TARGETING RUBELLA ELIMINATION

Tuesday, 15th of October 2013

[source]Indian Journal of Public Health[|source]

The authors of this review article on Rubella elimination in India recommend the synergistic use of MR or MMR vaccines in routine or supplemental immunizations. Full text describes Rubella burden of disease, vaccines available, efficacy and effectiveness of RA 27/3 vaccines in rubella and CRS elimination, duration of vaccine induced immunity, vaccine safety and adverse reaction, epidemiological impact of Rubella vaccination, approaches to use and cost effectiveness are presented. A review of the WHO position paper on Rubella Vaccines against the context situation in India is made and a recommendation for Rubella vaccines introduction made. This review recommendation is also already available to countries that have homogenous and high measles coverage.

In the event that Rubella vaccination requires one dose while measles vaccination requires two doses, does this imply that MR use in routine replaces the first dose of measles containing vaccines (MCV-1) while maintaining measles only vaccine for the second dose? If yes, as WHO recommends, are countries introducing MR vaccines into their routine immunization programs adequately preparing for this change? What is the risk of giving measles only vaccines in both MCV-1 and MCV-2? And what would be the implications on CRS elimination if such a risk was high? No answers from this article but adequate details on the subject are available at:  http://www.ijph.in/temp/IndianJPublicHealth564269-1926121_052101.pdf

 

Abstract

Rubella is an acute, usually mild viral disease. However, when rubella infection occurs just before conception or during the first 8 to10 weeks of gestation, it causes multiple fetal defects in up to 90% of cases, known as Congenital Rubella Syndrome (CRS). It may result in fetal wastage, stillbirths and sensorineural hearing deficit up to 20 weeks of gestation. Rubella vaccine (RA 27/3) is highly effective and has resulted in elimination of rubella and CRS from the western hemisphere and several European countries. Review of several studies documents the duration of protection over 10 to 21 years following one dose of RA27/3 vaccination, and persistent seropositivity in over 95% cases. Studies in India show seronegativity to rubella among adolescent girls to vary from 10% to 36%. Although due to early age of infection resulting in protection in the reproductive age group, incidence of rubella in India is not very high. However, due to severity of CRS coupled with introduction of Rubella Containing Vaccines (RCV) in private sector and in some of the states which is likely to lead to sub-optimal coverage and resulting higher risk of rubella during pregnancy in the coming decades, it is imperative to adopt the goal of rubella elimination. As in order to control measles, the country has adopted strategy of delivering second dose of measles through measles campaigns covering children 9 months to 10 years of age in 14 states, it is recommended to synergize efforts for elimination of rubella with these campaigns by replacing measles vaccine by MR or MMR vaccine. Other states which are to give second dose of measles through routine immunization will also have to adopt campaign mode in order to eliminate rubella from the country over 10-20 years. Subsequently, measles vaccine can be replaced by MR or MMR vaccine in the national schedule.