Rubella vaccination strategy

Abstract

Whenrubellavaccineswereintroducedin1969theywereinitiallyusedonlyinindustrializedcountries.Twomajorstrat-egies were used to prevent the occurrence of congenitalrubella syndrome (CRS). In the UnitedStates, the strategy aimed to interruptrubellaviruscirculationamongyoungchil-dren, thereby reducing the possibility ofexposure of a susceptible pregnantwoman. This was accomplished by massvaccinationofchildrenaged1-12(overthecourse of 1-3 years) followed by universalvaccination of children as they reached 1year of age. In the United Kingdom (UK),the approach was to provide individual protection to girls astheyenteredthechildbearingageandthisinvolvedvaccinat-ing girls (only) at 12-14 years of age.The U.S. approach greatly reduced the overall incidenceofrubellaandCRSandeliminatedtheprior6-9yearepidemiccycleofthedisease,butsporadiccasesofCRScontinuedwithtransmission among young adults. In the UK, there was littlechange in the secular trend of rubella occurrence and therewere sizeable epidemics with substantial increases in thenumber of cases of CRS, although fewer than in the pre-vaccine era. Thus, both approaches had some success, butneither had optimum impact. Reviewing the experience, in1983, we concluded that the first priority of rubella vaccina-tion programs should be to vaccinate women of childbearingage. The second priority should be to interrupt transmissionofrubella(byvaccinatingchildren).This“complete”strategyshould lead to maximal prevention of CRS.