Rubella infection occurring just
before conception and early pregnancy may result in fetal death or birth
defects - including blindness, deafness, and heart defects - known as
Congenital Rubella Syndrome (CRS)
CRS is a major public health problem
with an estimated 112,000 babies born with the condition globally,
90,000 of which are in GAVI-eligible countries
Dr. Phounphenjhack Kongxay, Lao's Deputy Manager of the national immunization programme, immunises a girl in Don Thalat school in the Champasack District of Southern Laos. A recent survey in Laos showed that 35% of girls aged 15-19 had no immunity against rubella, he said. Rubella infection in pregnant women can cause severe birth disorders in newborns such as heart disease, blindness, and deafness. CREDIT: The Measles Initiative/C. McNab/2011.
Disease burden
Rubella usually affects children and young adults and is considered a mild illness, except for pregnant women who contract the virus. The unborn children of a woman who contracts rubella in the first trimester have up to an 85% chance of developing CRS. The risk increases to 90% if the woman contracts rubella in the first ten weeks of pregnancy.
Africa and Southeast Asia are the regions with the highest number of estimated CRS cases and the lowest uptake of rubella-containing vaccine. The human and economic toll of rubella is staggering.
WHO estimates that in 1996, 22,000 children were born with CRS in Africa, 46,000 in Southeast Asia and almost 13,000 in the Western Pacific. Few countries in these regions had introduced rubella-containing vaccine (RCV) by 2008 so current estimates are believed to be in line with these figures.
Of WHO member states, more than one-third of countries, mostly in Africa, were not using rubella vaccine in the national immunization schedule as of 2010.
The vaccine
Rubella vaccine is safe, effective, and gives long-term protection. It is often given in combination with measles vaccine as MR (Measles-Rubella) or MMR (Measles-Mumps-Rubella) vaccine.
New WHO guidelines in 2008 supported a paradigm shift in vaccination strategy for introduction of rubella-containing vaccines. Earlier thinking in the rubella disease community placed an emphasis on immunising adolescent girls and women of child-bearing age to decrease the risk of CRS. However, in many settings women were difficult to access resulting in limited vaccine coverage and the rubella virus continued to circulate.
When routine childhood coverage is low, rubella virus continues to circulate and children remain susceptible into adulthood. The new approach focuses on interrupting transmission of rubella virus, thereby eliminating rubella as well as CRS over the long term.
