Rubella elimination, the Canadian experience.

Surveillance and outbreak data were reviewed to demonstrate interruption and elimination of indigenous rubella virus transmission in Canada. Rubella elimination was defined as (1) the interruption of endemic transmission and (2) failure to reestablish endemic transmission within 12 months following importation. Data indicate that indigenous transmission of rubella has been interrupted following effective immunization strategies and sustained high vaccine coverage. However, a 2005 outbreak of rubella, following importation into a community that opposes immunization, demonstrates that multiple chains of transmission can be reestablished where pockets of low vaccine coverage exist. While there has been no evidence of indigenous circulation of rubella viruses since the 2005 outbreak, population groups with low vaccine coverage remain at risk following disease importation. Awareness and targeted response strategies for these populations, particularly in response to risks for importation, are important to ensure rapid detection, reporting, and effective interruption of transmission.

Rubella outbreak in the Netherlands, 2004-2005: high burden of congenital infection and spread to Canada.

BACKGROUND: In The Netherlands and Canada the measles, mumps, rubella vaccine coverage is high. In 2004 a rubella outbreak started in the Netherlands in a population subgroup with low coverage, with subsequent spread to Canada. METHODS: We examined data on rubella cases in the Netherlands and Canada reported between September 2004 and July 2005. In The Netherlands we established enhanced surveillance for congenital rubella while in Canada we carried out a cohort study to estimate vaccine effectiveness. RESULTS: In The Netherlands and Canada, 387 and 309 rubella cases were reported, respectively. Of these, 97% were in unvaccinated individuals of orthodox protestant denomination. Reported consequences of rubella in pregnancy were 2 fetal deaths and 14 infants with congenital infection. Of the latter, 11 had clinical defects including deafness in all but eye defects in none. The estimated vaccine effectiveness was 99.3% (95% CI: 95.3%-99.9%). Closely related strains of rubella virus genotype 1G were found in Dutch and Canadian cases. CONCLUSIONS: A large rubella outbreak occurred in The Netherlands with spread to Canada in a population subgroup with religious objections to vaccination. Its major public health importance was due to the high burden of congenital disease, international spread and implications for measles and rubella surveillance and elimination. Congenital deafness occurred more frequently and eye defects less frequently than expected. The estimated rubella vaccine effectiveness was very high. Our results demonstrate the risks associated with heterogeneity in rubella vaccine coverage. High rubella vaccine coverage in all population subgroups and sensitive surveillance are crucial for elimination of rubella and CRS.

Identical genotype B3 sequences from measles patients in 4 countries, 2005.

Surveillance of measles virus detected an epidemiologic link between a refugee from Kenya and a Dutch tourist in New Jersey, USA. Identical genotype B3 sequences from patients with contemporaneous cases in the United States, Canada, and Mexico in November and December 2005 indicate that Kenya was likely to have been the common source of virus.