Rubella in Poland in 2021. / Rózyczka w Polsce w 2021 roku.

INTRODUCTION: Rubella is a viral infectious disease, and humans are the only reservoir of the virus. In 2020, all WHO member countries conducted epidemiological surveillance for rubella, and almost all (99%) had access to rubella testing at laboratories operating under the WHO Global Measles and Rubella Laboratory Network. OBJECTIVES: The aim of this study was to evaluate epidemiological indicators of rubella in Poland in 2021 compared to previous years, taking into account the impact of the COVID-19 pandemic. MATERIAL AND METHODS: The assessment of the epidemiological situation was based on a review of data from the bulletin , "Infectious Diseases and Poisons in Poland in 2021" (5), and the assessment of the immunization status of the population was based on data from the bulletin , "Immunization in Poland in 2021" (6). Classification of cases was made based on the definition used in the 2021 surveillance (7). Data from the epidemiological surveillance system "EpiBase" were also used. RESULTS: In 2021, 50 cases of rubella were registered, 48 fewer than in 2020 (98 cases). There was also a decrease in incidence to 0.13 per 100,000, compared to 0.26 per 100,000 in 2020. The highest incidence, regardless of gender and residential environment, was recorded in the 0-4 age group (1.23 per 100 thousand). No cases of congenital rubella syndrome were reported in 2021. CONCLUSIONS: In 2021, there was a decrease in the number of rubella cases in Poland, which could be a result of the COVID-19 pandemic and the introduced restrictions. In addition, rubella was registered 99% on the basis of clinical diagnoses, without the required laboratory confirmation, which means that other rash diseases could be registered as rubella.

After the honeymoon, the divorce: Unexpected outcomes of disease control measures against endemic infections.

The lack of effective vaccines for many endemic diseases often forces policymakers to rely on non-immunizing control measures, such as vector control, to reduce the massive burden of these diseases. Controls can have well-known counterintuitive effects on endemic infections, including the honeymoon effect, in which partially effective controls cause not only a greater initial reduction in infection than expected, but also large outbreaks during control resulting from accumulation of susceptibles. Unfortunately, many control measures cannot be maintained indefinitely, and the results of cessation are poorly understood. Here, we examine the results of stopped or failed non-immunizing control measures in endemic settings. By using a mathematical model to compare the cumulative number of cases expected with and without control, we show that deployment of control can lead to a larger total number of infections, counting from the time that control started, than without any control-the divorce effect. This result is directly related to the population-level loss of immunity resulting from non-immunizing controls and is seen in a variety of models when non-immunizing controls are used against an infection that confers immunity. Finally, we examine three control plans for minimizing the magnitude of the divorce effect in seasonal infections and show that they are incapable of eliminating the divorce effect. While we do not suggest stopping control programs that rely on non-immunizing controls, our results strongly argue that the accumulation of susceptibility should be considered before deploying such controls against endemic infections when indefinite use of the control is unlikely. We highlight that our results are particularly germane to endemic mosquito-borne infections, such as dengue virus, both for routine management involving vector control and for field trials of novel control approaches, and in the context of non-pharmaceutical interventions aimed at COVID-19.

Rubella IgM epidemiology in the pre-rubella vaccination era in Uganda.

BACKGROUND: Control of Rubella and Congenital Rubella Syndrome using vaccination has shown great success in the America's. Uganda is due to introduce the Rubella vaccine however the magnitude of transmission is not well documented. Therefore this study was done to determine IgM sero-prevalance for Rubella in order to help monitor vaccine effectiveness post introduction of the vaccine in routine vaccination programme. METHODS: A retrospective review of suspected measles cases data for the reporting period January 2007 to December 2016 in Uganda was Done. rubella IgM testing was done on 15,296 of the cases and the data was analyzed using STATA version 13. RESULTS: In total 15,296 cases were tested and 4255 (27.8%) tested positive and among females aged 15-49 years 88 out of 322 (27%) tested positive. The age distribution range was 0-80 years, rubella IgM positivity was reported in all the 15 regions of Uganda and throughout the ten year period in every month. Age group 5-15 years had OR 2.5 p-value < 0.001 of being rubella IgM positive compared to age < 5 years and testing measles IgM negative OR 6.3 p-value < 0.001. CONCLUSION: Rubella is endemic in Uganda and although rubella IgM positivity is highest in the age 5-15 years even the younger, older and women of reprodutive age are affected. This means the risk of Congenital Rubella Syndrome is high hence the need to introduce the rubella vaccine for infants and pregnant mothers and continued surveillance to enhance its control.

Epidemiology of acute rubella infection in Zambia during the pre-vaccination period (2005-2016) as a baseline for monitoring rubella epidemiology in the post-rubella vaccine introduction era.

BACKGROUND: Rubella is highly under reported in Zambia as in most sub-Saharan countries despite being a disease of major public health concern especially among women of childbearing age. In September 2016, Zambia introduced a combined measles-rubella vaccine in children 0-14 years. In this study, we estimated the proportion positive for acute rubella among suspected but negative measles cases between 2005 and 2016 and determined its correlates for monitoring rubella epidemiology post-rubella vaccine introduction. METHODS: In a retrospective study, 4497 measles IgM negative serum samples from 5686 clinically suspected measles cases were examined for rubella IgM antibodies using the Siemens, Enzygnost® ELISA kit at the national measles laboratory. Data on demographics, year and month of onset were extracted from the surveillance data. Multivariate logistic regression analysis using backward variable selection was conducted to determine independent predictors for acute rubella. The magnitude of association was estimated using adjusted odds ratio with a 95% confidence interval. RESULTS: Overall, a proportion of 29.2% (1313/4497) affecting mostly those between 5 and 24 years was determined. Only age, province, month and year were independently associated with acute rubella. The regional proportions varied from 21.8-37.3% peaking in the month of October. Persons in the age group 10-14 years (Adjusted Odds Ratio [AOR] = 2.43; 95% CI [2.01-2.95]) were more likely while those aged < 1 year less likely (AOR = 0.31; 95% CI [021-0.48]) to have acute rubella compared to those aged 25 years or older. Persons in 2010 were less likely (AOR = 0.12; CI [0.05, 0.28]) to have acute rubella compared to those in 2016. While acute rubella was more likely to occur between July and November compared to December, it was less likely to occur between February and May. CONCLUSIONS: Rubella virus was circulating in Zambia between 2005 and 2016 affecting mostly persons in the age group 5-24 years peaking in the hot dry season month of October. Although vaccination against rubella has been launched, these baseline data are important to provide a reference point when determining the impact of the vaccination program implemented.

A comparative study of the efficacy and safety of intralesional measles, mumps, and rubella vaccine versus intralesional vitamin D3 for the treatment of warts in children.

BACKGROUND: Intralesional vitamin D3 has recently emerged as a new treatment for cutaneous warts. The use of the measles, mumps, and rubella (MMR) vaccine for this purpose is an established modality. However, relevant data on the efficacy of either the MMR vaccine or vitamin D3 as immunotherapy for cutaneous warts in the pediatric population are limited. OBJECTIVES: To compare the efficacy and safety of intralesional injections of MMR vaccine to intralesional injections of vitamin D3 in children aged 8-16 years with multiple warts. METHODS: A total of 74 children were randomly allocated into two groups. Group A patients received intralesional MMR vaccine into the largest wart, and group B received intralesional vitamin D3 into the largest wart. The injections were repeated every 4 weeks until clearance or for a maximum of three treatments. After the last injection, children were followed up every 2 weeks for 3 months, and at the sixth month, a final clinical assessment was conducted. RESULTS: Of 74 children, 60 completed the study, with 30 children in each group. Complete clearance of the injected wart was observed in 26 (86.67%) patients in the MMR group (group A) and 23 (76.7%) patients in the vitamin D3 group (group B). Distant warts cleared in 23 (76.7%) patients in group A compared to 20 (66.6%) patients in group B. There was no significant difference between groups. No recurrence was seen in group A, whereas two (6.6%) children in group B exhibited recurrence in the ensuing 6-month follow-up. The most common adverse events were injection site pain and swelling. CONCLUSION: Both intralesional MMR and vitamin D3 are safe, generally well-tolerated, and equally effective in children for the treatment of cutaneous warts.

What are the beliefs and perceptions of practice nurses' influence about the uptake of the measles, mumps, and rubella vaccine?: An integrative literature review.

AIM: The aim of this study was to ascertain the beliefs and perceptions of practice nurses' influence about the uptake of the measles, mumps, and rubella vaccine. BACKGROUND: Immunization decision-making for parents is a complex process. Principle health professionals involved in immunization programmes are health visitors, general practitioners, and practice nurses. There is evidence that health visitors and general practitioners influence parental immunization decision-making. However, there is a lack of evidence about the influence of the practice nurse despite their well-documented role in immunization. DESIGN: Integrative literature review. DATA SOURCES: A systematic search of electronic databases, including CINAHL; Medline; PubMed; Google Scholar; ScienceDirect; and Scopus from February 1998 - April 2017. Hand searching and reviewing of secondary references were also undertaken. REVIEW METHODS: Two reviewers independently screened records on title and abstract. Studies where the beliefs and perceptions of practice nurses about the measles, mumps, and rubella vaccine were explored and were published in English were included. The data were analysed using the integrative review processes. RESULTS: Twelve studies were included; these studies were principally descriptive and were of variable methodological quality. Four themes were identified: parental immunization influencing factors, practice nurse characteristics, information and communication, and personal views and concerns. While this review provides an excellent baseline for this information, more recent research conducted in the current policy environment is urgently needed to determine if these views persist. CONCLUSION: Immunization training and annual updates are essential for practice nurses to keep abreast with the evidence base underpinning national immunization programmes.

Rubella vaccination in India: identifying broad consequences of vaccine introduction and key knowledge gaps.

Rubella virus infection typically presents as a mild illness in children; however, infection during pregnancy may cause the birth of an infant with congenital rubella syndrome (CRS). As of February 2017, India began introducing rubella-containing vaccine (RCV) into the public-sector childhood vaccination programme. Low-level RCV coverage among children over several years can result in an increase in CRS incidence by increasing the average age of infection without sufficiently reducing rubella incidence. We evaluated the impact of RCV introduction on CRS incidence across India's heterogeneous demographic and epidemiological contexts. We used a deterministic age-structured model that reflects Indian states' rural and urban area-specific demography and vaccination coverage levels to simulate rubella dynamics and estimate CRS incidence with and without RCV introduction to the public sector. Our analysis suggests that current low-level private-sector vaccination has already slightly increased the burden of CRS in India. We additionally found that the effect of public-sector RCV introduction depends on the basic reproductive number, R 0, of rubella. If R 0 is five, a value empirically estimated from an array of settings, CRS incidence post-RCV introduction will likely decrease. However, if R 0 is seven or nine, some states may experience short-term or annual increases in CRS, even if a long-term total reduction in cases (30 years) is expected. Investment in population-based serological surveys and India's fever/rash surveillance system will be key to monitoring the success of the vaccination programme.

No. 203-Rubella in Pregnancy.

OBJECTIVE: To provide an update on rubella and pregnancy so that health professionals remain aware of the potentially devastating effects on the developing fetus. OUTCOMES: Rubella vaccination has been effective in virtually eliminating congenital rubella syndrome in Canada. EVIDENCE: Medline, PubMed, and Cochrane Database were searched for articles published between 1985 and 2007. VALUES: The quality of evidence was rated using the criteria described in the report of the Canadian Task Force on Preventive Health Care. SPONSOR: The Society of Obstetricians and Gynaecologists of Canada.

Social capital, trust in health information, and acceptance of Measles-Rubella vaccination campaign in Tamil Nadu: A case-control study.

Background: Parents' decision about vaccination of children is influenced by social relationships and sources of information. The aim of this study was to assess the influence of social capital and trust in health information on the status of Measles-Rubella (MR) vaccination campaign in Tamil Nadu. Materials and Methods: This was a case-control study carried out in Kancheepuram district in Tamil Nadu where the MR vaccination campaign offered by Government of Tamil Nadu had poor acceptance. Cases were parents of children who had refused the MR vaccine and controls were parents having children in the same age group who had accepted the vaccine. Data on social capital and trust in health information were collected by using social capital scale developed by the researchers and trust in the source of information was measured by using simple questions on the level of trust in the information source. Results: Nonadministration of MR vaccine was high among young parents and parents of younger children. Vaccine acceptance was higher when it was offered at school (P < 0.000) and also among parents who trusted school teachers (P < 0.003) and other school children (P < 0.014) as source of information. MR vaccine acceptance was less among parents who trusted social media and WhatsApp information. Greater levels of health-related physical social capital led to greater vaccine hesitancy. Multivariate analysis revealed that greater the age of the child, better parental attitudes toward vaccination, poorer health-related physical social capital, and greater trust in health information provided by school teachers led to overall greater acceptance of the MR vaccine. Conclusion: Strong homogeneous bonding social capital had a negative influence on MR vaccine acceptance. Schools and school teachers played a vital role in influencing parental decision to vaccinate.

Modeling the Transmission of Measles and Rubella to Support Global Management Policy Analyses and Eradication Investment Cases.

Policy makers responsible for managing measles and rubella immunization programs currently use a wide range of different vaccines formulations and immunization schedules. With endemic measles and rubella transmission interrupted in the region of the Americas, all five other regions of the World Health Organization (WHO) targeting the elimination of measles transmission by 2020, and increasing adoption of rubella vaccine globally, integrated dynamic disease, risk, decision, and economic models can help national, regional, and global health leaders manage measles and rubella population immunity. Despite hundreds of publications describing models for measles or rubella and decades of use of vaccines that contain both antigens (e.g., measles, mumps, and rubella vaccine or MMR), no transmission models for measles and rubella exist to support global policy analyses. We describe the development of a dynamic disease model for measles and rubella transmission, which we apply to 180 WHO member states and three other areas (Puerto Rico, Hong Kong, and Macao) representing >99.5% of the global population in 2013. The model accounts for seasonality, age-heterogeneous mixing, and the potential existence of preferentially mixing undervaccinated subpopulations, which create heterogeneity in immunization coverage that impacts transmission. Using our transmission model with the best available information about routine, supplemental, and outbreak response immunization, we characterize the complex transmission dynamics for measles and rubella historically to compare the results with available incidence and serological data. We show the results from several countries that represent diverse epidemiological situations to demonstrate the performance of the model. The model suggests relatively high measles and rubella control costs of approximately $3 billion annually for vaccination based on 2013 estimates, but still leads to approximately 17 million disability-adjusted life years lost with associated costs for treatment, home care, and productivity loss costs of approximately $4, $3, and $47 billion annually, respectively. Combined with vaccination and other financial cost estimates, our estimates imply that the eradication of measles and rubella could save at least $10 billion per year, even without considering the benefits of preventing lost productivity and potential savings from reductions in vaccination. The model should provide a useful tool for exploring the health and economic outcomes of prospective opportunities to manage measles and rubella. Improving the quality of data available to support decision making and modeling should represent a priority as countries work toward measles and rubella goals.

Evaluation of impact of measles rubella campaign on vaccination coverage and routine immunization services in Bangladesh.

BACKGROUND: Like other countries in Asia, measles-rubella (MR) vaccine coverage in Bangladesh is suboptimal whereas 90-95 % coverage is needed for elimination of these diseases. The Ministry of Health and Family Welfare (MOHFW) of the Government of Bangladesh implemented MR campaign in January-February 2014 to increase MR vaccination coverage. Strategically, the MOHFW used both routine immunization centres and educational institutions for providing vaccine to the children aged 9 months to <15 years. The evaluation was carried out to assess the impact of the campaign on MR vaccination and routine immunization services. METHODS: Both quantitative and qualitative evaluations were done before and after implementation of the campaign. Quantitative data were presented with mean (standard deviation, SD) for continuous variables and with proportion for categorical variables. The overall and age- and sex-specific coverage rates were calculated for each region and then combined. Categorical variables were compared by chi-square statistics. Multiple logistic regression analysis were performed to estimate odds ratios (OR) and 95 % confidence intervals (CI) of coverage associated with covariates, with adjustment for other covariates. Qualitative data were analyzed using content analysis. RESULTS: The evaluations found MR coverage was very low (<13 %) before the campaign and it rose to 90 % after the campaign. The pre-post campaign difference in MR coverage in each stratum was highly significant (p < 0.001). The campaign achieved high coverage despite relatively low level (23 %) of interpersonal communication with caregivers through registration process. Child registration was associated with higher MR coverage (OR 2.91, 95 % CI 1.91-4.44). Children who attended school were more likely to be vaccinated (OR 8.97, 95 % CI 6.17-13.04) compared to those who did not attend school. Children of caregivers with primary or secondary or higher education had higher coverage compared to children of caregivers with no formal education. Most caregivers mentioned contribution of the campaign in vaccination for the children not previously vaccinated. CONCLUSIONS: The results of the evaluation indicated that the campaign was successful in terms of improving MR coverage and routine immunization services. The evaluation provided an important guideline for future evaluation of similar efforts in Bangladesh and elsewhere.

Vaccination in secondary school students expedites rubella control and prevents congenital rubella syndrome.

BACKGROUND: In order to control the spread of rubella and reduce the risk for congenital rubella syndrome, an additional rubella vaccination program was set up for all secondary school students since 2008 in Zhejiang, China. METHODS: We conducted a descriptive analysis of rubella incidence among different age groups from 2005 to 2015 and a serosurvey of female subjects aged 15-39 years to understand the possible effects of this immunization program. RESULTS: The average annual rubella incidence rate had decreased from 15.86 per 100,000 population (2005-2007) to 0.75 per 100,000 population (2013-2015) in Zhejiang. The decrease in the rate of rubella incidence in girls aged 15-19 years was more accelerated (from 138.30 to 0.34 per 100,000) than in the total population during 2008-2015 (from 32.20 to 0.46 per 100,000). Of 1225 female subjects in the serosurvey, 256 (20.9%) were not immune to rubella. The proportion of subjects immune to rubella was significantly different among different age groups (Wald χ2 = 22.19, p = 0.000), and subjects aged 15-19 years old had the highest immunity (88.0%). Rubella antibody levels were significantly lower in women aged 25-30 years with 26.7% of them not immune, followed by the group aged 20-24 years (25.0%) and 30-35 years (24.5%). CONCLUSIONS: Rubella vaccine included in the Expanded Program on Immunization together with vaccination activities for secondary school students can help in rubella control, particularly in targeted age groups in the program. Seroprevalence of antibodies to the rubella virus amongst the female population within childbearing age in Zhejiang, China, is still too low to provide immunity. In addition to vaccination programs in the secondary schools, rubella vaccination should also be encouraged in women of childbearing age, which can be done effectively combined with pre-marital examination in China.

Systematic Review of Health Economic Analyses of Measles and Rubella Immunization Interventions.

Economic analyses for vaccine-preventable diseases provide important insights about the value of prevention. We reviewed the literature to identify all of the peer-reviewed, published economic analyses of interventions related to measles and rubella immunization options to assess the different types of analyses performed and characterize key insights. We searched PubMed, the Science Citation Index, and references from relevant articles for studies in English and found 67 analyses that reported primary data and quantitative estimates of benefit-cost or cost-effectiveness analyses for measles and/or rubella immunization interventions. We removed studies that we characterized as cost-minimization analyses from this sample because they generally provide insights that focused on more optimal strategies to achieve the same health outcome. The 67 analyses we included demonstrate the large economic benefits associated with preventing measles and rubella infections using vaccines and the benefit of combining measles and rubella antigens into a formulation that saves the costs associated with injecting the vaccines separately. Despite the importance of population immunity and dynamic viral transmission, most of the analyses used static models to estimate cases prevented and characterize benefits, although the use of dynamic models continues to increase. Many of the analyses focused on characterizing the most significant adverse outcomes (e.g., mortality for measles, congenital rubella syndrome for rubella) and/or only direct costs, and the most complete analyses present data from high-income countries.

Rubella in Poland in 2014

BACKGROUND: In 2004, Poland has adopted the WHO goal of rubella elimination and congenital rubella syndrome prevention. The main target of the Programme is to stop transmission of the virus in the environment and prevention of congenital rubella in children. In Poland participation in the rubella elimination program requires clinical diagnosis of rubella cases and their confirmation with laboratory tests. Vaccination against rubella was introduced in 1987, initially only in 13 - year-old girls. Since 2003, single jab vaccination against rubella, measles and mumps is used (MMR vaccine for all children: primary vaccination at the age 13-15 months and a booster vaccination at the age of 10). AIM: To assess epidemiological situation of rubella in Poland in 2014, including vaccination coverage in Polish population. MATHERIAL AND METHODS: The descriptive analysis was based on data retrieved from routine mandatory surveillance system and published in the annual bulletins "Infectious diseases and poisonings in Poland in 2014" and "Vaccinations in Poland in 2014" (MP. Czarkowski, Warszawa 2014, NIZP-PZH, GIS). RESULTS: In 2014, there was a significant decrease in the number of rubella cases - with registered 5891 cases (in 2013 - 38 548 cases) - and a decline in incidence (from 101.1 per 100 000 to 15.3). The highest incidence, regardless of gender and the environment was observed in the age group 5-6 years (respectively 93.8 and 109.4 per 100 000). Similarly to 2013, rubella incidence of males was higher than the incidence in girls and women (20.0 versus 10.9). In 2014, no cases of congenital rubella syndrome were registered. SUMMARY AND CONCLUSIONS: The proportion of laboratory tests confirming/excluding rubella infection is still very low in Poland. In 2014, only 0.6% of rubella cases were laboratory confirmed.

Global Progress Toward Rubella and Congenital Rubella Syndrome Control and Elimination - 2000-2014.

Rubella virus usually causes a mild fever and rash in children and adults. However, infection during pregnancy, especially during the first trimester, can result in miscarriage, fetal death, stillbirth, or a constellation of congenital malformations known as congenital rubella syndrome (CRS). In 2011, the World Health Organization (WHO) updated guidance on the preferred strategy for introduction of rubella-containing vaccine (RCV) into national routine immunization schedules, including an initial vaccination campaign usually targeting children aged 9 months-15 years . The Global Vaccine Action Plan endorsed by the World Health Assembly in 2012 and the Global Measles and Rubella Strategic Plan (2012-2020) published by Measles and Rubella Initiative partners in 2012 both include goals to eliminate rubella and CRS in at least two WHO regions by 2015, and at least five WHO regions by 2020 (2,3). This report updates a previous report and summarizes global progress toward rubella and CRS control and elimination during 2000-2014. As of December 2014, RCV had been introduced in 140 (72%) countries, an increase from 99 (51%) countries in 2000 (for this report, WHO member states are referred to as countries). Reported rubella cases declined 95%, from 670,894 cases in 102 countries in 2000 to 33,068 cases in 162 countries in 2014, although reporting is inconsistent. To achieve the 2020 Global Vaccine Action Plan rubella and CRS elimination goals, RCV introduction needs to continue as country criteria indicating readiness are met, and rubella and CRS surveillance need to be strengthened to ensure that progress toward elimination can be measured.

Rubella outbreak in a Rural Kenyan District, 2014: documenting the need for routine rubella immunization in Kenya.

BACKGROUND: Rubella infection has been identified as a leading cause of birth defects commonly known as Congenital Rubella Syndrome (CRS). Kenya does not currently have a rubella immunization program nor a CRS surveillance system. In 2014, a rubella outbreak was reported in a rural district in Kenya. We investigated the outbreak to determine its magnitude and describe the outbreak in time, place and person. We also analyzed the laboratory-confirmed rubella cases from 2010 to 2014 to understand the burden of the disease in the country. METHODS: The Rubella outbreak was detected using the case-based measles surveillance system. A suspected case was a person with generalized rash and fever while a confirmed case was a person who tested positive for rubella IgM. All laboratory-confirmed and epidemiologically linked cases were line listed. The measles case-based surveillance database was used to identify rubella cases from 2010 to 2014. RESULTS: A total of 125 rubella cases were line listed. Fifty four percent of cases were female. Case age ranged from 3 months to 32 years with a median of 4 years. Fifty-one percent were aged less than 5 years, while 82 % were aged less than 10 years. Six percent of the cases were women of reproductive age. All cases were treated as outpatients and there were no deaths. The number of confirmed rubella cases was 473 in 2010, 604 in 2011, 300 in 2012, 336 in 2013 and 646 in 2014. CONCLUSIONS: Analysis of Kenya rubella data shows that rubella is endemic throughout the country, and many outbreaks may be underestimated or undocumented. Six percent of all the cases in this outbreak were women of reproductive age indicating that the threat of CRS is real. The country should consider initiating a CRS surveillance system to quantify the burden with the goal of introducing rubella vaccine in the future.

Rubella in Poland in 2013.

BACKGROUND: In 2004, Poland has adopted the WHO goal of rubella elimination and congenital rubella syndrome prevention. The main target of the Programme is to stop transmission of the virus in the environment and prevention of congenital rubella in children. This can be achieved by carrying out the vaccination. Participation in the rubella elimination program requires clinical diagnosis of rubella cases and their confirmation with laboratory test. In Poland, until 2003, national vaccination recommendation included a dose of rubella vaccine only for girls aged 13 years. Among men, the incidence of measles remained high creating a risk of infection of non-immune pregnant women which may lead to the development of congenital rubella syndrome in the child. AIM: To assess epidemiological situation of rubella in Poland in 2013, including vaccination coverage in Polish population. METHODS: The descriptive analysis was based on data retrieved from routine mandatory surveillance system and published in the annual bulletins "Infectious diseases and poisonings in Poland in 2013" and "Vaccinations in Poland in 2013" (MP. Czarkowski, Warszawa 2014, NIZP-PZH, GIS). RESULTS: In 2013, there was big epidemic of rubella in Poland--with 38,548 registered cases (6 times more than in 2012), incidence 84.4 per 100,000 (5 times higher than in the previous year). The highest incidence rate, regardless of gender and the environment, was observed among adolescents aged 15-19 years (911.6 per 100,000). The incidence of rubella in boys and men was significantly higher than the incidence in girls and women (181.4 versus 23.9). In 2013, two cases of congenital rubella syndrome were registered. SUMMARY AND CONCLUSIONS: Rubella epidemic which occurred in Poland in 2013 was the result of use in the past vaccination against rubella only for girls 13 years of age. The proportion of laboratory tests confirming/excluding rubella infection is still very low in Poland. In 2013, only 0.2% of rubella cases were laboratory confirmed.

Rubella in Poland in 2012.

BACKGROUND: In 2004, Poland has adopted the WHO goal of rubella elimination and congenital rubella syndrome prevention. Participation in the rubella elimination program requires clinical diagnosis of rubella to be confirmed with laboratory test. In Poland, until 2003, national vaccination recommendation included a dose of rubella vaccine only for girls aged 13 years. Among men, the incidence of measles remained high creating a risk of infection of non-immune pregnant women which may lead to the development of congenital rubella syndrome in the child. AIM: To assess epidemiological situation of rubella in Poland in 2012, including vaccination coverage in Polish population. METHODS: The descriptive analysis was based on data retrieved from routine mandatory surveillance system and published in the annual bulletins "Infectious diseases and poisonings in Poland in 2012" and "Vaccinations in Poland in 2012". RESULTS: In 2012, there was a significant increase in the number of cases of rubella - 6 263 cases (in 2011, 4 290 cases) - and the increase in incidence (from 11.1 per 100 thousand. 16.3). The highest incidence rate, regardless of gender and the environment, was observed among adolescents aged 15-19 years (118.0 per 100 000). As in 2011, the incidence of rubella in boys and men was higher than the incidence in girls and women (25.6 versus 7.5). In 2012, no cases of congenital rubella syndrome were registered. SUMMARY AND CONCLUSIONS: The proportion of laboratory tests confirming/excluding rubella infection is still very low in Poland. In 2012, only 0.2% of rubella cases were laboratory confirmed.

Post-campaign coverage evaluation of a measles and rubella supplementary immunization activity in five districts in India, 2019-2020.

BACKGROUND: In alignment with the Measles and Rubella (MR) Strategic Elimination plan, India conducted a mass measles and rubella vaccination campaign across the country between 2017 and 2020 to provide a dose of MR containing vaccine to all children aged 9 months to 15 years. We estimated campaign vaccination coverage in five districts in India and assessed campaign awareness and factors associated with vaccination during the campaign to better understand reasons for not receiving the dose. METHODS AND FINDINGS: Community-based cross-sectional serosurveys were conducted in five districts of India among children aged 9 months to 15 years after the vaccination campaign. Campaign coverage was estimated based on home-based immunization record or caregiver recall. Campaign coverage was stratified by child- and household-level risk factors and descriptive analyses were performed to assess reasons for not receiving the campaign dose. Three thousand three hundred and fifty-seven children aged 9 months to 15 years at the time of the campaign were enrolled. Campaign coverage among children aged 9 months to 5 years documented or by recall ranged from 74.2% in Kanpur Nagar District to 90.4% in Dibrugarh District, Assam. Similar coverage was observed for older children. Caregiver awareness of the campaign varied from 88.3% in Hoshiarpur District, Punjab to 97.6% in Dibrugarh District, Assam, although 8% of children whose caregivers were aware of the campaign were not vaccinated during the campaign. Failure to receive the campaign dose was associated with urban settings, low maternal education, and lack of school attendance although the associations varied by district. CONCLUSION: Awareness of the MR vaccination campaign was high; however, campaign coverage varied by district and did not reach the elimination target of 95% coverage in any of the districts studied. Areas with lower coverage among younger children must be prioritized by strengthening the routine immunization programme and implementing strategies to identify and reach under-vaccinated children.

Rubella and congenital rubella syndrome control and elimination - global progress, 2000-2012.

Rubella virus usually causes a mild fever and rash in children and adults. However, infection during pregnancy, especially during the first trimester, can result in miscarriage, stillbirth, or infants with congenital malformations, known as congenital rubella syndrome (CRS). In 2011, the World Health Organization (WHO) updated guidance on the preferred strategy for introduction of rubella-containing vaccine (RCV) into national routine immunization schedules with an initial wide-age-range vaccination campaign that includes children aged 9 months-15 years. WHO also urged all member states to take the opportunity offered by accelerated measles control and elimination activities as a platform to introduce RCVs. The Global Measles and Rubella Strategic Plan (2012-2020) published by the Measles Rubella Initiative partners in 2012 and the Global Vaccine Action Plan endorsed by the World Health Assembly in 2012 include milestones to eliminate rubella and CRS in two WHO regions by 2015, and eliminate rubella in five WHO regions by 2020. This report summarizes the global progress of rubella and CRS control and elimination during 2000-2012. As of December 2012, a total of 132 (68%) WHO member states had introduced RCV, a 33% increase from 99 member states in 2000. A total of 94,030 rubella cases were reported to WHO in 2012 from 174 member states, an 86% decrease from the 670,894 cases reported in 2000 from 102 member states. The WHO Region of the Americas (AMR) and European Region (EUR) have established rubella elimination goals of 2010 and 2015, respectively. AMR has started to document the elimination of measles, rubella, and CRS; in EUR, rubella incidence has decreased significantly, although outbreaks continue to occur.