Ramped-Up Campaign Lowers Global Rubella Cases by 86%

Diedtra Henderson

December 06, 2013

One year after the World Health Organization (WHO) updated its guidance on the preferred strategy for introducing vaccines to combat rubella, the number of reported rubella cases among WHO member states dropped by 86%. However, some populations remain vulnerable for outbreaks, according to a new report.

Alya J. Dabbagh, PhD, from the Department of Immunization, Vaccines, and Biologicals, WHO, Geneva, Switzerland, and coauthors present their findings in an article published in the December 6 issue of the Morbidity and Mortality Weekly Report.

Although children and adults usually only suffer a mild fever and rash, rubella risks spike among pregnant women, especially if they are infected in the first 3 months of pregnancy. Infection can result in miscarriages, stillbirths, or congenital rubella syndrome (CRS).

In 2011, the WHO recommended that member states introduce rubella-containing vaccines (RCVs) to tamp down these risks, and campaigns targeted children aged from 9 months to 15 years. In addition, the global health organization recommended leveraging measles control programs as a vehicle to introduce RCVs. The World Health Assembly aims to completely eliminate rubella in 2 WHO regions by 2015 and wipe out measles and rubella in 5 WHO regions by 2020.

"Following a period of steady but slow increases in rubella control, a new phase of accelerated rubella control and CRS prevention has begun, marked by the 2011 WHO position paper recommending a strategy to eliminate rubella and CRS, and emphasizing RCV introduction in all member states and the linkage of rubella to measles control activities," Dr. Dabbagh and colleagues report. "Programmatic integration of RCV into an existing measles schedule is straightforward, involving no increase in the number of injections or in cold-chain requirements with a combined measles-rubella vaccine, no change in age of vaccine administration, and minimal change in recording and reporting formats."

From 2000 to 2012, rising numbers of WHO member states began using RCVs in their immunization program and began reporting rubella and CRS surveillance data. As of December 2012, 132 (68%) WHO member states had introduced RCV, a 33% increase from 99 member states in 2000. Some 43% of infants had received a RCV dose in 2012, a 96% increase from the 22% of infants who had been vaccinated against rubella in 2000.

Just 94,030 rubella cases were reported to the WHO in 2012 from 174 member states, an 86% decrease from the 670,894 cases reported in 2000 from 102 member states.

Still, rubella outbreaks that infected more than 2000 people were reported in 2012 in Japan, Poland, and Romania — WHO member states with established rubella control programs. Because those vaccination efforts targeted girls and women, a "large proportion" of the population remains vulnerable to infection, especially men, the authors note. The authors also point to missed opportunities, as in 2012, 83% of the world's children received their first dose of measles-containing vaccine, whereas just 43% of infants received their first rubella vaccination.

"With a new phase of rubella control, member states should consider introducing or strengthening RCVs immunization activities and strengthening their existing rubella and CRS surveillance systems," the researchers conclude.

Morb Mortal Wkly Rep. 2013;62:983-986. Full text

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