Measles and rubella eradication in the Americas.

The challenge for regions embarking on measles elimination will be to maintain high population immunity with excellent vaccination coverage and high-quality surveillance. Meeting this challenge will be especially critical for dealing with importations of measles virus that will occur as long as the virus is circulating anywhere in the world. Implementation of measles elimination strategies will uncover the "hidden" disease burden of rubella and congenital rubella syndrome. As was the experience in countries of Latin America and the Caribbean (LAC), integrating the elimination of measles with the elimination of rubella will greatly enhance the capacity of countries to sustain progress in the reduction of measles mortality. Countries of LAC prioritized the routine national immunization program over short-term successes. While doing so, they have also encountered new opportunities to expand the benefits of disease control and elimination activities to other aspects of public health, most importantly towards improving health care for women and newborns and reducing inequities in health in the region's poorest communities. Implementation of similar strategies could lead to the global eradication of measles, rubella, and congenital rubella syndrome early this century, while strengthening routine immunization programs, and developing the capacity to introduce new and underutilized vaccines.

Strengthening surveillance: confronting infectious diseases in developing countries.

Effective management and coordination in regions currently lacking surveillance capacity will require significant increases in existing human resources to manage vitally needed expanded national systems. An adequate investment in human resources is essential for ensuring surveillance functions well. This was the experience in the Americas. By taking this path, other benefits to the overall public health of nations will occur. Monitoring deaths will help as an indicator for impending epidemics or other threats. Better equipped labs will detect antigen shifts in virus and circulating bacterial serotypes more rapidly and other earlier changes in patterns of transmission more efficiently. Any strategy must promote and galvanize the commitment of countries to excellence, equity, and access, above all.