Progress Toward Rubella Elimination - Western Pacific Region, 2000-2019

Abstract

Rubella is the leading vaccine-preventable cause of birth defects. Rubella typically manifests as a mild febrile rash illness; however, infection during pregnancy, particularly during the first trimester, can result in miscarriage, fetal death, or a constellation of malformations known as congenital rubella syndrome (CRS), commonly including one or more visual, auditory, or cardiac defects (1). In 2012, the Regional Committee of the World Health Organization (WHO) Western Pacific Region (WPR)* committed to accelerate rubella control, and in 2017, resolved that all countries or areas (countries) in WPR should aim for rubella elimination^† as soon as possible (2,3). WPR countries are capitalizing on measles elimination activities, using a combined measles and rubella vaccine, case-based surveillance for febrile rash illness, and integrated diagnostic testing for measles and rubella. This report summarizes progress toward rubella elimination and CRS prevention in WPR during 2000-2019. Coverage with a first dose of rubella-containing vaccine (RCV1) increased from 11% in 2000 to 96% in 2019. During 1970-2019, approximately 84 million persons were vaccinated through 62 supplementary immunization activities (SIAs) conducted in 27 countries. Reported rubella incidence increased from 35.5 to 71.3 cases per million population among reporting countries during 2000-2008, decreased to 2.1 in 2017, and then increased to 18.4 in 2019 as a result of outbreaks in China and Japan. Strong sustainable immunization programs, closing of existing immunity gaps, and maintenance of high-quality surveillance to respond rapidly to and contain outbreaks are needed in every WPR country to achieve rubella elimination in the region.

FIGURE

Confirmed rubella cases, by year of rash onset and country, and estimated regional coverage with first and second doses of rubella-containing vaccine — World Health Organization (WHO) Western Pacific Region, 2000–2019 Abbreviations: RCV1= first dose of a rubella-containing vaccine; RCV2 = second dose of a rubella-containing vaccine. *Confirmed rubella cases reported by countries and areas to WHO. A case of rubella was laboratory-confirmed when rubella-specific immunoglobulin M antibody was detected in serum, rubella-specific RNA was detected by polymerase chain reaction testing, or rubella virus was isolated in cell culture in a person who had not been vaccinated in the 30 days before rash onset; a case of rubella was confirmed by epidemiologic linkage when a case of febrile rash illness was linked in time and place to a laboratory-confirmed rubella case. ^† The following countries began reporting rubella surveillance data after 2000: China (2004), Vietnam (2005), Cambodia (2006), Laos (2007), Papua New Guinea (2007), and Malaysia (2010). ^§ WHO and United Nations Children’s Fund Estimates of National Immunization Coverage, July 15, 2019. https://www.who.int/immunization/monitoring_surveillance/data/en/.