Integrating measles and rubella surveillance: the experience in the Caribbean

In 1988, the Ministers of Health in the Caribbean Community resolved to eliminate cases of indigenous measles. Specific performance indicators were developed to regularly monitor the program. In 1998, selected countries in the Caribbean elected to accelerate rubella control. As a first step, surveillance for both measles and rubella was integrated, using the measles eradication system as a template. Between 1995 and 2000, 98%-99% of the surveillance sites reported weekly. During that time, the number of suspected measles and rubella cases that were disqualified by laboratory testing remained relatively constant at 94%-99%; however, the indicator for suspected cases investigated within 48 h improved from 89% in 1996 to 95% in 2000. This integrated surveillance system has thus proven to be as effective and efficient as the measles surveillance system alone. Limited changes were made to the initial measles system, and the transition was relatively smooth. The integrated system has been crucial to the control of rubella and for the maintenance of measles elimination in the Caribbean.