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      Transitioning Lessons Learned and Assets of the Global Polio Eradication Initiative to Global and Regional Measles and Rubella Elimination


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          The Global Polio Eradication Initiative has built an extensive infrastructure with capabilities and resources that should be transitioned to measles and rubella elimination efforts. Measles continues to be a major cause of child mortality globally, and rubella continues to be the leading infectious cause of birth defects. Measles and rubella eradication is feasible and cost saving. The obvious similarities in strategies between polio elimination and measles and rubella elimination include the use of an extensive surveillance and laboratory network, outbreak preparedness and response, extensive communications and social mobilization networks, and the need for periodic supplementary immunization activities. Polio staff and resources are already connected with those of measles and rubella, and transitioning existing capabilities to measles and rubella elimination efforts allows for optimized use of resources and the best opportunity to incorporate important lessons learned from polio eradication, and polio resources are concentrated in the countries with the highest burden of measles and rubella. Measles and rubella elimination strategies rely heavily on achieving and maintaining high vaccination coverage through the routine immunization activity infrastructure, thus creating synergies with immunization systems approaches, in what is termed a “diagonal approach.”

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          Measles is an infectious disease in humans caused by the measles virus (MeV). Before the introduction of an effective measles vaccine, virtually everyone experienced measles during childhood. Symptoms of measles include fever and maculopapular skin rash accompanied by cough, coryza and/or conjunctivitis. MeV causes immunosuppression, and severe sequelae of measles include pneumonia, gastroenteritis, blindness, measles inclusion body encephalitis and subacute sclerosing panencephalitis. Case confirmation depends on clinical presentation and results of laboratory tests, including the detection of anti-MeV IgM antibodies and/or viral RNA. All current measles vaccines contain a live attenuated strain of MeV, and great progress has been made to increase global vaccination coverage to drive down the incidence of measles. However, endemic transmission continues in many parts of the world. Measles remains a considerable cause of childhood mortality worldwide, with estimates that >100,000 fatal cases occur each year. Case fatality ratio estimates vary from 5% in developing countries. All six WHO regions have set goals to eliminate endemic transmission of MeV by achieving and maintaining high levels of vaccination coverage accompanied by a sensitive surveillance system. Because of the availability of a highly effective and relatively inexpensive vaccine, the monotypic nature of the virus and the lack of an animal reservoir, measles is considered a candidate for eradication.
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            Using Seroprevalence and Immunisation Coverage Data to Estimate the Global Burden of Congenital Rubella Syndrome, 1996-2010: A Systematic Review

            Background The burden of Congenital Rubella Syndrome (CRS) is typically underestimated in routine surveillance. Updated estimates are needed following the recent WHO position paper on rubella and recent GAVI initiatives, funding rubella vaccination in eligible countries. Previous estimates considered the year 1996 and only 78 (developing) countries. Methods We reviewed the literature to identify rubella seroprevalence studies conducted before countries introduced rubella-containing vaccination (RCV). These data and the estimated vaccination coverage in the routine schedule and mass campaigns were incorporated in mathematical models to estimate the CRS incidence in 1996 and 2000–2010 for each country, region and globally. Results The estimated CRS decreased in the three regions (Americas, Europe and Eastern Mediterranean) which had introduced widespread RCV by 2010, reaching <2 per 100,000 live births (the Americas and Europe) and 25 (95% CI 4–61) per 100,000 live births (the Eastern Mediterranean). The estimated incidence in 2010 ranged from 90 (95% CI: 46–195) in the Western Pacific, excluding China, to 116 (95% CI: 56–235) and 121 (95% CI: 31–238) per 100,000 live births in Africa and SE Asia respectively. Highest numbers of cases were predicted in Africa (39,000, 95% CI: 18,000–80,000) and SE Asia (49,000, 95% CI: 11,000–97,000). In 2010, 105,000 (95% CI: 54,000–158,000) CRS cases were estimated globally, compared to 119,000 (95% CI: 72,000–169,000) in 1996. Conclusions Whilst falling dramatically in the Americas, Europe and the Eastern Mediterranean after vaccination, the estimated CRS incidence remains high elsewhere. Well-conducted seroprevalence studies can help to improve the reliability of these estimates and monitor the impact of rubella vaccination.
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              The expanded programme on immunization: a lasting legacy of smallpox eradication.

              Since the mid-1970s, the widespread establishment and implementation of the Expanded Programme on Immunization (EPI) has led to remarkable achievements in controlling vaccine preventable diseases worldwide. Today, more children than ever are being reached with immunization; interruption of poliomyelitis transmission has occurred in most countries; mortality due to measles, tetanus, diphtheria and pertussis has been reduced to record low levels. In addition, increasing numbers of vaccines are being used for infants and older age persons, such as vaccines against hepatitis A and hepatitis B, Haemophilus influenzae type b, rotavirus, pneumococcus, meningococcus, human papilloma virus (HPV) and varicella. The design of EPI reflects in large part the experience accumulated during the implementation of the intensified campaign for smallpox eradication during the period 1966-1977. At that time, the existing health infrastructure and network was found inadequate to reach most individuals with community wide immunization programmes in most countries. Thus, efforts were made to train dedicated health personnel and allocate specific resources for programme coordination and implementation. With the establishment of EPI, there was a gradual shift in emphasis from vaccination campaign strategies using mobile teams to the delivery of immunization services as part of routine health services of health facilities. Both the campaign and the outreach strategies are nevertheless required to reach those segments of the population not reached by the routine health services and to accelerate the achievement of disease control initiatives such as polio eradication and measles elimination. Whilst the campaign for smallpox eradication was set up as special and time-limited effort, the EPI requires long-term sustainable approaches to protect new cohorts of susceptible persons with vaccination and monitor trends and progress towards disease control with high quality surveillance. Copyright © 2012 Elsevier Ltd. All rights reserved.

                Author and article information

                J Infect Dis
                J. Infect. Dis
                The Journal of Infectious Diseases
                Oxford University Press (US )
                01 July 2017
                01 July 2017
                : 216
                : Suppl 1 , Polio Endgame & Legacy-Implementation, Best Practices, and Lessons Learned
                : S308-S315
                [1 ] Expanded Program on Immunization, Immunizations, Vaccines, and Biologicals Department, World Health Organization , Geneva, Switzerland;
                [2 ] Health Section, Program Division, United Nations Children’s Fund , New York, New York; and
                [3 ] Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention , Atlanta, Georgia
                Author notes

                Correspondence: K. Kretsinger, MD, Expanded Program on Immunization, Immunizations, Vaccines, and Biologicals, World Health Organization, Avenue Appia 20, CH-1211, Geneva, Switzerland ( kretsingerk@ 123456who.int ).

                © The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution 3.0 IGO (CC BY 3.0 IGO) License ( https://creativecommons.org/licenses/by/3.0/igo/) which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.

                Page count
                Pages: 8
                Supplement Article

                Infectious disease & Microbiology
                measles,rubella,poliomyelitis,vaccine-preventable diseases,polio transition,polio legacy.


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