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December 19, 2003

Use of rubella vaccine is growing worldwide, but more work remains

From: EurekAlert, DC - Dec 19, 2003

Contact: Dr. María Luisa Clark
Pan American Health Organization

Use of rubella vaccine is growing worldwide, but more work remains

Around the world, use of the vaccine to prevent rubella ("German measles") has grown rapidly in recent years, but much more needs to be done to better track the illness and to prevent the infection of pregnant women, which can lead to serious birth defects in their infants. That is according to a study that was carried out by Dr. Susan E. Robertson and other staff members of the World Health Organization (WHO) and that is published in the November 2003 issue of the "Revista Panamericana de Salud Pública/Pan American Journal of Public Health," a journal published monthly by the Pan American Health Organization (PAHO). PAHO serves as the Regional Office for the Americas of the World Health Organization.

The number of countries using rubella vaccine in their national immunization programs has increased dramatically in recent years. A WHO survey had found that 78 of 214 countries and territories (36% of them) were using rubella vaccine in 1996. By the end of 2002, according to the article, that number had risen to 124 (58% of the 214). Among the WHO regions, the single largest increase in vaccine use over that six-year period occurred in the Western Hemisphere, with use growing from 47% to 94% of all the countries and territories in the Americas. Two other WHO regions showing large increases were Europe (from 64% to 84%) and the Western Pacific (from 31% to 59%). The two regions with the lowest rubella vaccine usage rates at the end of 2002 were Africa and South-East Asia.

"Surveillance" of rubella--the systematic, ongoing collection, analysis, dissemination, and application of information on the illness--has also improved around the world. For example, in 2001, 123 out of 214 countries and territories (57% of them) reported to WHO the number of cases of rubella that had been reported through their national surveillance systems. In 1999, only 98 of the countries/territories (46%) had reported that information to WHO; in 2000, 109 of them (51%) did that. In 2001, those 123 countries and territories reported a total of 836,356 rubella cases.

The area where the most improvement is still needed, according to the article, is in surveillance for congenital rubella syndrome (CRS) among newborns and infants up to 11 months of age. When a woman is infected with rubella during the first trimester of pregnancy, the infection can be transmitted to the developing fetus and can result in fetal death or the birth of an infant with blindness, deafness, congenital heart disease, mental retardation, or other serious afflictions. In other persons, rubella is generally a mild illness, causing low-grade fever and generalized rash.

CRS reporting has increased gradually, with 51 of 214 countries/territories providing reports on cases in 1999 (24%), 80 (37%) in 2000, and 89 (42%) in 2001. However, the total number of cases reported--39 in 1999, 181 in 2000, and 50 in 2001--indicates that those data are "grossly incomplete," according to the article, with those reported cases representing fewer than 0.1% of the estimated true total. Worldwide, it is estimated that there are more than 100,000 infants born with CRS each year.

Rubella vaccination can produce cost savings for a country. For example, research done on the English-speaking Caribbean countries and Suriname had indicated that a campaign to eliminate CRS over the period of 1997 to 2017 would cost approximately US$ 4.5 million, versus more than US$ 60 million to treat CRS cases if there were no elimination initiative.

Unfortunately, because of their lack of financial resources, many less-developed countries have been unable to add rubella immunization to their national vaccination programs, according to the article. While 100% of the industrialized countries in the world have included rubella vaccination in their national programs, only 48% of the developing countries have done so.

In preventing CRS, WHO recommends that priority go to protecting women of childbearing age from rubella. If a country implements rubella immunization of children, then rubella vaccination of adult women should be introduced at the same time or earlier. Rubella vaccine should be added to the childhood immunization schedule only if coverage for at least 80% of all children can be sustained on a long-term basis. If fewer children are vaccinated, that can pose risks to unvaccinated women who are now of childbearing age and also to other unvaccinated females in the future as they reach childbearing age. To prevent an increase in the numbers of cases of CRS, notes the article, "it is essential that childhood rubella vaccination programs achieve and maintain high levels of coverage."

The "Revista Panamericana de Salud Pública/Pan American Journal of Public Health" is the main scientific and technical periodical that PAHO publishes. PAHO was established in 1902. PAHO Member States include all 35 countries in the Americas. Puerto Rico is an Associate Member. France, the Kingdom of the Netherlands, and the United Kingdom of Great Britain and Northern Ireland are Participating States, and Portugal and Spain are Observer States.