Rubella is an acute, contagious, viral infection. Although it is an infection with generally mild symptoms in children, its consequences are severe when it infects pregnant women because it causes the death of the fetus or causes congenital malformations, and is known as congenital rubella syndrome.
The German measles virus is transmitted by airborne droplets when a person sneezes or coughs, and is the only known host for this disease.
Symptoms of infection
Symptoms of a child being infected with the disease are usually mild and include the appearance of a skin rash, a cold fever of less than (39 degrees Celsius), nausea, and a slight sore throat. The rash, which occurs in between 50 and 80% of cases, usually begins to appear on the patient's face and neck before spreading to the lower part of his body and lasts for between one and three days. The most characteristic symptom of this disease from a clinical standpoint is swelling of the lymph nodes located behind the ears and in the neck. As for the disease infection in adults, which is more common among women, it leads to arthritis and excruciating pain that usually lasts for a period ranging between 3 and 10 days.
Once an individual becomes infected, the virus spreads throughout his body in approximately 5 to 7 days. Symptoms of the disease usually appear within 2 to 3 weeks after exposure to the virus. The period during which transmission is most severe is usually between 1 and 5 days after the appearance of the rash.
When a pregnant woman is infected with the rubella virus in the early stages of pregnancy, the probability of transmitting the infection to her fetus is 90%, which may cause the fetus to miscarry, be stillborn, or suffer from congenital malformations known as congenital rubella syndrome. It may take one year or more for an infant with the aforementioned syndrome to get rid of the virus.
Congenital rubella syndrome
A child with congenital rubella syndrome can suffer from hearing and vision impairment, heart defects, and other lifelong disabilities, including autism, diabetes, and thyroid disorders - many of which require expensive treatment, surgeries, and more. Of expensive care.
The risk of developing congenital rubella syndrome is highest in countries where women of reproductive age do not have immunity to the disease (either through vaccination or after becoming infected with rubella). Before the introduction of the vaccine, the number of infants infected with congenital rubella syndrome at birth reached about 4 infants out of every 1,000 live births.
Widespread vaccination against rubella over the past decade has practically eliminated it and congenital rubella syndrome in many developed and some developing countries. In April 2015, the World Health Organization's Region of the Americas became the first to declare itself free of an endemic rubella outbreak.
Rates of congenital rubella syndrome are highest in the WHO African and South-East Asia regions, where vaccine coverage rates against the disease are lowest.
Vaccination
The rubella vaccine is a live attenuated strain that has been in use for more than 40 years. A single dose gives an individual long-lasting immunity of more than 95% similar to that acquired from natural infection.
Rubella vaccines are available either in monovalent form (a vaccine directed exclusively at one pathogen) or in combinations, which are most commonly combined with other vaccines, such as measles-mumps or measles-mumps-varicella vaccines.
Adverse reactions following vaccination are generally moderate and may include pain, redness at the injection site, low-grade fever, skin rash, and muscle pain. Mass immunization campaigns in the Americas region, which covered more than 250 million adolescents and adults, did not result in the diagnosis of any serious adverse reactions resulting from the vaccine.
WHO response
WHO recommends that all countries that have not yet introduced the rubella vaccine should consider taking it up using existing, well-established measles vaccination programmes.
After Member States in the Western Pacific Region set a target for measles elimination, three WHO regions have set similar targets for eliminating this preventable cause of birth defects. The Organization and its partners are committed to helping Member States achieve their goals.
In April 2012, the Measles Eradication Initiative - now known as the Measles and Rubella Eradication Initiative - launched a global strategic plan to eradicate these diseases covering the period 2012-2020, a plan that includes new global goals for the years 2015 and 2020.
By the end of 2015, do the following:
- Reducing deaths from measles in the world by at least 95% compared to levels in the year 2000.
- Reaching regional measles and rubella/congenital rubella syndrome eradication goals.
B
End of 2020:
- Measles and rubella eradication in at least 5 WHO regions.
The strategy focuses on implementing the following 5 core components:
- Achieve and maintain high rates of vaccination coverage with two (2) doses of vaccines containing measles and rubella viruses;
- Monitor the disease using effective surveillance methods and evaluate programmatic efforts to ensure progress and positive results in vaccination activities;
- Develop and maintain preparedness measures to respond to disease outbreaks, accelerate response to them and provide effective treatment of disease cases;
- Communicate and engage the public in order to build bridges of trust with its members and promote the demand for vaccination;
- Conduct the necessary research and development to support cost-effective measures and improve disease vaccination and diagnosis.
Based on the 2016 mid-term review of the Global Vaccine Action Plan, rubella control efforts were lagging behind as 45 Member States failed to introduce the vaccine and two regions (African and Eastern Mediterranean) had not yet set targets for rubella elimination or control.
The WHO Strategic Advisory Group of Experts on Immunization recommends increased focus on improving national immunization systems in general, to ensure additional gains in the control of rubella.
One region (the Americas) succeeded in eliminating epidemiological transmission of rubella, and the end of congenital rubella syndrome was verified in 2015.
As one of the founding members of the Measles and Rubella Eradication Initiative, WHO provides technical support to governments and communities to improve routine immunization programs and launch targeted vaccination campaigns. In addition, the WHO global network of laboratories for measles and rubella eradication supports activities to diagnose cases of rubella and congenital rubella syndrome and track the prevalence of rubella viruses.