vaccination coverage. 5,6 Similar rapid-monitoring approaches have been implemented in other WHO regions. However, such approaches have generally been applied to stable populations in areas where the risk of poor coverage has already been estimated.…”

“…4 Rapid monitoring is typically conducted in communities or neighbourhoods that are known to be at high risk of low vaccination coverage. 5,6 The large population movements in postearthquake Haiti made it impossible to identify areas of low coverage with any accuracy. Therefore, at the start of the emergency vaccination campaign, we assumed that there would be problems in achieving immunization targets in all communities in Port-au-Prince and so planned for rapid monitoring in every camp.…”

Use and abuse of rapid mnitoring to assess coverage during mass vaccination campaigns

“…5 The Rapid Coverage Monitoring strategy was designed to provide local authorities with "a quick impression of the completeness of vaccination". 6 While formalized during the measles initiative, the concept of rapid monitoring had been used in the Americas in the mid-to-late 1980s during the regional polio eradication effort (Jean Marc Olive, PAHO, personal communication).…”