Rubella is the leading vaccine-preventable cause of birth defects. In children and adults it usually causes only a mild fever and rash, but infection during pregnancy — especially in the first trimester — can cause miscarriage, fetal death, or congenital rubella syndrome (CRS), a set of malformations that commonly includes vision, hearing and heart defects and developmental delay.
In 2013, the World Health Organization's South-East Asia Region (SEAR) — Bangladesh, Bhutan, India, Indonesia, Maldives, Myanmar, Nepal, North Korea, Sri Lanka, Thailand and Timor-Leste — set a goal to eliminate measles and control rubella and CRS by 2020. "Control" means a 95% reduction in rubella and CRS cases from the 2010 baseline. The two efforts are linked: rubella-containing vaccine (RCV) is given as a combined measles-rubella vaccine, and rubella cases are found through measles or fever-and-rash surveillance.
Key findings, 2000–2016
- Before 2000, only Sri Lanka and Thailand used RCV in routine infant immunization. By the end of 2016, eight of the 11 countries did.
- Coverage with a first dose (RCV1) rose from 3% of the region's birth cohort in 2000 to 15% in 2016.
- About 83 million people were vaccinated in 13 supplementary campaigns in eight countries.
- From 2010 to 2016, reported rubella incidence fell 37%, from 8.6 to 5.4 cases per million people.
- Bangladesh, Maldives, Sri Lanka and Thailand each cut incidence by 95% or more since 2010, and have likely controlled rubella and CRS.
- India and Indonesia, home to 83% of the region's birth cohort, began introducing RCV in 2017, so coverage was expected to rise quickly.
Country by country
| Country (year RCV introduced) | RCV1 coverage 2016 | Rubella cases 2010 | Rubella cases 2016 | Incidence per million, 2010 → 2016 | Change |
|---|---|---|---|---|---|
| Bangladesh (2012) | 94% | 12,963 | 165 | 87.4 → 1.0 | −99% |
| Bhutan (2006) | 97% | 9 | 3 | 12.9 → 4.0 | −69% |
| India (not yet) | — | not reported | 8,274 | not reported → 6.4 | — |
| Indonesia (not yet) | — | 1,323 | 1,238 | 5.6 → 4.8 | −15% |
| Maldives (2007) | 99% | 4 | 0 | 12.5 → 0.0 | −100% |
| Myanmar (2015) | 91% | 11 | 10 | 0.2 → 0.2 | 0 |
| Nepal (2013) | 83% | 510 | 656 | 18.5 → 22.9 | +24% |
| North Korea (not yet) | — | 0 | 0 | 0.0 → 0.0 | 0 |
| Sri Lanka (1996) | 99% | 68 | 0 | 3.3 → 0.0 | −100% |
| Thailand (1993) | 99% | 387 | 7 | 6.1 → 0.1 | −98% |
| Timor-Leste (2016) | 78% | not reported | 8 | not reported → 6.5 | — |
| Region | 15% | 15,275 | 10,361 | 8.6 → 5.4 | −37% |
Confirmed CRS cases in the region numbered 8 in 2010 and 319 in 2016.
Reported rubella cases and first-dose vaccine coverage, South-East Asia Region, 2000–2016. Source: WHO and UNICEF data, from CDC's MMWR.
Vaccination campaigns
Campaigns usually go with measles campaigns. A national catch-up campaign aims at children aged 9 months to 15 years to wipe out susceptibility in the general population; periodic follow-up campaigns then reach children born since. The largest were:
| Country | Year | Type | Ages | People reached |
|---|---|---|---|---|
| Bangladesh | 2014 | Catch-up, national | 9 months–15 years | 53,644,603 |
| Myanmar | 2015 | Catch-up, national | 9 months–15 years | 13,160,764 |
| Nepal | 2012 | Catch-up, national | 9 months–15 years | 8,524,991 |
| Nepal | 2016 | Follow-up, subnational | 9 months–5 years | 2,528,539 |
| Thailand | 2015 | Follow-up, national | 2.5–7 years | 2,244,906 |
The 13 campaigns together reached 83,096,311 people, 98% administrative coverage.
Who got rubella in 2016
The region reported 10,361 confirmed rubella cases: 1,720 sporadic and 8,641 in 263 rubella outbreaks and 68 mixed measles-rubella outbreaks. Only five outbreak cases were in countries that had introduced RCV. India and Indonesia accounted for 9,512 (92%) of all cases.
| Age of outbreak cases | Cases | Share |
|---|---|---|
| Under 1 year | 698 | 8% |
| 1–4 years | 2,682 | 31% |
| 5–9 years | 3,297 | 38% |
| 10–14 years | 1,207 | 14% |
| 15 and older | 757 | 9% |
7,884 (91%) were children under 15 — the group that catch-up campaigns target.
Surveillance
- Countries reporting rubella: 3 in 2000 (Bhutan, Sri Lanka, Thailand), 9 in 2010, all 11 in 2013. By 2016 all tested measles-negative suspected cases for rubella antibodies.
- The regional measles-rubella laboratory network began in 2003 with eight labs; by 2016 it had a regional reference lab in Thailand and 39 proficient labs (13 in India, 14 in Thailand, four in Indonesia and one in each other country).
- Countries reporting CRS to WHO and UNICEF rose from two in 2002 to 10 in 2016; eight run sentinel-site CRS surveillance, starting with Bangladesh in 2012. Reported CRS cases rose from 26 to 319 over the same years, reflecting more reporting.
- 84 rubella viruses, all genotype 1E or 2B, were reported to the global sequence database.
Limits and next steps
30%–50% of rubella infections are typically without symptoms or mild, so many cases go undetected, and surveillance quality and case definitions vary between countries. The authors call for sustained investment in high routine coverage, periodic high-quality campaigns to close immunity gaps, and stronger surveillance — including watching for a shift in cases from children to women of childbearing age. With that, they say, the 2020 control goal looked achievable, and a regional elimination goal might follow.
Sources
Based on Khanal S, Bahl S, Sharifuzzaman M, et al., "Progress Toward Rubella and Congenital Rubella Syndrome Control — South-East Asia Region, 2000–2016," Morbidity and Mortality Weekly Report 67(21), CDC; a work of the United States government in the public domain.
Licence: CC0 1.0 (public domain) · Adapted from www.cdc.gov
1
0
0
0
Comments
