Update on global rubella and congenital rubella syndrome prevention

Rubella, usually a mild febrile rash illness in children and adults, can produce devastating consequences of fetal death and congenital rubella syndrome (CRS) when a woman becomes infected early in pregnancy. In 1996, the burden of CRS in developing countries was estimated to be 110,000 cases.

In 1969, rubella vaccines were first licensed in the United States leading to widespread use in industrialized countries during the 1970s and 1980s. However, rubella vaccine was not included in the Expanded Programme on Immunization of most developing countries until after the mid-1990s due to several concerns which included increased cost for combination measles-rubella (MR) or measles-mumps-rubella (MMR) vaccine and lack of burden of CRS disease information to support vaccine usage.

In 1996, 80 (42%) of 191 WHO member countries had introduced rubella-containing vaccine (RCV) into their national childhood programs. By 2007, the number of countries introducing RCV into their routine program had increased to 125 (65%) with the most significant increases occurring in the Region of the Americas (57% to 97%), the European Region (73% to 96%) and the Western Pacific Region (37% to 67%). These significant increases have resulted in two WHO regions establishing goals for rubella and CRS elimination by 2010 (Americas Region), and for rubella elimination and prevention of congenital rubella infection by 2010 (European Region). While there has been significant progress toward control and elimination of rubella and CRS, more work needs to be done to document disease burden, build political and financial commitment for sustained financing and address remaining policy questions.