Abstract
BackgroundRubella outbreaks occurred among adults in Japan in 2013-2014 and 2018-2019 due to immunity gaps. In response and aiming at rubella elimination by 2020, the government introduced countermeasures comprising supplementary immunization activities for voluntary testing of adult non-healthcare-related workers and vaccination of susceptible individuals. However, as of October 2020, rubella immunity testing and vaccination rates remained low. This study was conducted to identify factors associated with adults voluntarily confirming their rubella immune status, to help develop effective promotion activities for hard-to-reach and left-behind populations.MethodsIn this cross-sectional study, a general population sample of non-healthcare workers aged 20-49 years in Japan completed an online survey in November 2020. Univariate analysis was performed to examine associations of specific actions taken to confirm rubella immune status with social background characteristics, knowledge of rubella, and attitude to testing and vaccination. Log binomial regression analysis was performed to explore the associations following adjustment for social background characteristics.ResultsAmong 1,854 respondents (927 men, 927 women), only 23.4% of men and 39.4% of women in their 20s to 40s have taken some action related to rubella prevention. Three major factors were associated with the targeted population having taken voluntary action: (1) knowing about testing for confirmation of immunity status (adjusted odds ratio [AOR] 4.29 men, 2.89 women), the rubella outbreak in 2013 among men in their 20s to 40s (AOR 2.79 men, 1.64 women), and congenital rubella syndrome (AOR 1.89 men, 3.10 women); (2) having acquaintances who were vaccinated against or tested for rubella (AOR 2.98 men, 1.95 women); and (3) having a positive attitude toward influenza vaccination (AOR 2.48 men, 1.83 women). Marriage, desire for pregnancy, and having children were weakly associated with taking action.ConclusionsCurrently, insufficient voluntary action is being taken by high-risk adult populations to close the identified immunity gaps. In this last mile to rubella elimination, our findings and suggested potential interventions via annual health check-ups and occupational health and public health initiatives could prove helpful in developing further countermeasures that actively promote and implement supplementary immunization activities targeting all adult generations.
Highlights
Rubella outbreaks occurred among adults in Japan in 2013-2014 and 2018-2019 due to immunity gaps
Currently, insufficient voluntary action is being taken by high-risk adult populations to close the identified immunity gaps
In this last mile to rubella elimination, our findings and suggested potential interventions via annual health check-ups and occupational health and public health initiatives could prove helpful in developing further countermeasures that actively promote and implement supplementary immunization activities targeting all adult generations
Summary
Rubella outbreaks occurred among adults in Japan in 2013-2014 and 2018-2019 due to immunity gaps. In Japan in 2013, a rubella outbreak occurred among the working-age population that had not been previously vaccinated; 14,344 adults mostly in their 20s to 40s were infected and 45 cases of congenital rubella syndrome (CRS) were recorded [5,6,7]. This 2013 outbreak was due to immunity gaps. In 1977, the government had started a rubella vaccination program for adolescent females (age 12-15 years) to prevent CRS and the policy continued until 1995, when universal infant immunization was introduced. The historical routine immunization of adolescent females, subsequent introduction of childhood immunization, and lack of supplementary immunization activities (SIAs) for testing of adults resulted in immunity gaps among adults born before April 1, 1990 who were not infected with rubella naturally and who did not have the opportunity to be vaccinated twice
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