Volume XXXVIII Number 3 Immunize and Protect Your Family September 2016 Region of the Americas is Declared Free of Measles Smallpox Zero: A Tribute to Dr. Donald A. Henderson Donald Ainslie Henderson, known as D.A. to many of his colleagues and field staff, passed away on 19 August 2016 surrounded by his family. He was well known for his leadership and guidance in establishing the immunization program that vanquished smallpox from the face of the earth under the auspices of the World Health Organization (WHO). To date, this is the only disease that has been eradicated using a vaccine.2 D.A.’s field experience with smallpox actually started in the Region of the Americas; in June 1956 he was sent to Argentina to assist authorities with an outbreak of botulism, but during this visit he also went to investigate smallpox outbreaks in northern Argentina upon the request of health authorities.3 D.A. used the lessons learned from the Smallpox Eradication Program (SEP) to advocate, within The declaration of measles elimination in the Region of the Americas at PAHO’s 55th meeting of the Directing Council, 27 WHO, for the establishment of what was to become September 2016. Credit: PAHO/WHO. the Expanded Program on Immunization (EPI) before he departed to become the dean of the On 27 September 2016 in Washington, DC, the Region of the Americas became the first in the world to School of Public Health at Johns Hopkins (now the have eliminated measles, a viral disease that can cause severe health problems, including pneumonia, brain Johns Hopkins Bloomberg School of Public Health) swelling and even death. This achievement culminates a 22-year effort involving mass vaccination against in 1977. measles, mumps and rubella throughout the Americas. At Johns Hopkins, D.A. used the experiences he The declaration of measles’ elimination was made by the International Expert Committee for Documenting and gained from the SEP to not only influence public Verifying Measles, Rubella, and Congenital Rubella Syndrome Elimination in the Americas. The announcement health curriculum at the school, but also encourage public health professionals to innovate and think came during the 55th Directing Council of the Pan American Health Organization/World Health Organization about new paradigms for confronting the challenges (PAHO/WHO), which was attended by ministers of health from throughout the Region. faced when attacking new emerging diseases, such as HIV. Later, D.A. would also go on to work for the Measles is the fifth vaccine-preventable disease to be eliminated from the Americas, after the regional U.S. government in several capacities, including eradication of smallpox in 1971, poliomyelitis in 1994, and rubella and congenital rubella syndrome in 2015. advising on issues of bio-terrorism, both before 9/11 “This is a historic day for our Region and indeed the world,” said PAHO/WHO Director Carissa F. Etienne. “It and after. is proof of the remarkable success that can be achieved when countries work together in solidarity towards a At the heart of D.A.’s thinking were several important common goal. It is the result of a commitment made more than two decades ago, in 1994, when the countries lessons learned from the successful push to end of the Americas pledged to end measles circulation by the turn of the 21st century.” smallpox, which he applied to his work tackling other public health issues. One was the importance Before mass vaccination was initiated in 1980, measles caused nearly 2.6 million annual deaths worldwide. of doing fieldwork, to understand what was going on In the Americas, 101,800 deaths were attributable to measles between 1971 and 1979. A cost-effectiveness first-hand and evaluate how a program was being study on measles elimination in Latin America and the Caribbean has estimated that with vaccination, 3.2 implemented. In 1975, D.A. met me in Bangladesh to million measles cases and 16,000 deaths will have been prevented in the Region between 2000 and 2020.1 have an in-person look at their smallpox eradication program. He spent three days with me in the Jessore See FREE OF MEASLES on page 2 district, which lies southwest of Dacca. We visited the outbreak I was working on. One problem that IN THIS ISSUE worried me there was the lack of wooden blocks to 1 Region of the Americas is Declared Free of Measles 5 Workshop on High-Quality Follow-Up Campaigns for hold the smallpox vials and protect them from the 1 Smallpox Zero: A Tribute to Dr. Donald A. Henderson Measles and Rubella Conducted in Peru 2 In 1769, British physician Edward Jenner demonstrated that “using 6 25 Years without Polio in the Americas bovine serum from cowpox” was effective in protecting individuals from 3 Questions and Answers on Measles Elimination smallpox infections (http://bit.ly/2iRPrzL). 4 Eliminating Measles: A Conversation among Experts 7 Measles/Rubella/Congenital Rubella Syndrome Surveillance Data, Final Classification, 2015 3 Donald A. Henderson, informed me of this at a PAHO TAG meeting held 5 Remembering the Moment: Measles Elimination in the Region 8 COLUMN: What I Have Learned... by Dr. Susan Reef in Guatemala circa 1990’s. I confirmed fact with Ms. Leigh Henderson, daughter of Donald and Nana Henderson, November 2016. See DA HENDERSON on page 3 2 Immunization Newsletter Volume XXXVIII Number 3 September 2016 Pan American Health Organization MEASLES continued from page 1 “This historic milestone would never have been strategies recommended by PAHO/WHO. possible without the strong political commitment of PAHO/WHO’s elimination strategy recommended our Member States in ensuring that all children have three lines of action for countries: 1) conduct a access to life-saving vaccines,” Etienne continued. “It one-time national campaign to bring children between would not have been possible without the generosity 1 and 14 years of age up-to-date with measles and commitment of health workers and volunteers vaccination; 2) strengthen routine vaccination to who have worked so hard to take the benefits of reach a minimum of 95% of children every year; and vaccines to all people, including those in vulnerable 3) undertake massive follow-up campaigns every four and hard-to-reach communities. Indeed it would not years, to reach a minimum of 95% of children aged 1 have been possible without the strong leadership to 4 with a second dose of vaccine. and coordination provided by PAHO, Regional Office for the Americas of WHO.” Following this strategy, the last indigenous measles Measles transmission had been considered outbreak was registered in Venezuela in 2002. interrupted in the Region since 2002, when the However, some countries in the Region still notified last endemic case was reported in the Americas. imported cases. Between 2003 and 2014, 5,077 imported measles cases were reported in the However, as the disease had continued to circulate WHO’s Director General, Dr. Margaret Chan (left), and in other parts of the world, some countries in PAHO’s Director, Dr. Carissa F. Etienne (right), celebrating the Americas. declaration of measles elimination. Credit: PAHO/WHO. the Americas experienced imported cases. The After declaring the elimination of rubella and International Expert Committee reviewed evidence congenital rubella syndrome in 2015, the on measles elimination presented by all the countries International Expert Committee waited for evidence of the Region between 2015 and August 2016 of the interruption of a measles outbreak in Brazil, and decided that it met the established criteria which had begun in 2013 and lasted for more than a for elimination. The process included six years of year. After a year of targeted actions and enhanced work with countries to document evidence of the surveillance, the last case of measles in Brazil was elimination. reported in July 2015. Measles is one of the most contagious diseases and With this achievement and considering that the affects primarily children. It is transmitted by airborne (Left to right): Dr. Susan Reef, Dr. Carissa F. Etienne, Dr. Region has sustained elimination for more than 12 droplets or via direct contact with secretions from Merceline Dahl-Regis and Dr. Mary Agocs participate in a press conference to declare measles elimination. Credit: years, the International Expert Committee accepted the nose, mouth, and throat of infected individuals. PAHO/WHO. the evidence presented by the countries and Symptoms include high fever, generalized rash all “I would like to emphasize that our work on this declared the elimination of measles in the Americas. over the body, stuffy nose, and reddened eyes. It can front is not yet done,” warned Etienne. “We can cause serious complications including blindness, not become complacent with this achievement but Key partners involved in the effort to eliminate encephalitis, severe diarrhea, ear infections and must rather protect it carefully. Measles still circulates measles and rubella include the ministries of health pneumonia, particularly in children with nutritional widely in other parts of the world, and so we must of PAHO/WHO’s Member States, the United States problems and in immunocompromised patients. be prepared to respond to imported cases. It is Centers for Disease Control and Prevention (CDC), critical that we continue to maintain high vaccination the United States Department of Health and Human As a result of global measles elimination efforts, only coverage rates, and it is crucial that any suspected Services, Health Canada, the (former) Canadian 244,704 measles cases were reported worldwide in measles cases be immediately reported to the International Development Agency, the Spanish 2015, representing a significant decline from earlier authorities for rapid follow-up.” Agency for International Development Cooperation, years. However, more than a half of these reported Process to eliminate measles the Sabin Vaccine Institute, the Serum Institute of cases were notified in Africa and Asia.