The World Health Organisation estimates that “more than 100,000 cases [of rubella] occur each year in developing countries alone”. They argue, based on cost benefit studies, that the benefits of vaccination outweigh the costs.117 countries are using a rubella vaccine in their national immunisation strategy, representing 26% of the global birth cohort. They urge that current global efforts to control measles should be used as “an opportunity to pursue control of rubella through use of MR and MMR vaccines”. They urge that if childhood vaccination is used to eliminate transmission of rubella, then high uptake is needed to prevent increased risk of cogenitial rubella syndrome (CRS) due to higher numbers of susceptible women of childbearing age. They also recommend the regular screening of women of childbearing age for rubella susceptibility.
There are several examples of where a mass childhood rubella immunisation programme, combined with effective systems to monitor the disease, has led to the elimination of rubella and congenital rubella syndrome. The most recent example is the US where effective implementation of rubella immunisation in Latin America was a major factor in stopping rubella in the US.
The WHO European region is aiming to eliminate measles and prevent congenital rubella infection by 2010. The Western Pacific region has aims to eliminate measles.
Even in countries with immunisation programmes that enjoy high uptake, and with good surveillance systems to back them up, we can’t be complacent. During the 1990s in the UK, most of the very few cases of CRS in the UK were to women who had either acquired the infection abroad or who acquired the infection in the UK but had no history of vaccination in their country of origin. In 1996 there was an outbreak of rubella, mostly in young adults. That year we saw 12 CRS births, mostly to women who acquired the infection in the UK and who had lived her all their lives.
We live in a world of technological advances, in both travel and communication.There is significant movement of populations across national boundaries. Recent developments in science have enabled far better identification of different strains of virus and where they come from.
This means that protection against preventable diseases is a global issue. In recent years we have been able to link a CRS birth in Scotland to an outbreak of rubella in Greece. Identifying different strains of the rubella virus and where they originated from was part of the increased surveillance that enabled the US to claim they have eliminated endemic rubella and CRS. As we have already seen, the successful immunisation campaigns in Latin America were also a major factor in the US’ success. In developed countries with high uptake of immunisation and little wild virus circulating, those that come into the country from places with little or no immunisation are going to be most susceptible.
Despite significant successes and global campaigns to protect against diseases like measles and rubella, the majority of the global birth cohort does not receive a rubella containing vaccine.Incidence of rubella and CRS will be significantly under reported around the world. Rubella continues to place a significant burden on individuals and society the world over.
Any global attempt to eliminate measles, rubella and CRS is going to rely on co-operation between the developed and developing world on issues such as vaccine supply, storage and distribution; monitoring uptake of immunisation programmes; monitoring incidence of the diseases and their impact ; and, for rubella, monitoring susceptibility of rubella amongst women of child bearing age.
Research on MMR
The questions that suggested MMR might be linked to Autism started in the UK, and perhaps have had most impact there, yet the ripples have been felt across the world.If nothing else the internet ensures that information (and mis-information), scare stories and conspiracies are but a click away no matter where in the world you are.
MMR is used in 90 countries around the world and since 1972 children have received over 500,000,000 doses. So any questions about its safety and efficacy were always going to generate an international response. Evidence about MMR countering its possible link to autism has come from a wide range of countries including the UK, US, Canada, Japan, Denmark, and Finland, to name but a few.
