Progress Toward Control of Rubella and Prevention of Congenital Rubella Syndrome—Worldwide, 2009
JID
Progress Toward Control of Rubella and Prevention of Congenital Rubella Syndrome-Worldwide, 2009
S. E. Reef 1
P. Strebel 0
A. Dabbagh 0
M. Gacic-Dobo 0
S. Cochi 1
0 Department of Immunization , Vaccines, and Biologicals , World Health Organization , Geneva , Switzerland
1 Global Immunization Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention , Atlanta , Georgia
Rubella, usually a mild rash illness in children and adults, can cause serious consequences when a pregnant woman is infected, particularly in early pregnancy. These serious consequences include miscarriage, fetal death or an infant born with birth defects (i.e., congenital rubella syndrome (CRS)). The primary purpose for rubella vaccination is the prevention of congenital rubella infection including CRS. Since 1969, several rubella virus vaccines have been licensed for use; however, until the 1990s, use of rubella-containing vaccine (RCV) was limited primarily to developed countries. In 1996, it was estimated that 110,000 infants with CRS were born annually in developing countries. In 2000, the first World Health Organization rubella vaccine position paper was published to guide introduction of RCV in national childhood immunization schedules. From 1996 to 2009, the number of countries that introduced RCV into their national routine childhood immunization programs increased by 57% from 83 countries in 1996 to 130 countries in 2009. In addition, three of the six WHO regions established rubella control and CRS prevention goals: Region of the Americas and Europe rubella elimination by 2010 and 2015, respectively, and Western Pacific Region-accelerated rubella control and CRS prevention by 2015. Also, during this time period, the number of rubella cases reported decreased from 670,894 in 2000 to 121,344 in 2009. Rubella control and prevention of CRS can be accelerated by integrating with current global measles mortality reduction and regional elimination activities.
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Rubella usually is a mild, febrile rash illness in children
and adults; however, infection early in a woman’s
pregnancy, particularly during the first 16 weeks, can
result in miscarriage, fetal death, or an infant born with
birth defects (ie, congenital rubella syndrome [CRS])
[
1
]. In 2000, the World Health Organization (WHO)
published the first rubella vaccine position paper to
guide introduction of rubella-containing vaccine (RCV)
in national childhood immunization schedules [
2
].
As of December 2009, a total of 130 WHO member
states had introduced RCV, a 57% increase from 83
member states in 1996. In addition, goals to eliminate
rubella and CRS were established in the WHO Region of
the Americas (by 2010) and the WHO European Region
(by 2015; (during the September 2010 WHO Regional
Committee for Europe meeting, the goal of eliminating
measles and rubella and prevention of CRS was changed
to 2015), and the WHO Western Pacific Region has
established targets for accelerated rubella control and
CRS prevention by 2015. This report summarizes
reported rubella and CRS cases globally and progress
toward global introduction and use of RCV.
Member states submit information to WHO on the
number of reported cases of rubella and CRS and the use,
timing, and number of RCV doses administered in the
national immunization schedule using the
WHO/UNICEF Joint Reporting Form (JRF). JRF data were analyzed
for 1996 and 2009 to assess changes in rubella vaccine use
and from 2000 to 2009 to measure changes in reported
burden of rubella and CRS (WHO/UNICEF started
requesting reports for rubella and CRS in 2000). Case
definitions for rubella and CRS have been published by WHO.
(Laboratory-confirmed CRS is clinically confirmed CRS in an
infant who has a positive blood test for rubella-specific
immunoglobulin M or, where available, detection of rubella virus in
specimens from pharynx or urine. CRS is clinically confirmed in
an infant if a qualified physician detects at least two of the
following complications in the infant: cataract[s], congenital
glaucoma, congenital heart disease, loss of hearing, or pigmentary
retinopathy; or one of those complications and one of
the following: purpura, splenomegaly, microcephaly, mental
retardation, meningoencephalitis, radiolucent bone disease, or
jaundice that begins within 24 h after birth.) However, the exact
definition used might differ slightly to reflect specific regional
conditions [
3
]. WHO recommends that member states have
firstdose measles-containing vaccine (MCV1) coverage of .80%
before introducing RCV [
2
]. To assess member state eligibility for
RCV introduction, WHO/UNICEF MCV1 coverage estimates for
2009 were reviewed. To assess overall MCV1 coverage for 2009,
median and interquartile ranges of MCV1 coverage estimates were
calculated separately for member states using RCV and for
member states not using RCV.
USE OF RUBELLA-CONTAINING VACCINE
As of December 2009, a total of 130 (...truncated)