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EPI Newsletter, February 2001, Vol XXIII, Number 1

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EPI Newsletter, February 2001, Vol XXIII, Number 1 EPI Newsletter Expanded Program on Immunization in the Americas Volume XXIII, Number 1 IMMUNIZE AND PROTECT YOUR CHILDREN February 2001 Costa Rica Embarks on Accelerated Rubella and Congenital Rubella Syndrome Program Background 1999 rubella outbreak affected both men and women (a Costa Rica introduced rubella vaccine into the national ratio of 1.15 female/1 male. Results of a national serological vaccination schedule in 1972. No significant changes in the survey conducted in 1996 indicated that the seroprevalence trend of the disease were observed for the first two decades of susceptibles to rubella was 7% among preschool children due to the low coverage (40%) obtained. It was only in1984 and 36% for women of childbearing age. that vaccination coverage of approximately 80% was reached. The endemicity of rubella in Costa Rica and the fact that In 1992 a booster dose was included at 7 years of age recent outbreaks (1998-1999) had affected primarily women resulting in further decrease in the number of cases (Figure 1). of childbearing age suggested that cases of congenital For the last 14 rubella syndrome years, rubella out- Figure 1 (CRS) were occur- break cycles were re- Number of rubella cases by age group and vaccination strategies ring. However, the ported in 1987-1988 Costa Rica, 1977 to 1999 countrys compul- 1400 45 and over sory notification (1,079 cases), 1993- 25 to 44 May 2001 system had not re- 1994 (492 cases) and 1200 15 to 24 NID targeting NID and 10 to 14 men and change of women 15 to ported any case of 1998-1999 (1,282 1000 5 to 9 vaccination 39 years of 0 to 4 schedule age to reach CRS since 1992. cases). A progressive among risk elimination 800 groups reduction in the pro- of CRS and Introduction of a 2nd dose measles An active search portion of cases was 600 MR at 7 years Start of vaccination (1992) of CRS cases was with MR in 1972 NID with MR in observed in these out- MMR is added 1-4 and 7-14 400 in 1986 Age groups (1996-97) carried out at the breaks in the 15-24 National Childrens 200 age group from 45% Hospital by analyz- between 1987-1988, 0 ing the database of 9 7 4 9 to 25% between 77 78 7 80 81 82 83 84 85 86 8 88 89 90 91 92 93 9 95 96 97 98 9 2000 the immunology 1993-1994, to 11% Source: Information Center, Epidemiological Surveillance, Ministry of Health section of that hos- between 1998-1999. pitals laboratory. In the 25-44 age Cases of children group, a steady in- under 3 months of age were identified which had undergone crease to 23%, 31% and 41% respectively was observed. an IgM test for rubella virus with positive results between Furthermore, when analyzing attack rates by age group in the the periods of 1996 to 2000. Forty-nine children with CRS last two outbreaks it was observed that those at greater risk showing the following diagnosis were detected: 20 cases were in the 20-29 age group, followed by the 30-39 age group with hepato-splenomegaly (41%); 10 with microcephaly (Figure 2). (20%); 10 multi-malformation (20%); 7 without a known Rubella incidence by sex has not shown important cause (15%); and 2 cases with cataracts (4%). None of the differences since the introduction of the vaccine. The 1998- records hinted to any suspicion of rubella, and the main In this issue: Costa Rica Embarks on Accelerated Rubella and Congenital Rubella WHO Position on Use of Measles Mumps and Rubella (MMR) Vaccine .. 5 Syndrome Program .............................................................................. 1 Analysis of Country Performance of AFP Surveillance and Vaccination March of Dimes Foundation Renews Support to PAHO ......................... 3 Coverage ............................................................................................. 6 Update: OPV-Derived Poliomyelitis Outbreak in the Dominican Republic Reported Cases of Selected Diseases .................................................... 7 and Haiti ............................................................................................... 4 In Memoriam of Polio Pioneers Dorothy M. Horstmann and Joseph Melnick . 8 diagnosis was TORCHS (toxoplasmosis, rubella, cytome- surveillance aimed at consolidating measles eradication and galovirus, herpes simplex virus, varicella-Zoster virus and ensuring rubella and CRS prevention. syphilis). The Plan incorporates the following strategies: The magnitude of CRS in Costa Rica also became Intersectoral action, especially with the education and evident in the preliminary results of a study of deafness labor sectors. conducted between 1996-1997, which evaluated the hearing Social mobilization with the community as well as politi- of a total of 12,612 first graders in 250 schools in the cal, union and religious leaders, community associations, country. The survey detected a 4% prevalence of deafness presidents of student federations, representatives of among school-aged children, whose source was unknown secondary education, artists, entrepreneurs, local non- in 40% of the cases, congenital in 38% and acquired in 22%. governmental organizations, and the media. A history of rubella during pregnancy was reported as one of the leading causes of acquired deafness. Integrated management between the Ministry of Health and CCSS. These results only partially reflect the severity of CRS in Planning and management of the countrys health service the country, since they only correspond to cases of children networks. under 3 months of age detected at the National Childrens Hospital, and to a study showing the situation of deafness Interagency cooperation for effective resource mobiliza- among schoolchildren, as well as their difficulties in being tion. inserted into society. International coop- This information also Figure 2 eration for technical pointed to a serious un- Distribution of rubella cases and attack rates by age group cooperation and re- derreporting of CRS Costa Rica, 1999* source mobilization. # Cases Rates cases in the notifica- A National Com- tion system. 450 70 400 mission of Immuni- Action Plan for 60 zation chaired by the 350 Cases Rates Rubella and CRS 50 Health Minister is di- Prevention 300 recting the Action 250 40 The analysis of Plan, and a Commis- epidemiological data 200 30 sion led by the Vice 150 on rubella and CRS 20 Minister of Health will from the early seven- 100 coordinate the activi- 10 ties, the results of 50 ties. A Coordinating seroprevalence stud- 0 0 Commission has been ies, the evaluation of <1 1-4 5-14 15-19 20-29 30-39 40-44 =>45 established to over- see vaccination cam- coverage and the ex- Source: Costa Rica Ministry of Health * Preliminary data perience of the coun- paigns and epidemio- try with rubella vacci- logical surveillance. As nation for several decades prompted Costa Ricas health part of the vaccination campaign component, the Commis- authorities at the Ministry of Health and its Social Security sion will oversee the areas of logistics, cold chain and Administration (CCSS) to work towards the prevention of immunization safety, mass media, social communication, rubella and CRS. In support of this goal, both the Ministry social participation, system of registries, staff training and and Costa Ricas Social Security have developed an Action supervision. For the epidemiological surveillance compo- Plan which seeks the: nents, two working teams will focus on strengthening Implementation of a national mass campaign for men and measles and rubella monitoring, as well as the development women 15-39 years of age with rubella and measles- and implementation of a CRS surveillance system. containing vaccines The national campaign will be coordinated with the Maintenance of MMR in childhood vaccination sched- regional and local epidemiology and vaccination commis- ules sions throughout the entire country. Social mobilization is Vaccination against measles and rubella of all postpartum expected to be widely used. Activities have included: women that have not been previously vaccinated Identification of needs of the different organizations at Updating and strengthening of the integrated measles and the community level (municipalities, schools, trade, church, rubella surveillance system and local organized groups). Development of a CRS surveillance system. Identification of national personalities that should partici- The national campaign will take place May 2-31, 2001. pate in the social communication efforts during vaccina- The Action Plan promotes the use of an integrated tion campaigns (soccer players, singers, actors, religious vaccination strategy and strengthening of epidemiological and political leaders, societies and professional schools). 2 Preparation and dissemination of a mass media proposal Editorial Note: Together with the efforts of the En- for the vaccination campaign. glish-speaking Caribbean countries and Chile, the initiative This initiative represents a joint effort of national health of Costa Ricas Ministry of Health and its Social Security institutions represented in the Ministry of Health and the Administration will generate useful knowledge and experi- CCSS, specialized agencies and the international commu- nity. The Pan American Health Organization and the Centers ence for the development of strategies for rubella and CRS for Disease Control and Prevention are providing financial prevention and control in the Americas, and for their and technical support. eventual eradication. Costa Ricas Action Plan is consistent Source: For more information regarding this initiative, please contact with the recommendations of PAHOs Technical
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