Guidelines for surveillance of congenital rubella syndrome in the Region of the Americas

The elimination of congenital rubella syndrome (CRS) in the Region of the Americas represents a historic milestone in public health, achieved through sustained immunization and epidemiological surveillance strategies. Circulation of the rubella virus in other global regions, however, continues to pose a risk of reintroduction, with potential transmission to susceptible individuals and a consequent risk of infection in pregnant women, fetal infection, and congenital rubella syndrome in newborns. These technical guidelines, developed by the Pan American Health Organization (PAHO), provide a regulatory and operational framework for enhancing CRS surveillance in the countries of the Region. They include updated case definitions, clinical and laboratory criteria, classification algorithms, investigation procedures, and tools for active institutional and community case-finding. They also provide standardized indicators for monitoring the performance of the surveillance system, which are essential to verify the sustainability of rubella elimination. The guidelines provide for exhaustive follow-up of pregnant women exposed to the rubella virus, recognizing the importance of early detection and timely intervention in newborns with suspected rubella infection. CRS surveillance not only enables the timely detection of imported or import-related cases but helps document the absence of endemic transmission, protect vulnerable populations, and consolidate the achievements of the countries of the Region of the Americas. PAHO invites health teams, national authorities, and strategic partners to implement these guidelines as an integral part of their surveillance programs. Maintaining CRS elimination requires technical commitment, intersectoral coordination, and ongoing action. No child in the Region should be born with a vaccine-preventable disease; together, we can make that a reality.