Building Towards Rubella Elimination: Lessons from the Field

How can the coronavirus 2019 (COVID-19) pandemic impact us in other ways? This seems to be a question at the forefront of everything right now. Beyond morbidity and mortality, every day we learn more about the impact of this virus.

One piece that is increasingly worrying public health officials though, is the implication for vaccine preventable diseases.

There is concern that with fewer childhood vaccines given during the pandemic, a surge of vaccine-preventable disease like measles and rubella, will see considerable spikes. Such spikes could dismantle the hard work to combat vaccine hesitancy in recent years, which has caused large spikes in measles and pertussis cases.

Beyond the US though, there has been ongoing work to combat such diseases, especially rubella. In the Western Pacific Region (WPR), which includes countries like Australia, Japan, New Zealand, and Singapore, they’ve been working to combat childhood diseases for decades. In fact, a recent review of their efforts against rubella, shows what considerable investment and progress can lead to.

In a recent report from the US Centers for Disease Control and Prevention (CDC) Morbidity and Mortality Weekly Report, researchers assessed work in rubella elimination within the Western Pacific Region between 2000-2019. Sixteen countries across the WBR implemented rubella immunization as part of their infant immunization programs.

Acknowledging that the disease is the leading cause of vaccine-preventable causes of birth defects, public health teams piggybacked measles elimination efforts by using a combination vaccine. From 2000-2019, efforts made it possible to have first-dose coverage in 96% of children.

The authors noted that rubella incidence increased from 35.5 to 71.3 cases per million population among reporting countries during 2000—2008, then decreased to 2.1 in 2017, and then again increased to 18.4 in 2019 as a result of China and Japan outbreaks.

"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,” they wrote.

Considering that rubella regional incidence nearly doubled in China and Vietnam, these efforts are highly impressive. Once the first dose of the rubella-containing vaccine (RCV1) was introduced into these countries, it brought down incidence of the virus to 2.1 per million in China in 2017.

Of the 37 countries within the Western Pacific Region, all of them have pushed out the rubella containing vaccines within their infant immunization programs, which is what brought that coverage to 96%. Of those 37 countries, 8 were unable to reach the vaccination levels to ensure 85% protective herd immunity.

Not surprisingly, the authors did note that despite the declining incidence in 2017, outbreaks in those groups with limited immunity, did impact incidence of the disease.

While each country utilized different immunization strategies to address widespread utilization and success, their lessons regarding immunity gaps are an important reminder for us all. Targeted strategies, like those of Japan and Vietnam, will hopefully be successful in their efforts to address immunity gaps, especially in the face of COVID-19.

Ultimately, dedication to including and pushing out rubella vaccines within childhood vaccine programs has been highly successful. There is still much work to be done though, especially if a decline in childhood vaccinations.