The Caribbean experience in maintaining high measles vaccine coverage.

The Caribbean subregion was the first area of the world to eliminate measles. From 1991 through 2010, the 21 countries of the subregion were remarkably successful in maintaining their measles-free status despite importations of the virus from areas where it continues to circulate. This task has been accomplished by ensuring that each country in the subregion maintains measles vaccine coverage of ≥95%. The absence of measles is the result of a collaboration between the various national authorities and the Pan American Health Organization in ensuring vaccination campaigns to deliver the second dose of a measles-containing vaccine, estimating and validating vaccine coverage for both the first and second doses of measles vaccine for all local populations; developing detailed plans of action to improve coverage in those populations where coverage is <95%; providing technical assistance for the implementation of the plan; and performing follow-up to confirm that all aspects of the plans were in fact implemented and that the target vaccination level was achieved. These efforts have been extremely successful in maintaining high vaccine coverage and, therefore, in keeping the virus from circulating on those occasions when it has been reintroduced into the subregion. Although sophisticated statistical methods have been used to identify weaknesses in national vaccine programs, the program is basically quite simple and can be systematically implemented in any country that has the desire to eliminate measles from its population.