Rubella and CRS Elimination: A Race Worth Winning

AEFI Management Kit. Photo credit: Rania Tohme/CDC

More than 100,000 children worldwide are born with congenital rubella syndrome (CRS) every year to mothers infected with the rubella virus. Sadly, these children will suffer a lifetime because of birth defects such as blindness, deafness, and heart disease, even though a cost-effective vaccine is widely available to prevent both rubella and CRS. This is why rubella and CRS elimination is a race worth winning.

Many people underestimate the value of vaccines when it comes to protecting unborn children, especially if the vaccine-preventable disease does not have devastating effects in children and adults. This is the case with rubella. Rubella usually causes a mild fever and rash in children and adults. Though uncommon, it can also cause encephalitis and arthritis in women. However, rubella infection during pregnancy, especially during the first trimester, can result in miscarriage, stillbirth, or infants with congenital malformations, known as CRS. Up to 90% of neonates born to mothers infected in the early weeks of pregnancy will have CRS.

A report this week shows that 125 countries around the world still report CRS cases. Various countries are diligently using vaccines to fight and eliminate both rubella and CRS. As of 2016, 152 of 194 countries introduced rubella-containing vaccines into their national immunization schedule – an increase of 53 countries since 2000. As a result, overall rubella cases declined 97% from 670,894 in 2000 to 22,361 in 2016. In the Americas, the last endemic rubella and CRS cases were reported in 2009, and the region was verified free of endemic rubella virus transmission in 2015. In the World Health Organization (WHO) European Region, 33 countries had eliminated rubella by 2016. Despite these achievements, there is still more work ahead.

Rubella and CRS surveillance play a critical role in assessing and monitoring disease burden and epidemiology before and after vaccine introduction, and progress towards elimination. Surveillance also helps identify pregnant women infected with rubella virus who will require follow up to assess pregnancy outcomes as well as to identify, diagnose, and manage CRS-affected infants medically. We also must work diligently to overcome challenges in achieving rubella elimination goals, including natural disasters or civil unrest affecting vaccine delivery, transmission in older populations, vaccine hesitancy, and weak healthcare service delivery with low routine vaccination coverage.

It is widely recognized that vaccines can protect people from certain debilitating and deadly diseases. This is why agencies like the WHO provide guidance to countries on their national immunization schedules. Nevertheless, vaccine-preventable diseases still pose public health challenges. The Global Vaccine Action Plan 2011-2020 includes goals to eliminate rubella and CRS throughout most of the world by 2020. The increase in countries introducing rubella-containing vaccines into their national immunization schedule and the achievement of rubella elimination in the Region of the Americas proves that we are making progress. Now it is time to cross the finish line to win the race in eliminating CRS around the world.