New Horizons in the Control of Rubella and Prevention of Congenital Rubella Syndrome in the Americas

Abstract

Data from the regional measles surveillance system have documented widespread rubella virus circulation in many different countries in the Americas. In response to the ongoing endemic incidence of the disease and the potential for a major rubella epidemics in the region, the Pan American Health Organization Technical Advisory Group on Vaccine Preventable Diseases recommended the implementation of a regional initiative to strengthen rubella and congenital rubella syndrome (CRS) preventive efforts in 1997. This article summarizes and highlights the progress toward accelerated rubella control and CRS prevention in the English-speaking Caribbean and in Chile, Costa Rica, and Brazil. Useful knowledge is being generated for the adaptation of similar rubella strategies elsewhere. The findings also document the feasibility of implementing the recommended strategies and their rapid impact on disease burden.Rubella, usually a mild febrile rash illness in children and adults, can produce devastating consequences when a woman becomes infected in early pregnancy. The sequels of infection during pregnancy include miscarriage, stillbirth, and a series of birth defects known as congenital rubella syndrome (CRS). Since 1969, rubella-containing vaccines have been shown to be safe and effective in preventing rubella and CRS.Data generated by a regional measles surveillance system developed by the Pan American Health Organization (PAHO) document widespread rubella virus circulation in many countries in the Americas. Some countries also have CRS cases. In the Western Hemisphere, an estimated 20,000 infants with CRS are born annually-even in the absence of major epidemics [1].In response to the ongoing rubella virus circulation and the potential for major rubella epidemics in the region, the PAHO Technical Advisory Group on Vaccine Preventable Diseases recommended in 1997 that a regional initiative be implemented to strengthen rubella and CRS prevention efforts. To achieve this initiative, PAHO developed a rubella control and CRS strategy [2] that includes the introduction of rubellacontaining vaccines into routine childhood immunization programs, vaccination of women at childbearing age, development of specific vaccination strategies for accelerated rubella control and CRS prevention, support to countries in the development of integrated surveillance systems for measles and rubella, implementation of a CRS surveillance system, and rubella virus isolation. Here we summarize the progress made toward rubella control and CRS prevention with emphasis on experience gained in the accelerated control of rubella in the English-speaking Caribbean and in Chile, Costa Rica, and Brazil. METHODSData from an integrated measles-rubella surveillance system and a CRS surveillance system were analyzed to assess the burden of rubella and CRS disease. Coverage

Rubella susceptibility in pregnant women and results of a postpartum immunization strategy in Catalonia, Spain

“…However, individuals may be immunized by past vaccination or natural infection [2]. The effectiveness of the rubella vaccine has been demonstrated by the elimination of rubella and CRS from the Region of the Americas [2,7]. The aim of interrupting the endemic transmission of measles and rubella in Europe in 2015 will only be achieved with a high coverage of vaccination (> 95% with two doses of measles, mumps and rubella (MMR) vaccine) in all geographical areas and all population groups, together with a high-quality surveillance system [8].…”

Soroprevalência da rubéola na população urbana e rural de Guaratinguetá

“…Aproximadamente 30% a 40% dos municí-pios, nos últimos dois anos, não atingiram a meta de vacinar 95% das crianças com um ano de idade com a vacina tríplice viral. Este fato, juntamente com a falha vacinal que compreende cerca de 5%, contribuiu para o acúmulo de pessoas suscetíveis 4 . Até o final da década de 1980 era desconhecida a verdadeira magnitude da rubéola na maior parte dos países da América Latina, incluindo o Brasil.…”

“…Até o final da década de 1980 era desconhecida a verdadeira magnitude da rubéola na maior parte dos países da América Latina, incluindo o Brasil. Nos últimos anos, estudos de soroprevalência vem sendo realizados em alguns grupos populacionais, cujos resultados vêm norteando a definição e a implementação de estratégias de vacinação 4,5,6,7,8 . …”

Incidencia y patrones de transmisión de rubeola en México

“…Los cambios observados sugieren la conveniencia de reforzar la vigilancia de sarampión-rubeola, [36][37][38][39] con base en investigación de casos, y no sólo de brotes para identifi car factores vinculados con la transmisión, que orienten las actividades de vacunación suplementaria. Asimismo, debe aprovecharse la experiencia nacional e internacional en la defi nición de grupos con mayor riesgo de contraer y transmitir estos trastornos: trabajadores de la salud, magisterio, turismo y estancias infantiles, además de los trabajadores de plantaciones agrícolas e industrias maquiladoras en estados como Aguascalientes, Baja California, Tamaulipas, Sinaloa y Sonora, sitios que pueden atraer a individuos susceptibles provenientes de áreas rurales marginadas de otros estados del país.…”