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Progress Toward Measles Elimination—Region of the Americas, 2002–2003 In 1994, countries in the Region of the Americas adopted the goal of eliminating endemic measles transmission in the Western hemisphere by 2000. Since 1994, rapid progress has been made. The number of measles cases has declined >99%, from approximately 250 000 in 1990 to 105 confirmed cases reported in 6 countries in 2003. During 2003, only Mexico and the US reported outbreaks. Since November 2002, no transmission of the D6 and D9 genotypes has been reported; these genotypes were responsible for several large outbreaks in the region during 1997–2002. This report summarizes the epidemiology of measles in the Americas during 2002–2003. Because the region is under constant threat of measles importation from regions where the disease is endemic, countries must maintain high population immunity to measles and sensitive surveillance to ensure the timely detection of imported cases and allow for rapid implementation of control measures. Key vaccination activities in the measles-elimination initiative include implementing the Pan American Health Organization’s recommended vaccination strategies or attaining ≥95% routine vaccination coverage with 2 doses of measles-containing vaccine. Special efforts in the region have focused on identifying and increasing vaccination levels in districts at high risk because of high population density, high rural-to-urban migration, presence of indigenous populations and tourism, populous border regions, areas with low vaccination coverage, and areas with poor surveillance or poor access to health services. The most important of these activities was nationwide supplemental immunization activities (SIAs). The estimated number of children vaccinated against measles in SIAs was 10.4 million in 2000, 10.6 million in 2001, and 9.9 million in 2002. Routine measles vaccination coverage for the region was 94% in 2000, 96% in 2001, and 92% in 2002. In 2002, reported routine coverage ranged from 51% in the Latin American/Caribbean subregion to 99% in the Southern Cone subregion (ie, Argentina, Chile, Paraguay, Uruguay). Coverage of ≥90% was reported by 28 countries; 12 reported coverage of <90%. During 2002–2003, the number of suspected measles and rubella cases notified to national surveillance systems decreased from 46 629 to 30 118. The proportion of suspected cases with a timely home visit for case investigation increased from 65% in 2002 to 85% in 2003. During 2002–2003, the proportion of persons with suspected measles with adequate specimens taken for laboratory diagnosis increased from 74% to 81%, and the proportion of notification sites sending weekly reports increased from 85% to 91%. The rate of notification of febrile rash illnesses that are not measles, rubella, or dengue declined from 6.7 per 100 000 population in 2001, to 6.2 in 2002, and to 4.6 in 2003. In 2002, a total of 2584 confirmed measles cases were reported in the Americas. Of these, 2397 occurred during an outbreak in Venezuela after an importation of a D9 measles virus from Europe. The age groups most affected were children aged <1 year (120 cases per 100 000 population). This outbreak spread to Colombia, where 139 cases were reported. The last confirmed measles case in these outbreaks, and the last case attributed to the D9 virus in the Americas, occurred in Venezuela in November 2002. In 2002, an additional 44 confirmed cases were reported in the US, 6 were reported in Canada, and one was reported in Brazil. In 2003, a total of 105 confirmed measles cases were reported in the Americas, the lowest number ever reported in the region. Of these, one occurred in Chile, one in Costa Rica, 2 in Brazil, 15 in Canada, 42 in the US, and 44 in Mexico. The case in Chile occurred in a man aged 33 years who had rash onset after travel to Japan. The case in Costa Rica occurred in a man aged 38 years who had rash onset after returning from travel to India. In Brazil, the first case occurred in a man aged 34 years who had rash onset after travel to Germany, England, and Holland. The second case occurred in a child aged 11 months of the initial patient. The 15 cases in Canada were all imported. Of 42 US cases, 33 were imported or linked to an importation; the remaining 9 cases were of unknown origin. During 2003, Mexico reported 3 chains of transmission, with a total of 44 confirmed measles cases. Of the 44 confirmed cases, 14 occurred in infants aged <1 year and 12 in adults aged 20–29 years; 42 patients were unvaccinated. To control the outbreaks, Mexican authorities conducted clinical and epidemiologic case studies and active case searches around homes of confirmed patients and in areas at high risk. Approximately 10 million children aged 6–11 years were vaccinated as well as groups at high risk (eg, healthcare workers). During 2003, 2 measles-related deaths occurred in the US. One death occurred in an immunosuppressed male aged 13 years who had neurologic complications and had measles virus isolated from a brain biopsy. The other fatal case occurred in a man aged 75 years who, within 2 weeks of his arrival from overseas, had a rash illness and subsequently died of pulmonary and neurologic complications. Serologic tests were positive for measles immunoglobulin M. The H1 virus genotype, known to circulate in parts of Eastern Asia, was identified from 3 separate chains of transmission in Mexico and from one chain of transmission in Hawaii that were either imported from the Marshall Islands (H1) or of unknown source. This genotype also was found in Chile’s imported measles case. The D9 virus, imported from Europe, circulated for 16 months in Venezuela and Colombia during 2001 through November 2002. In addition to the Hawaiian cases, outbreaks and cases reported in the US during 2003 for which viral genotype information was available were associated with travel from Lebanon (D4), Germany (D7), France or Italy (D7), and Israel (D6). (MMWR 2004;53:304-6)