Academic journal article Bulletin of the World Health Organization

Vaccination against Rubella

Academic journal article Bulletin of the World Health Organization

Vaccination against Rubella

Article excerpt

Introduction

Live attenuated rubella vaccines were licensed in the USA in 1969 and introduced throughout much of the industrialized world soon afterwards. Rubella vaccine has, however, not been recommended for inclusion in the Expanded Programme on Immunization (EPI) in developing countries (1) since when sustained high coverage cannot be guaranteed its introduction could increase the susceptibility of adult women by slowing, but not interrupting, rubella transmission (2). Even without a global recommendation, some countries have added rubella vaccine to their national immunization programmes, reflecting the high coverage levels ([is greater than] 80%, often [is greater than] 90%) with childhood vaccines in these countries, as well as a national response to studies documenting the burden of congenital rubella syndrome (CRS) (3).

There is considerable documentation of the burden of disease related to CRS in some developing countries (3). Approximately 50 developing countries have already conducted substantial studies to assess their CRS disease burden. For countries that have not yet done so, part 1 of this review provides guidance on various methods suitable for surveillance of CRS. In part 2, we present information on the current use of rubella vaccine in different WHO regions, with emphasis on developing countries. Summarized are lessons learned about the effect of different vaccination policies on rubella and CRS control, and recommendations are made for developing comprehensive rubella control programmes in those countries that have or are considering a rubella vaccination policy.

Methods

We conducted a literature review of congenital rubella syndrome, acquired rubella, and rubella vaccine in developing countries as well as referring to key articles on rubella immunization in industrialized countries. In addition, we consulted UNICEF, which facilitates vaccine purchases for the poorest countries, about rubella vaccine prices.

In 1995, the WHO Global Programme for Vaccines and Immunization carried out a global survey of rubella immunization policies. Information was gathered from national governments, and updates as reported to WHO by June 1996 are included in this review. We classified immunization strategies according to the primary target group. Cases of CRS may be prevented as follows: by directly protecting women and/or schoolgirls (a selective vaccination strategy); by vaccinating boys and girls in childhood to provide indirect protection by reducing the transmission of rubella virus (a childhood vaccination strategy); or by a combination of these approaches (a combined strategy).

To examine the effect of economic status on use of rubella vaccine, we classified countries according to two schemes; first, using a United Nations scheme, which considers countries as industrialized, economies-in-transition (including Eastern European countries and most of the newly independent states of the former Soviet Union), or developing (4); second, according to categories for vaccine support developed by the WHO Global Programme for Vaccines and Immunization (5). The latter classification combines information on population and income to assess the capacity of a country to be self-sufficient in vaccine supply; band A consists of small low-income countries that should continue to receive support for vaccines from donors; and band B consists of countries that currently need donor support, but which will gradually assume financial responsibility for vaccine purchases. Bands C and D include countries that are already able to procure vaccines independently, while band E consists of high income countries.

Results

Rubella vaccine

Between 1965 and 1967, several live, attenuated rubella strains were developed, and most industrialized countries began rubella vaccination soon afterwards. The live rubella vaccine currently distributed in most countries contains the RA 27/3 strain, which is prepared in human diploid cell culture (6). …

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