Successes and challenges in achieving and sustaining the elimination of measles, rubella, and congenital rubella syndrome in the Americas, 2013-2023Conquistas e desafios para alcançar e manter a eliminação do sarampo, da rubéola e da síndrome da rubéola congênita na Região das Américas, 2013-2023

To document the historical facts and the challenges faced in the Region of the Americas in achieving and sustaining measles, rubella, and congenital rubella syndrome (CRS) elimination between 2013 and 2023. Special report with a narrative description of the main achievements, challenges, and lessons learned during the period, and an analysis of vaccination coverage, surveillance indicators, and measles outbreaks using data from the Pan American Health Organization and the United Nations Children's Fund, among others. Between 2003 and 2016, regional vaccination coverage with the first dose of the measles, rubella, and mumps vaccine was between 92% and 94%; after 2017 there was a marked decline due to lower coverage levels in the most populous countries. The regional reporting rate of suspected cases remained at the expected level, with differences in each subregion. Between 2017 and 2023, measles outbreaks tested the strengths and weaknesses in the quality of each country's response. Starting in 2020, the COVID-19 pandemic had a negative impact on both vaccination coverage and the quality of epidemiological surveillance. The elimination of measles in 2016 and rubella in 2015 were major achievements in the Region of the Americas. Between 2017 and 2020, the main challenge was to address measles outbreaks that caused the re-establishment of endemic transmission in two countries. Between 2020 and 2023, the main challenge was to tackle the negative impact of the COVID-19 pandemic on declining vaccination coverage and surveillance indicators.