For the first time, more than half of all the world’s infants are protected against the debilitating rubella virus, according to a new study by the World Health Organization (WHO) and the United States Centers for Disease Control and Prevention (CDC). Worldwide, more than 80 countries have eliminated the disease.
This progress has been achieved through broadening access to the safe and highly effective rubella vaccine – especially across lower-income countries. This vaccine has been shown to prevent more than 95% of rubella infections.
A severely debilitating disease
For the majority of children and adults, rubella – also known as German measles – is a mild infection, causing little more than a mild fever and a rash. However, it brings immense health risks if a woman contracts it when she is pregnant. 90% of women who get rubella early in pregnancy will pass it on to their unborn babies.
Rubella infection early in pregnancy can lead to miscarriage, stillbirth or congenital rubella syndrome (CRS) in the baby – a condition that includes severe birth defects and lifelong disability, like vision and hearing impairments and heart defects. Deafness occurs in about two-thirds of all those born with CRS.
In many countries, thanks to vaccination, rubella and CRS have become diseases of the past. As the example of measles reminds us, however, vaccine-preventable diseases can quickly resurface wherever people are unvaccinated.
“There is no room for complacency. Even in countries that have eliminated the disease, the job is not yet done. The only way to ensure protection against rubella is to make sure that all children are vaccinated against it, alongside surveillance systems that are strong enough to quickly detect cases and respond rapidly to stop the spread – especially to pregnant women.” says Dr Shalini Desai, an expert in rubella at WHO and author of the report.
And rubella can be devastating. Prior to the introduction of the vaccine, the United States experienced a major outbreak in 1964 with 12.5 million infections, causing more than 20 000 cases of CRS and over 11 000 miscarriages and stillbirths. Rubella has since been eliminated from the United States, but severe outbreaks recur elsewhere – including, most recently, Japan in 2018-19.
Globally, it is estimated that around 100 000 children are born with CRS every year.
Strong elimination programmes needed
In order to eliminate rubella, rubella vaccine must be included in national immunization schedules. Often this vaccine is given in combination with measles and sometimes mumps vaccines, meaning it can be easily and affordably introduced into existing programmes.
It is also important for countries to have strong disease surveillance systems in place that will accurately detect rubella and CRS if it occurs, says Dr Desai, because cases can be imported even where diseases have become rare.
Four WHO regions have targets in place to control or stop the spread of rubella virus . The latest countries to have achieved elimination –meaning the virus has not been circulating for at least 12 months – are Australia, Bahrain, Brunei Darussalam, Bulgaria, the Islamic Republic of Iran, Kyrgyzstan and Oman.
“This… achievement for the country… reflects our commitment to eliminating childhood infections and ensuring universal health coverage. High vaccination coverage and surveillance must be maintained to ensure prevention and early detection,” said Dr Haji Md Isham bin Jaafar, Minister of Health for Brunei Darussalam, speaking on the occasion of the declaration of elimination.
Countries that have stopped transmission also emphasized the need for strong political commitment – locally, nationally, regionally, and globally – to eliminate rubella infections once and for all.
Challenges on the horizon
While there has been significant progress, 26 countries are yet to introduce the rubella vaccine, leaving 3 in 10 children globally without access. The greatest gaps persist in Africa, where roughly 6 in 10 countries are yet to make the vaccine routinely available to infants.
And even in countries that have the vaccine in their schedules, significant gaps in access and uptake can persist – potentially leaving large numbers of people still vulnerable to infections with the rubella virus.
“Stopping rubella for good means not only introducing the vaccine, but also building the strong immunization and healthcare systems that will ensure no child misses out on essential vaccinations,” says the head of WHO’s immunization programme, Dr Kate O’Brien. “It will take political and community leadership and commitment to ensure elimination targets are set, achieved, and sustained, so that rubella can become a disease of the past, in every part of the world.”
In the last WHO/CDC rubella elimination study, published in the WHO Weekly Epidemiological Record with data for 2016, it was estimated that 47% infants were protected against rubella. In 2018, this figure stood at 69%.
Since 2000, with support from partnerships including the Measles & Rubella Initiative (comprised of WHO, UNICEF, CDC, American Red Cross and the United Nations Foundation) and Gavi, the Vaccine Alliance, 69 more countries have made the rubella vaccine available to infants in their national immunization programmes – bringing the total to 168 of 194 WHO member states.
Source: WHO
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