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Full text record of Rubella and CRS control/elimination are available at http://www.who.int/wer/2013/wer8849.pdf
Editorial Note
A new phase of accelerated rubella and CRS prevention has begun, marked by the 2011 WHO position paper recommending a strategy consistent with rubella and CRS elimination and emphasizing the linkage of rubella to measles control activities and with the MRI plan, the GVAP goals and the GAVI funding window. During the previous phase, from 2000, there was a slow but consistent increase in the number of Member States conducting Rubella and CRS surveillance and introducing RCV. With the beginning of this new phase acceleration in control activities is expected.
Programmatic integration of RCV into an existing measles schedule is straightforward, involving no change in schedule or in cold-chain requirements, and minimal change in recording and reporting formats. However, some challenges need to be overcome for regions to achieve their rubella control targets.
Sustainable financing to introduce and maintain rubella routine immunization activities after introduction is required. Rubella vaccine is combined with measles vaccine, the cost to include the rubella antigen is between US$ 0.199 and US$0.399 per dose, this additional cost should be included for routine activities, introduction of wide age-range campaigns and measles follow-up campaigns. A GAVI funding window facilitates RCV introduction in GAVI-eligible member states, supporting initial introduction operational costs and a wide-age range RCV campaign; 9 member states applied for RCV introduction funding in 2012. GAVI ineligible member states need to mobilize resources for the introductory wide age-range campaigns, and the inclusion of RCV into their routine immunization schedule, as well as other measles elimination activities
Sub-optimal implementation of rubella control strategies may result in an increase in CRS cases, emphasizing the need for high quality implementation of the preferred strategy in member states which have and those which have not yet introduced RCV. The preferred RCV introduction strategy comprises an initial wide age-range campaign, followed by integration into the routine immunization programme. Post SIA coverage surveys validate the campaign coverage and can identify potential population immunity gaps that require strengthening to avoid an increase in rubella and CRS cases
Surveillance for rubella infection benefits from the integration with measles surveillance systems, though additional efforts are required to strengthen the system to ensure that febrile rash illness cases reported in pregnant women or their immediate contacts are fully investigated, including ascertaining pregnancy outcomes. Surveillance to detect CRS cases also monitors the impact of control activities
The synergy of rubella and measles control through shared delivery systems and integrated surveillance provides the opportunity to reach levels of control in all regions similar to those achieved in PAHO. The difference between the 2012 global coverage with the first dose of MCV (83%) and RCV (43%) highlights the extent of the opportunity missed by the lack of integration of RCV with MCV. With a new phase of rubella control, member states should consider introducing or strengthening RCV immunization activities as well as strengthening their existing rubella and CRS surveillance systems
In summary, key challenges include a) Building support for additional regions to adopt rubella elimination goals, b) advocating for resources needed to meet EURO elimination goal as well as goals in additional regions, c) ensuring high routine coverage of RCV, d) ensuring high quality MR SIA that reach at least 95% of targeted children, as verified through surveys, and e) strengthening synergies between rubella and measles surveillance and expanding CRS surveillance. Political commitment at all levels, is needed to address these challenges. In addition, leadership, coordination, technical expertise and financial resources available from MRI in conjunction with MRI partners provide a foundation for regions to accelerate rubella control and CRS prevention to a level similar to the achievements in PAHO, intensify activities to complete the task in EURO and reach the MRI and GVAP milestones for 2020.