Progress towards rubella elimination after implementation of rubella immunization for over 20 years in Shandong province, China

Changyin Wang,Aiqiang Xu,Zhen Zhu,Qing Xu,Xiaodong Liu,Xueqiang Fang,Lizhi Song,Ping Xiong,Wenbo Xu

doi:10.1038/s41598-017-18281-2

Abstract

The rubella vaccine has been included in the immunization program in Shandong province of China since 1995. Here we observed the rubella vaccine coverage, epidemiology, serosurvey, and virological surveillance data, in order to identify the challenges impeding the progress towards to its elimination following the implementation of rubella immunization over a 21-year period in Shandong province. We first noted that the annual increase in vaccination coverage resulted in decreased rate of rubella incidence, which was maintained at a low level. Second, the average age of rubella patients had shifted to the 15–29-year age group, making this group the main population affected by the rubella virus (RV). Third, more than 90% of the study population were immune to rubella. However, the positive rate of rubella IgG in some cities was relatively lower indicating that an insufficient proportion of individuals had been vaccinated. Finally, the transmission of the genotype 1E RV was gradually interrupted due to the implementation of rubella vaccination. Unfortunately, the endemicity of the imported genotype 2B RV was established due to the pockets with unvaccinated people. Therefore, comprehensive vaccination coverage of the population, combined with high quality monitoring of rubella, is necessary to achieve the rubella elimination goal.

Highlights

Rubella virus (RV) is the only member of the genus Rubivirus within the family Togaviridae, and contains a single-stranded positive polarity RNA genome[1]
If rubella virus (RV) infection occurs just before conception and during the first 8–10 weeks of pregnancy, it can be transferred across the placenta causing fetal infection, and lead to serious consequences, including spontaneous abortion, stillbirth, and congenital rubella syndrome (CRS) alongside cardiac defects, cataracts, and hearing impairment, which are of great public health concern worldwide[1]
Rubella vaccine has been included in the immunization program of Shandong province since 19959

Summary

Introduction

Rubella virus (RV) is the only member of the genus Rubivirus within the family Togaviridae, and contains a single-stranded positive polarity RNA genome[1]. The WHO recommended that all countries that have not yet introduced rubella vaccine, and are providing 2 doses of measles vaccine using routine immunization or SIAs, or both, should consider including rubella-containing vaccine (RCV) in their immunization programs[8]. Rubella vaccine has been included in the immunization program of Shandong province since 19959. All the suspected rubella cases found in hospitals were reported, and the surveillance data flowed from hospitals and county-level Centers for Disease Control and Prevention (CDC) to the Shandong provincial CDC. We aimed to observe the changes to rubella epidemiology and to identify the challenges in rubella elimination in Shandong province after the implementation of a rubella vaccine immunization strategy over a period of 21 years (1995–2015), and provide a reference for other countries

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Conclusion