Rubella infection occurring just before conception and early pregnancy may result in foetal death or birth defects - including blindness, deafness, and heart defects - known as Congenital Rubella Syndrome
Despite impressive drops in measles mortality around the world, measles remains one of the top vaccine-preventable killers of children
Rubella is no longer the threat it once was in many countries thanks to widespread vaccination.But for millions of mothers and their children in poorer countries, rubella poses an on-going danger. Every year, an estimated 90,000 of the total 112,000 cases worldwide occur in GAVI-eligible countries.
Measles is highly infectious and deadly disease. Thanks to the introduction of measles vaccine and the efforts of the Measles & Rubella Initiative, global measles deaths have dropped dramatically. However, progress has stalled and outbreaks have occurred in Africa and Europe.
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 Congenital Rubella Syndrome (CRS). The risk increases to 90% if the woman contracts rubella in the first ten weeks of pregnancy.
Africa and South-East Asia are the regions with the highest number of estimated CRS cases and the lowest uptake of rubella-containing vaccine. Among WHO member states, more than one-third of countries, mostly in Africa, were not using rubella vaccine in the national immunisation schedule as of 2010. 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.
Measles kill an estimated 450 people every day. Before 2001, more than 750,000 children died every year from measles, whose symptoms include a high fever, severe skin rash, and a cough.
Since then, global measles deaths fell by 74% from an estimated 535,000 in 2000 to 139,000 in 2010, helped by the Measles & Rubella Initiative, a global partnership committed to ensuring no child dies from measles or is born with congenital rubella syndrome.
Recent experience shows that failure to vaccinate enough children and maintain high levels of herd immunity can result in serious outbreaks of measles. In 2011, more than 33,000 cases of measles were reported in Europe.
The vaccine
Rubella vaccine gives long-term protection. It is often given in combination with measles vaccine as measles‑rubella (MR) or measles‑mumps‑rubella (MMR) vaccine.
The MR vaccine is considered safe and cost-effective at around 50 cents per dose.
New WHO guidelines in 2011 supported a paradigm shift in vaccination strategy for the 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.
