Rubella Elimination in the Americas

Courtesy CDCThe Pan-American Health Organization of the World Health Organization announced that endemic transmission of rubella in the Americas has ended and that the Americas are rubella-free.

The announcement comes after years of surveillance to ensure that any new cases of rubella have resulted from importations from outside the Americas. This task was made more complex by the mild nature of rubella illness in nonpregnant individuals: it is easily mistaken for other illnesses. All suspect cases had to be ruled out, and all true cases of rubella had to be studied carefully to ensure that their origin was from outside the Americas. The last confirmed case of endemic transmission occurred in 2009 in Argentina.

The true scourge of rubella, of course, is its consequences when pregnant women contract the disease and their fetuses are harmed. Miscarriage can result, and infants born after their mothers’ infections may have devastating birth defects (a condition known as congenital rubella syndrome, or CRS).

Rubella vaccines developed in the 1960s led the way to effective immunization programs in many parts of the world. Stanley Plotkin, MD, developer of the rubella vaccine in worldwide use today, said of PAHO’s announcement, “I am delighted at the result of work that was done in the 1960s and look forward to worldwide eradication of congenital rubella syndrome.”

Dr. Plotkin was deeply involved in the last major rubella epidemic in the United States. In this video, he describes his work in 1964-65, when approximately 12.5 million US cases of rubella occurred along with more than 20,000 cases of CRS. The resulting medical costs reached the billions.

Plotkin on Rubella and Rubella Vaccine

Worldwide eradication is likely some time away. Eradication in the Americas resulted in large part from administration of rubella vaccine as part of the measles, mumps, and rubella vaccine (MMR) or the measles, mumps, rubella, and varicella vaccine (MMRV). Measles-only vaccines are part of the immunization platform in many parts of the developing world that haven’t yet adopted rubella vaccine. Currently, according to the Measles and Rubella Initiative, 59 countries do not yet use a rubella-containing vaccine, and this results in 6 out of 10 children not being protected from rubella. More than 100,000 children are born with CRS each year.

In 2011, GAVI introduced a funding mechanism for certain countries wishing to adopt rubella vaccination. Worldwide coverage with rubella-containing vaccine is expected to rise.

Goals related to rubella control include elimination of rubella in at least five WHO regions by 2020 and, also by that year, the establishment of a target date for global rubella and CRS eradication.

Sources

CDC. Measles, Rubella, and&Congenital Rubella Syndrome (CRS) Elimination. http://www.cdc.gov/globalhealth/measles/elimination.htm

Measles and Rubella Initiative Strategic Plan. http://www.measlesrubellainitiative.org/wp-content/uploads/2013/06/Measles-Rubella-Strategic-Plan.pdf