Since the World Health Assembly (WHA) in 2012 endorsed the Global Vaccine Action Plan (GVAP), which included regional measles and rubella elimination goals by 2020, global progress towards verification of measles and rubella elimination has been incremental. Even though the 2020 elimination goals were not achieved, commitment towards achieving measles and rubella elimination has been firmly established in the Immunization Agenda 2030 (IA2030) and the Measles and Rubella Strategic Framework (MRSF) 2021–2030. In 2023, the six Regional Verification Commissions for measles and rubella elimination (RVCs) reviewed data as of 31 December 2022 and confirmed that 82 (42%) Member States have been verified for measles elimination, and 98 (51%) Member States have been verified for rubella elimination. The six RVCs are composed of independent public health and immunization experts who are well-placed to support accelerating measles and rubella elimination. RVCs should be leveraged not only to review elimination documents but also to advocate for and champion public health programming that supports measles and rubella activities. The verification of elimination process is one of many tools that should be deployed to reinforce and accelerate efforts towards achieving a world free of measles and rubella.

Background: Microarray patches (MAPs) are innovative, needle-free vaccine delivery systems, suitable for administration by minimally trained health care workers or trained community health workers. Their introduction may transform immunization programmes, particularly for vaccines where high coverage is required for population immunity, such as measles, and where vaccine delivery is challenging, such as in low- and middle-income countries. Recognizing the need to understand how best to tailor these products to reflect country priorities, workshops on measles and rubella MAPs (MR-MAPs) were conducted in multiple regions to collect insights on needs and preferences from relevant stakeholders at country level. Methods: The CAPACITI Innovation Framework was used to structure stakeholder discussions in nine countries in the period from August 2022 to July 2023. The discussions, building on the findings from a situation analysis on the barriers related to measles and rubella vaccine delivery, followed the four-step process outlined in the framework. Results: Key barriers hindering delivery of measles and rubella vaccines across the countries were in the categories of human resource management, service delivery, and demand generation. MR-MAP attributes that stakeholders believed would reduce or eliminate these barriers included ease of preparation and administration, improved thermostability, fewer (ancillary) components, and single-dose presentation. Some attributes such as the site of administration, wear time, and storage volume could exacerbate certain barriers. Based on an understanding of key barriers, product attributes, and underserved populations, stakeholders identified several potential use cases for MR-MAPs: (i) delivery at a fixed health post, (ii) delivery through outreach sessions conducted by health workers, and (iii) administration by community health workers. To enable robust national decision making about the introduction of MR-MAPs and successful implementation, global and national evidence on feasibility and acceptability of MR-MAPs should be generated. To prepare for the potential introduction of MR-MAPs, immunization programmes should evaluate their immunization policies based on their preferred use cases and modify them if needed, for example, to enable community health workers to administer vaccines, along with making programmatic adjustments to waste management and training. Conclusions: MR-MAPs have the potential to reduce key barriers to MR delivery. Yet, their future impact depends on the ability of global stakeholders to steer the development of MR-MAPs to be responsive to country needs and preferences. The generation of evidence to enable robust decision making, timely modification of vaccine policies, and addressing programmatic considerations will be key to successful uptake.

This report reviews national data from all Member States on measles, rubella, and congenital rubella syndrome (CRS) elimination in the Region of the Americas during 2019–2023. It includes an analysis of compliance with vaccination coverage, surveillance indicators, and measles outbreaks, as well as an analysis of the response capacity of the laboratory network and a country case study that meets all indicators. The sources of information were the integrated epidemiological surveillance system for measles and rubella of the Pan American Health Organization (PAHO)/World Health Organization (WHO) and the Joint Reporting Form (eJRF), among others. From 2020 to 2022, regional coverage with first (MMR-1) and second doses (MMR-2) decreased to rates below 90%. The regional suspected case notification rate was maintained above the minimum expected 2.0 suspect cases per 100,000 population, except in 2021. During 2019 to 2023, 18 countries experienced outbreaks, with two of the outbreaks resulting in re-established endemic transmission. In conclusion, two countries in the Americas have not maintained measles elimination, but by the end of 2023 no country showed endemic measles transmission. One of the countries that lost its certification of elimination in 2018 managed to be reverified in 2023; the other is pending reverification. All countries maintained rubella elimination. Despite these challenges, the sustainability of the elimination of these diseases remains a health priority in the Region.

Documentar los hechos históricos y desafíos que la Región de las Américas enfrentó para alcanzar y sostener los grandes logros de la eliminación del sarampión, la rubéola y el síndrome de rubéola congénita (SRC) entre el 2013 y el 2023. Informe especial que incorpora la descripción narrativa de los principales logros, desafíos y lecciones aprendidas durante ese período y el análisis de coberturas de vacunación, indicadores de vigilancia y brotes de sarampión mediante datos de la Organización Panamericana de la Salud y del Fondo de las Naciones Unidas para la Infancia, entre otros. Entre el 2003 y el 2016, la cobertura de vacunación regional con la primera dosis de vacuna contra el sarampión, la rubéola y la parotiditis estuvo entre 92% y 94%; después del 2017 tuvo un descenso marcado determinado por las coberturas de países de mayor población. La tasa de notificación regional de casos sospechosos se mantuvo en el nivel esperado con diferencias en cada subregión. Entre el 2017 y el 2023, los brotes de sarampión pusieron a prueba las fortalezas y las debilidades en la calidad de la respuesta de cada país. La pandemia de COVID-19 tuvo un impacto negativo a partir del 2020, tanto en coberturas de vacunación como en la calidad de la vigilancia epidemiológica. Los grandes logros de la Región de las Américas fueron la eliminación del sarampión en el 2016 y la rubéola en el 2015. Entre el 2017 y el 2020, el primer desafío fueron los brotes de sarampión que ocasionaron el restablecimiento de la transmisión endémica en dos países, y el segundo desafío fue el impacto negativo de la pandemia de COVID-19 entre el 2020 y el 2023, en el descenso de coberturas de vacunación e indicadores de vigilancia.

Documentar y comparar los factores de riesgo y medidas de control de los brotes de sarampión de mayor magnitud en la era poseliminación en la Región de las Américas. Descripción de los factores de riesgo como coberturas de vacunación, tasa de notificación de casos sospechosos e incidencia de sarampión, y un resumen de las medidas de control de los principales brotes de sarampión en seis países, entre el 2017 y el 2023. El plan de análisis también incluye la revisión de las características de los brotes en tiempo, lugar y persona. Entre los años 2017 y 2023, 19 países de las Américas notificaron un total de 50 082 casos y 121 muertes por sarampión. De esos casos, 49 738 (99,3%) se notificaron en seis países: Argentina, Brasil. Colombia, Estados Unidos de América, México y Venezuela. En dos de estos seis países se restableció la transmisión endémica por la presencia de factores de riesgo que no pudieron resolverse con las medidas de control inicialmente establecidas. Entre el 2017 y el 2019, los genotipos y linajes predominantes fueron el D8 linaje MVi/Hulu Langat.MYS/26.11 y el D8 linaje Gir Somnath.IND/42.16. Los países que tuvieron mejores coberturas con dos dosis de vacuna contra sarampión, rubéola y parotiditis, tasas de notificación de casos sospechosos óptimas y tasas de incidencia <5 casos por millón de habitantes respondieron mejor y con mayor rapidez a los brotes de sarampión, y lograron interrumpir la transmisión del virus antes de doce meses de circulación.