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Annual reported number of cases of rubella and congenital rubella syndrome (CRS) in Hong Kong, 1977-94; MMR: measles-mumps-rubella (ref. 52).
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In 1995-96 we conducted a review of rubella immunization strategies. Worldwide, 78 countries (more than one-third) reported a national policy of using rubella vaccine. This was closely related to country economic status. Based on the United Nations country classification, rubella vaccine is used in 92% of industrialized countries, 36% of those with...
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Background
Control of rubella infection is essential for preventing congenital rubella syndrome (CRS) and one of the important steps is to define a target population for vaccination. Therefore this study was done to determine serological evidence of acute rubella infection among under-fives in order to anticipate the magnitude of rubella virus tran...
Introduction: During May 2012, a rubella outbreak was declared in Solomon Islands. A suspected case of congenital rubella syndrome (CRS) was reported from one hospital 11 months later in 2013. This report describes the subsequent CRS investigation, findings and measures implemented.
Methods: Prospective CRS surveillance was conducted at the newbo...
The number of rubella cases has increased in Japan, especially among adults. Rubella infection in pregnant females can lead to congenital rubella syndrome (CRS). The Japanese government is promoting vaccination to prevent CRS. This study performs a cost-effectiveness analysis of the following four methods: (1) females who wished to become pregnant...
Molecular data on rubella viruses are limited in Uganda despite the importance of congenital rubella syndrome (CRS). Routine rubella vaccination, while not administered currently in Uganda, is expected to begin by 2015. The World Health Organization recommends that countries without rubella vaccination programs assess the burden of rubella and CRS...
Background
Rubella virus infection in early pregnancy lead to serious multi-organ birth defects known as congenital rubella syndrome (CRS). The incidence of CRS varies in different populations and the highest burden is found in developing countries in which rubella vaccination is not included in their national immunization programs. In Ethiopia, th...
Citations
... Nevertheless, the finding in this study shows that 98.1% of the pregnant women studied had moderate to strong protection against re-infection with the wild type rubella virus. The other 1.9% have weak protection and may still benefit from rubella vaccination once made available by the Federal Government of Nigeria, as this has been shown by many studies to boost immune strength [56,57]. ...
Context: Rubella is a disease caused by a virus –rubella virus. Major obstetrics concerns are profound effects of the virus on developing fetuses, which may result in multiple congenital malformations. Although vaccination has reduced the incidence of rubella virus substantially; the world health organization (WHO) estimated that more than 100,000 cases of congenital rubella syndrome occur each year worldwide, most of them in developing countries. Diagnosis of rubella cannot be made on clinical grounds alone due to lack of specific symptoms or signs that are unique to the disease. Laboratory confirmation of suspected cases is done based on the detection of the presence of immunoglobulin M (IgM) during the acute illness or a significant rise in rubella – immunoglobulin G (IgG) antibody titres in the serum of previously infected individuals. Methodology: This is a descriptive cross-sectional study conducted at the antenatal clinic of the Department of Obstetrics and Gynaecology of the University of Maiduguri Teaching Hospital (UMTH), Maiduguri, Borno State, North-Eastern Nigeria. Eligible women who presented for booking for antenatal care at the hospital were recruited. Their bio-data, educational status, and history of vaccination with measles and previous obstetrics outcomes were obtained. Five milliliters of venous blood was taken and the serum obtained from the sample was analyzed for anti-rubella IgG antibodies. The samples that were negative for IgG were tested for IgM antibodies. Data obtained analyzed using the statistical package for social science SPSS v16.0.0 (Sept 13, 2007) Inc, Illinois, USA. Results: There were 459 pregnant women who consented and participated in the study. Their age range is 17-43 years (mean= 25.8±5.3). There were 280 (61.0%) patients who were multiparous (mean=3.5±2.1) and women with secondary education accounted for 39.4%. Four hundred twenty-one women (91.7%) women tested positive for rubella-specific IgG antibodies, and of the remaining 38 women, 6 (15.8%) were positive for IgM rubella-specific antibody. Most of the patients (98.1%) with positive IgG had serum titers in the range of 51-150U/mL. All the patients with positive IgM antibodies were followed up till birth, all the pregnancies were carried to term and none of the neonates was found to have any congenital malformation. None of the socio-demographic characteristics were found to be significantly associated with presence of IgG antibodies. Past history of abortions and congenital cataracts were significantly associated with IgG sero-positivity. Conclusion: The sero-prevalence of anti-rubella IgG sero-positivity is high in Maiduguri and this indicates high herd immunity. The number of pregnant women requiring rubella vaccination postpartum in also large. It is recommended that inclusion of rubella vaccination in the National programme on Immunization protocol will be cost effective in the control of rubella and CRS.
... The vaccine was introduced throughout the country with special mass vaccination campaigns targeting children between the ages of 9-14 years as well in a successful start in the three northern regions (http://www.gov.gh/). However, vaccination strategies that focused on women and children in Brazil were associated with a 5.5-fold increase in rubella in men and an increase in the incidence of CRS [17]. More recent data in Ghana suggests that the non-immune status of pregnant women may be >5% [18,19]. ...
Background
Congenital rubella syndrome (CRS) is a recognised cause of childhood deafness and blindness caused by the transplacental transmission of rubella virus during pregnancy. Women in the reproductive age group, and by extension their unborn babies may therefore be at increased risk. The prevalence of Rubella virus specific IgM and IgG antibodies, including IgG avidity, was determined in pregnant women attending the antenatal clinic at a Teaching Hospital in Ghana.
Methods
One hundred and forty-five women in their second and third trimesters of pregnancy from the outpatient clinic were recruited over a period of 2 months after written informed consent was obtained. Study participants completed a questionnaire and venous blood drawn for IgM, IgG, and avidity testing using SERION ELISA (SERION ® Immunologics, Würzburg, Germany). Babies of mothers with positive or indeterminate IgM and low avidity IgG antibodies were offered specialist cardiological, ophthalmological or hearing assessment during follow up.
Results
One hundred and twenty-eight (88.3%) had only IgG antibodies, 5 (3.4%) had IgM and IgG antibodies, while 12 (8.3%) had no antibodies. No patient had IgM antibodies alone. Ten women (6.9%) had indeterminate levels of IgM antibodies. Majority of the women had high avidity IgG antibodies, while 5 (3.4%) had low avidity antibodies. No patient had IgM with low avidity antibodies. There was no statistical association between socio-demographic factors and the presence of IgM, IgG (low or high avidity) antibodies. Of all the children followed, none had the clinical definition of CRS.
Conclusions
Consistent with the World Health Organization elimination strategy for measles and rubella viruses, non-immune women in the reproductive age group should be vaccinated. The immunization programme should be expanded to include teenagers and adults. Though Congenital Rubella Syndrome was not detected, the risk still remains.
... [1][2][3] However, infection in pregnant women is of public health importance due to the teratogenic effects of rubella virus resulting into Congenital Rubella Syndrome (CRS). 2,4,5 CRS refers to variable constellations of birth defects brought by intrauterine infection with the rubella virus. 1,2,5 The risk of congenital infection and birth defects is high during the first 12 weeks of pregnancy. ...
Background:
Congenital Rubella Syndrome (CRS) is among the causes of infant mortality and lifelong disability due to severe birth defects. There has been an increasing number of neonates born with congenital abnormalities suggesting CRS, at the same time the rubella seroprevalence among pregnant mothers and healthy school children in the northwestern Tanzania has been noted to be alarmingly high. This study aimed to determine prevalence of rubella antibodies and associated factors among infants suspected to have CRS.
Methods:
This cross-sectional study included 174 infants aged ≤ 12 months with at least one clinical features of CRS. The study was conducted between Septembers 2017 and March 2018 at Bugando Medical Centre, a consultant teaching hospital in North Western Tanzania. Collection of Social demographic and other relevant information was done hand in hand with screening for clinical symptoms suggestive of CRS and Blood samples were collected. Indirect enzyme-linked immunosorbent assay (ELISA) Test were conducted on collected sera to test for specific Rubella IgM and IgG antibodies.
Results:
The majority of enrolled infants were below 1 year of age; of these 83 (47.7%) were neonates and only 13.2% had received MR vaccine. Out of these, 111 (63.8%, 95%CI: 56.6-70.9) were IgG Rubella seropositive whereas none was IgM Rubella seropositive. In multivariate logistic regression analysis being neonate was the only factor that independently predicted rubella IgG seropositivity (OR 2.3; 95% CI 1.2 - 4.4; p=0.012).
Conclusion:
A significant proportion children (<12 months) with suspected CRS are IgG seropositive which is predicted by being a neonate (0-4weeks); this indicates high maternal seroprevalence and hence extended surveillance and measures to target women of child bearing age are recommended.
... Rubella is typically a mild disease in children but may be more severe in adults and can result in severe complications when pregnant women are infected. Infection during pregnancy may result in miscarriage, stillbirth, or a range of congenital abnormalities known as congenital rubella syndrome (CRS) [3,4]. Transmission of rubella virus occurs through droplets from the respiratory tract, and infected individuals may be contagious from 7 days before to 7-12 days after rash onset [5]. ...
Background
Rubella vaccine has yet to be introduced into the national immunization schedule of the Democratic Republic of the Congo (DRC); the current burden of congenital rubella syndrome (CRS) is unknown and likely to be high. An important consideration prior to introducing rubella containing vaccine (RCV) is the potential inverse relationship between RCV coverage and CRS incidence. Increasing RCV coverage will also increase in the average age of infection. Cumulative infections across all age groups will decrease, but the number of infections in age groups vulnerable to CRS may increase.
Methods
Rubella transmission dynamics in the DRC were simulated using a stochastic agent-based model of transmission. Input parameter values for known properties, demographic variables, and interventions were fixed; infectivity was inferred from seropositivity profiles in survey data.
Results
Our simulations of RCV introduction for the DRC demonstrate that an increase in CRS burden is unlikely. Continued endemic transmission is only plausible when routine immunization coverage is less than 40% and follow-up supplemental immunization activities have poor coverage for decades.
Conclusion
Increased vaccination coverage tends to increase the annual variability of CRS burden. Simulations examining low vaccination coverage and high mean CRS burden are outbreak prone, with multiple years of reduced burden followed by acute outbreaks. These outcomes contrast simulations with no vaccination coverage and high mean CRS burden, which have more consistent burden from year to year.
... 27 According to Plotkin, vaccination of all infants will probably eradicate CRS in 30-40 years, vaccination of all schoolgirls will presumably eradicate CRS in 10-20 years, and vaccination of adult women will eradicate CRS immediately, but only if 100% are immunized. 28 Countries that have not introduced rubella vaccination may introduce it along with the accelerated measles control and elimination (according to updated WHO rubella vaccine recommendations). 29 The preferred strategy for this is to initiate a campaign with MR/MMR vaccine targeting a wide range of ages and immediate introduction of MR/MMR vaccine into the national immunization program. ...
... Congenital Rubella syndrome has virtually been eliminated in the United States and this is achieved through universal vaccination as a component of childhood immunization. In contrast the burden of congenital rubella in developing countries has been estimated to be about 100,000 per year [37], but only 28% of all developing countries have rubella immunization in place, as compared to 92% of industrialized countries [38]. Africa is the continent worse off compared to other regions as only one of 47 countries in Africa immunize against rubella. ...
There is paucity of knowledge on the causes, diagnosis, management and prevention of fetal congenital anomalies in Africa. The chapter will highlight on the general causes and specific factors concerning congenital anomalies in Africa. The problems of diagnosis and management of congenital anomalies will be extensively discussed. There is also going to be a discussion on how fetal anomalies contribute to maternal and perinatal mortality and morbidity. Screening of congenital anomalies is another black point and will be discussed emphasizing on simple strategies applicable in resource constrained environment. A section will be dedicated on prevention of fetal congenital anomalies, particularly prevention of specific factors that increase the risk of fetal anomalies in Africa. Finally, there will also be discussion on collaborative care as a panacea in the management of fetal congenital fetal anomalies, including my experience in this area. Specific examples will be given to illustrate the utility of collaborative in resource limited countries.
... However, little is known of the magnitude and distribution of other febrile rash illnesses including rubella. [6][7][8][9] Rubella is still common in some regions of the world and Susan E. Reef, team lead for rubella at the C.D.C.'s global immunization division, who joined in the announcement, said there was no chance it would be eradicated worldwide before 2020. The move in many countries towards accelerated measles control and measles elimination raises the question of the marginal cost of including rubella control strategies with this initiative. ...
... Based on the epidemiologic situation of rubella in six Persian Gulf countries and the EMRO region, the routine vaccination for rubella was recommended by National Committee on Immunization. The emphasis was placed on children (Cutts et al., 1997). ...
The first Attenuated rubella vaccine was developed by Parkman and Meyer in 1966. Ten years later in the 1975s, the rubella vaccine was developed in Razi Vaccine and serum research institute) RVSRI). In 1977, the rubella TAKAHASHI vaccine successfully passed the clinical trial and was initially used voluntarily only in the private sector. Since 1987, the administration of rubella as MMR (Measles/AIK-C; Rubella/TAKAHASHI; Mumps/HOSHINO) strain vaccine has been included in the immunization program in Iran. This review article focused on the development and production of the rubella TAKAHASHI/HDC vaccine in RVSRI. The herd immunity and rubella cases were investigated in the pre- and post-vaccine era. The effectiveness and proper coverage of the rubella vaccine led to the elimination of rubella from Iran in 2019. The current study aimed to assess local rubella vaccine manufacturing and its consequences on rubella elimination from Iran, using various search engines. A complete search was carried out in medical databases, including PubMed, Scopus, Web of Science, Scientific Information Database, IranMedex, Magiran, and Google Scholar. Within 1972-1975, Rubella TAKAHASHI/HDC vaccine was developed by RVSRI and successfully passed clinical trial in 1977. Over the four last decades (1980-2020), more than 40 million infants, young, and adults were vaccinated by million doses of local Rubella, measles-rubella (MR) or measles-mumps-rubella (MMR) vaccine in Iran. In 1972, the pre-vaccine era, the overall sensitivity to rubella infection was 69% in one-year-old Iranian children and 23% in childbearing women. The use of a safe, inexpensive, and effective vaccine increased herd immunity to 95% (85%-99%) in our country. During the last two decades, we have witnessed a 91% decline in the confirmed rubella cases, from 1124 in 2000 to 33 cases in 2018. The current article presented the process of vaccine development, tracked it through more than four decades, and discussed disease status before and after the rubella vaccine era, as well as the history of its elimination from Iran. The effectiveness of the local Razi Rubella vaccine resulted in a significant increase in seroprevalence in Iran. Expanded vaccination against rubella, usually with measles, has led to the elimination of Rubella from Iran as confirmed by World Health Organization in 2019.
... For rubella, the number of reported cases has declined by 97% after the introduction of the vaccination campaigns [28]. Whereas previously the primary goal of rubella vaccination was to prevent congenital rubella syndrome cases by immunizing girls before childbearing age, it is now considered that this can be more easily reached through universal childhood vaccination, which may eventually also eliminate rubella infections [28,45]. ...
Introduction:
Measles, mumps, and rubella incidence decreased drastically following vaccination programs' implementation. However, measles and mumps' resurgence was recently reported, outbreaks still occur, and challenges remain to control these diseases.
Areas covered:
This qualitative narrative review provides an objective appraisal of the literature regarding current challenges in controlling measles, mumps, rubella infections, and interventions to address them.
Expert opinion:
While vaccines against measles, mumps, and rubella (including trivalent vaccines) are widely used and effective, challenges to control these diseases are mainly related to insufficient immunization coverage and changing vaccination needs owing to new global environment (e.g. traveling, migration, population density). By understanding disease transmission peculiarities by setting, initiatives are needed to optimize vaccination policies and increase vaccination coverage, which was further negatively impacted by COVID-19 pandemic. Also, awareness of the potential severity of infections and the role of vaccines should increase. Reminder systems, vaccination of disadvantaged, high-risk and difficult-to-reach populations, accessibility of vaccination, healthcare infrastructure, and vaccination services management should improve. Outbreak preparedness should be strengthened, including implementation of high-quality surveillance systems to monitor epidemiology. While the main focus should be on these public health initiatives to increase vaccination coverage, slightly more benefits could come from evolution of current vaccines.
... Additionally, it emphasized that countries should make efforts to vaccinate all non-pregnant WBCA who are not already vaccinated or who are seronegative for rubella by 1 dose of RCV. 19,20 Robertson et al. warned against the strategy of a mass campaign for 1-14-year-olds with routine RCV vaccination for children, resulting in the resurgence of rubella in teens/adults, leading to CRS. 21 In a systematic review, Mongua-Rodríguez et al. compared the impact of rubella vaccination strategies on acquired rubella and CRS rates in the Americas. 22 In the review, vaccination strategies for children, similar to those conducted in Vietnam, reduced the rate of acquired rubella incidence 23,24 and prolonged the epidemic cycles. ...
Following a rubella outbreak in 2011, Vietnam implemented a mass measles-rubella vaccination campaign for children aged 1–14 years in 2014–2015, further expanding the target age to 16–17 years in 2016; routine vaccination was introduced in 2014. However, there was concern that a substantial proportion of women of child-bearing age were still susceptible to rubella, with the fear of congenital rubella emergence. Thus, we conducted a prospective cohort study in Nha Trang, Vietnam, from 2017–2018 to investigate pregnant women’s susceptibility to rubella infection, the incidence of congenital rubella infection, and factors associated with susceptibility. Cord blood was tested for rubella-specific immunoglobulin M (IgM) and IgG; neonatal saliva and cord blood specimens were examined for rubella-RNA. We analyzed 2013 mother-baby pairs. No baby was rubella-IgM or rubella-RNA positive. Overall, 20.4% of mothers were seronegative (95% confidence interval, 18.6%–22.1%). The seronegativity was significantly low among mothers aged <35 years. We found that maternal age groups of 20–24 and 25–29 years, and the lack of self-reported vaccination history were significantly associated with seronegativity. Many pregnant women who were not covered by the vaccination campaign are still at risk of rubella infection.
