W.E.R., Rubella and Congenital Rubella Syndrome Control and Elimination -- Global Progress, 2000-2014

Friday, 25th of September 2015

Rubella and congenital rubella syndrome control and elimination –global progress, 2000–2014

 

Gavin B. Grant,1Susan E. Reef,1Alya Dabbagh,2 Marta Gacic-Dobo,2Peter M.Strebel.2

1 Centers for Disease Control and Prevention, Atlanta, Georgia USA

2 World Health Organization, Geneva, Switzerland

 

Excerpt below; full text, with figures, is at http://www.who.int/wer/2015/wer9039.pdf?ua=1

 

Discussion

Since the last progress report in 2012, which described the beginning of a new phase of accelerated rubella control and CRS prevention, with an updated WHO position paper on RVS published and availability of  GAVI funding for rubella vaccine introduction, member states have begun to increase the introduction of RCV into immunization schedules. However greater efforts are needed to improve surveillance in order to monitor elimination. RCV has been introduced into national immunization schedules in 41 member states since 2000, including 8 member states with introduction during 2013–2014. RCV should be introduced in member states as WHO criteria1for introduction are met. GAVI funding support is available to ensure continued RCV introduction, as 42 (78%) of the 54 member states where RCV is not included in the national immunization schedule are eligible for GAVI support. Leadership, coordination, technical expertise, and financial resources provided by the Measles and Rubella Initiative partners have also provided critical support to accelerate RCV introduction and increase RCV coverage.

Recent and future RCV introductions provide an opportunity and motivation to establish and achieve regional rubella and CRS elimination goals. During 2012–2014, a rubella elimination goal was established in the Western Pacific Region, and a rubella and CRS control goal was established in the South-East Asia Region as an initial step towards establishing an elimination goal.9

The interruption of rubella virus transmission announced this year in the Region of the Americas provides evidence that rubella elimination can be achieved by introduction of rubella vaccine into routine infant vaccination schedules accompanied by a wide age range (infants to 15 years, and in some cases up to 39 years) immunization campaign. However, key challenges to achieving rubella elimination goals in other regions include civil unrest hindering programme implementation in the Eastern Mediterranean Region, weak health-care delivery systems with low routine vaccination coverage in the African and South-East Asian Regions, and vaccination hesitancy in the European Region. 

High quality rubella and CRS surveillance is needed to monitor the impact of rubella vaccination programmes, and verify the achievement of rubella and CRS elimination goals. Guidelines for rubella and CRS surveillance,1 and a framework for verifying elimination of rubella and CRS have been published.10

Member states need to institute CRS surveillance and to report both rubella and CRS cases, in order to monitor the impact of the vaccination programme on the epidemiology of both rubella and CRS. Reporting is particularly critical for member states with elimination goals and is necessary for the elimination verification process; the recent decrease in the number of member states reporting rubella and CRS cases is therefore of special concern. 

A vaccine delivery system that achieves and maintains high coverage with both RCV and MCV, together with integrated measles and rubella surveillance, are the foundation for continued progress towards rubella and CRS control and elimination. Implementation of additional global WHO recommendations on the use of RCV assists member states which have introduced RCV to optimize the use of the vaccine.11

These recommendations include: the use of RCV when measles vaccine is administered in routine immunization services for vaccination of health-care workers; use of RCV for all measles campaigns; and a review of measles and rubella epidemiology to determine target age ranges. In addition, the recommendations call for improved monitoring of activities reflecting RCV use, including joint measles and rubella vaccination coverage surveys and regular analysis of measles and rubella surveillance data, in order to identify geographic areas and population groups with low immunity and therefore at risk for outbreaks, for which vaccination and other prevention and control measures should be implemented.

Immunization and surveillance activities are the foundation for rubella control and CRS prevention and for reaching the GVAP goals, member states at all levels following the WHO recommendations will need to introduce RCV, strengthen routine immunization services and improve surveillance, and accelerate coordinated rubella control and elimination efforts to reach regional elimination goals.