Rubella Vaccination Coverage Research Articles

Examining vaccination coverage in Germany: spatiotemporal clustering of MMR coverage, 2008-14.

Vaccine hesitancy is an increasing global health threat but much of the recent research has centred on the USA. European countries provide an interesting context due to increases in vaccine-preventable disease outbreaks as well as variability in vaccination laws. We investigated the spatiotemporal clustering of Measles, Mumps, and Rubella vaccination coverage in Germany, a country with a historic absence of compulsory vaccination laws. We also examined measles incidence in the context of the spatiotemporal clustering results. While we did not identify strong spatial patterns of geographic clustering in Germany, our results suggest a potential relationship between measles incidence and vaccination coverage cluster status.

Strategies for elimination of rubella in pregnancy and of congenital rubella syndrome in high and upper-middle income countries.

SummaryRubella infection generally leads to mild symptoms; otherwise, in pregnant women it can cause severe damages. The only way to prevent rubella is vaccine. Before the introduction of the vaccine, up to 4 babies in 1000 live births were born with CRS.This work aims to review the most important strategies for the elimination of CRS in upper and high-income countries.Papers were selected through a PubMed search up to January 2019, using keywords rubella, congenital rubella syndrome and epidemiology. Articles published in the last 12 years and referred to upper income and high-income countries in title or abstract were included.Sixty-five papers were selected dealing with one or more of the following strategies: increasing of rubella vaccination coverage in childbearing age women, males, immigrants; exploitation of all appropriate occasions; improving of rubella surveillance.Despite numerous suggestions and indications for valid strategies to eliminate rubella in pregnancy and congenital rubella syndrome, a practical application is often missing.

Health Departments' Experience With Mumps Outbreak Response and Use of a Third Dose of Measles, Mumps, and Rubella Vaccine.

During January 2016 to June 2017, US health departments (HDs) reported 150 mumps outbreaks. Most occurred among populations with high 2-dose measles, mumps, and rubella (MMR) vaccine coverage, prompting the Advisory Committee on Immunization Practices to examine the evidence for use of a third dose of MMR vaccine. To evaluate HD experiences with mumps outbreak control and use of a third MMR dose during outbreaks. An online survey assessing mumps outbreak characteristics, outbreak response measures, challenges, and lessons learned from previous outbreaks was distributed to all 81 Council of State and Territorial Epidemiologists member HDs in August 2017. Sixty-one (75%) HDs responded; 46 (75%) had experience with ≥1 mumps outbreak(s) during January 2016 to August 2017. Twenty (43%) HDs recommended a third or outbreak MMR dose during mumps outbreaks; of these, 19 completed the section on use of a third dose and 8 (40%) rated the intervention "somewhat effective" or better. Health departments that used a third/outbreak dose suggested implementing the recommendation early and to a targeted group. Forty-three (73%) HDs reported having a policy for excluding persons without presumptive immunity from outbreak settings; of these, 37 (86%) had some degree of legal authority to implement this policy. Exclusion compliance improved with the use of personalized notification letters, focus groups of excluded persons and the community, and standardized messaging. Other outbreak control measures included cohorting of exposed or susceptible persons, mobile vaccination clinics and home visits, contact monitoring via text messaging, and facilitating student isolation with meal delivery and excused class absences. Our study revealed heterogeneity across HDs' mumps outbreak responses but also identified common challenges that will inform future Centers for Disease Control and Prevention guidance. These results were considered in the October 2017 Advisory Committee on Immunization Practices recommendation for use of a third dose of MMR vaccine for persons at increased risk for mumps during an outbreak and in the development of Centers for Disease Control and Prevention guidance for HDs when applying the Advisory Committee on Immunization Practices recommendation.

Vaccination coverage for measles, mumps, and rubella in a tertiary hospital of Porto Alegre, state of Rio Grande do Sul.

Introduction:Measles, mumps, and rubella are viral contagious diseases preventable by the MMR vaccine. MMR is a part of the immunization schedule of the Brazilian Ministry of Health, which recommends 2 doses of the vaccine for professionals working in health care facilities.Objectives:To determine the vaccination coverage for measles, mumps, and rubella among active professionals of a tertiary hospital in the city of Porto Alegre, state of Rio Grande do Sul; to analyze the importance of vaccinating professionals that work at health care facilities; to detect and highlight high-risk services for contagious diseases according to patient profiles - children, pregnant and puerperal women, immunocompromised individuals.Methods:This is a descriptive transversal study that analyzed the database of the Occupational Medicine Service of Hospital de Clínicas de Porto Alegre considering active professionals in January 2019.Results:We evaluated the vaccination records of 7802 active professionals of this hospital; 52% of them had taken at least 1 dose of the MMR vaccine (1 or 2 doses) and 47% had not been vaccinated. Among high-risk services, 56.4% of the professionals had had at least 1 MMR dose, while 43.4% had not been vaccinated.Conclusions:This study revealed that the vaccination coverage for measles, mumps, and rubella at the analyzed health care facility was still far from the ideal; however, the Occupational Medicine Service has been making efforts to gradually broaden this coverage.

The 2016 California policy to eliminate nonmedical vaccine exemptions and changes in vaccine coverage: An empirical policy analysis.

Vaccine hesitancy, the reluctance or refusal to receive vaccination, is a growing public health problem in the United States and globally. State policies that eliminate nonmedical ("personal belief") exemptions to childhood vaccination requirements are controversial, and their effectiveness to improve vaccination coverage remains unclear given limited rigorous policy analysis. In 2016, a California policy (Senate Bill 277) eliminated nonmedical exemptions from school entry requirements. The objective of this study was to estimate the association between California's 2016 policy and changes in vaccine coverage. We used a quasi-experimental state-level synthetic control analysis and a county-level difference-in-differences analysis to estimate the impact of the 2016 California policy on vaccination coverage and prevalence of exemptions to vaccine requirements (nonmedical and medical). We used publicly available state-level data from the US Centers for Disease Control and Prevention on coverage of measles, mumps, and rubella (MMR) vaccination, nonmedical exemption, and medical exemption in children entering kindergarten. We used county-level data individually requested from state departments of public health on overall vaccine coverage and exemptions. Based on data availability, we included state-level data for 45 states, including California, from 2011 to 2017 and county-level data for 17 states from 2010 to 2017. The prespecified primary study outcome was MMR vaccination in the state analysis and overall vaccine coverage in the county analysis. In the state-level synthetic control analysis, MMR coverage in California increased by 3.3% relative to its synthetic control in the postpolicy period (top 2 of 43 states evaluated in the placebo tests, top 5%), nonmedical exemptions decreased by 2.4% (top 2 of 43 states evaluated in the placebo tests, top 5%), and medical exemptions increased by 0.4% (top 1 of 44 states evaluated in the placebo tests, top 2%). In the county-level analysis, overall vaccination coverage increased by 4.3% (95% confidence interval [CI] 2.9%-5.8%, p < 0.001), nonmedical exemptions decreased by 3.9% (95% CI 2.4%-5.4%, p < 0.001), and medical exemptions increased by 2.4% (95% CI 2.0%-2.9%, p < 0.001). Changes in vaccination coverage across counties after the policy implementation from 2015 to 2017 ranged from -6% to 26%, with larger increases in coverage in counties with lower prepolicy vaccine coverage. Results were robust to alternative model specifications. The limitations of the study were the exclusion of a subset of US states from the analysis and the use of only 2 years of postpolicy data based on data availability. In this study, implementation of the California policy that eliminated nonmedical childhood vaccine exemptions was associated with an estimated increase in vaccination coverage and a reduction in nonmedical exemptions at state and county levels. The observed increase in medical exemptions was offset by the larger reduction in nonmedical exemptions. The largest increases in vaccine coverage were observed in the most "high-risk" counties, meaning those with the lowest prepolicy vaccine coverage. Our findings suggest that government policies removing nonmedical exemptions can be effective at increasing vaccination coverage.

&lt;p&gt;Nurses’ Perceptions Of MMR Vaccine Hesitancy In An Area With Low Vaccination Coverage&lt;/p&gt;

Background and aimMeasles, mumps, and rubella vaccine (MMR) coverage is low in an area in the Northern part of Stockholm, Sweden. The overall aim of this study was to explore the perceptions, views, and experiences of child health clinic nurses related to vaccine hesitancy in Rinkeby and Tensta.MethodsThe study focused specifically on hesitancy towards measles-mumps-rubella (MMR) vaccination. Eleven in-depth interviews were conducted in Swedish with female nurses who were directly responsible for vaccination programmes. Their thoughts and experiences were sought using probing and question rephrasing techniques. Transcripts of the data were analysed using content analysis.ResultsFour themes emerged, namely hesitancy among Somali parents, lack of confidence in the MMR vaccine, loss of confidence in other vaccines due to mistrust of the MMR vaccine, and complacency regarding vaccination in general.ConclusionThere is a strong influence of fear of vaccine-induced autism among parents in the Somali community in areas of Stockholm, that requires continued attention by the health care providers.

Progress Toward Rubella and Congenital Rubella Syndrome Control and Elimination - Worldwide, 2000-2018.

Rubella is a leading cause of vaccine-preventable birth defects. Although rubella virus infection usually causes a mild febrile rash illness in children and adults, infection during pregnancy, especially during the first trimester, can result in miscarriage, fetal death, stillbirth, or a constellation of birth defects known as congenital rubella syndrome (CRS). A single dose of rubella-containing vaccine (RCV) can provide lifelong protection (1). In 2011, the World Health Organization (WHO) updated guidance on the use of RCV and recommended capitalizing on the accelerated measles elimination activities as an opportunity to introduce RCV (1). The Global Vaccine Action Plan 2011-2020 (GVAP) includes a target to achieve elimination of rubella in at least five of the six WHO regions by 2020 (2). This report on the progress toward rubella and CRS control and elimination updates the 2017 report (3), summarizing global progress toward the control and elimination of rubella and CRS from 2000 (the initiation of accelerated measles control activities) and 2012 (the initiation of accelerated rubella control activities) to 2018 (the most recent data) using WHO immunization and surveillance data. Among WHO Member States,* the number with RCV in their immunization schedules has increased from 99 (52% of 191) in 2000 to 168 (87% of 194) in 2018†; 69% of the world's infants were vaccinated against rubella in 2018. Rubella elimination has been verified in 81 (42%) countries. To make further progress to control and eliminate rubella, and to reduce the equity gap, introduction of RCV in all countries is important. Likewise, countries that have introduced RCV can achieve and maintain elimination with high vaccination coverage and surveillance for rubella and CRS. The two WHO regions that have not established an elimination goal (African [AFR] and Eastern Mediterranean [EMR]) should consider establishing a goal.§.

Triangulation of measles vaccination data in the United Kingdom of Great Britain and Northern Ireland.

ObjectiveTo illustrate how data triangulation involving routine data sources can optimize data usage and provide insights into vaccine programme effectiveness by considering measles vaccination and disease incidence data in England.MethodsWe obtained data on measles, mumps and rubella (MMR) vaccine coverage in birth cohorts from 1985 to 2016 from child health records and adjusted for under-ascertainment and catch-up campaigns. We assumed that the population had no natural immunity and that vaccine effectiveness was 95% for one dose and 99.75% for two doses. Vaccinations done outside the routine schedule and in people who entered England after the age of immunization were identified from primary care records. Measles susceptibility was defined as the percentage of individuals who were not immune despite all vaccination activities. We triangulated measles susceptibility and incidence data.FindingsMedian susceptibility was 4.6% (range: 1.2–9.2). Among cohorts eligible for two MMR vaccine doses, those born between 1998 and 2004 were most susceptible. Measles incidence was highest in these cohorts. Data from primary care and child health records were comparable for cohorts after 2000, suggesting that little supplementary vaccination took place. For cohorts before 2000, primary care data quality was insufficient for accurately estimating coverage.ConclusionTriangulating routine data on measles vaccination coverage and disease surveillance provided new insights into population immunity and helped identify vulnerable groups, which was useful for prioritizing public health actions to close gaps in immunity. This approach could be applied in any country that routinely records vaccine coverage and disease incidence.

Rubella Vaccination Coverage Among Women of Childbearing Age in Vietnam

Despite the availability of effective and safe rubella vaccines for women of childbearing age, prevention and control of congenital rubella syndrome in children remains challenging in Vietnam. In order to examine this issue, we conducted a cross-sectional study, examining the current coverage of rubella vaccination before pregnancy among 807 pregnant women and women with children under 12 months of age in urban and rural districts, Dong Da and Ba Vi, in Hanoi, Vietnam. In this population, we observed an alarming non-compliance rate with rubella vaccination before pregnancy in both localities. Among the 82.0% of participants who remained unvaccinated against this contagious viral infection, 95.8% of them were in Ba Vi district, compared to 68.0% in Dong Da district (p < 0.001). Besides the differences in age, number of children, education levels, primary occupations and monthly incomes among the participants between the two districts, other reasons for noncompliance with rubella vaccination includeddisinterest in rubella vaccination, the high cost and long distance to vaccination sites as well as unawareness of vaccination locations. In addition to addressing the unique socio-economicchallenges behind one’s accessibility to vaccination services in urban and rural areas, our study supports a continued effort in ensuring proper access to and education about pre-pregnancy vaccines and vaccination among women of childbearing age in order to achieve and sustain sufficient immunization coverage of rubella and other vaccine-preventable diseases in both settings.

Rubella in Poland in 2017

Rubella is the disease subject to the elimination programme coordinated by the World Health Organization (WHO). Generally, rubella is an infection of mild course among children but in the case of pregnant women, who are not immunized, the probability of the occurrence of severe congenital abnormalities (congenital rubella syndrome) may amount to 95%. The strategy of the countries belonging to the WHO European Region is directed to the interruption of the rubella virus transmission in the environment in order to prevent the cases of congenital rubella syndrome (CRS). The aims of the present article are to analyze the epidemiological situation of rubella in Poland in 2017 and to discuss the rubella vaccination coverage. The epidemiological situation of rubella in Poland was analyzed on the basis of publications: “Infectious diseases and poisonings in Poland in 2017” and “Vaccinations in Poland in 2017”. In 2017, there was a decrease in the number of rubella cases - with registered 476 cases (in 2016 – 1 105 cases) - and a decline in incidence (from 2.9 per 100 000 to 1.2). The highest incidence rate, regardless of gender and the environment, was observed among children aged 0-4 years (11.8 per 100,000). In 2017, no cases of congenital rubella syndrome were registered. In 2017, there was a decrease in the number of rubella cases. In Poland Rubella is reported exclusively on the basis of the clinical picture. The proportion of laboratory tests confirming/excluding rubella infection is still very low in Poland.

2468. Impact of a Herd Immunity Educational Intervention on Parental Concern About Measles

BackgroundMaintaining high coverage of measles, mumps, and rubella (MMR) vaccination is important for preventing outbreaks and maintaining herd immunity (HI), which benefits both individuals and communities. We aimed to determine whether information about the benefits of HI and local MMR vaccination rates could change a parent’s concern about their child’s risk of contracting measles.MethodsWe conducted a survey at the 2016 Minnesota State Fair among Minnesota residents ≥18 years who had at least one child aged 6–18 years. Participants were asked to choose the correct definition of HI, to estimate the MMR vaccination coverage in their county, and guess the minimum MMR vaccination coverage needed to prevent measles outbreaks. We delivered an educational intervention through the interactive survey informing participants about the benefits of herd immunity, the actual MMR coverage in their county, and that ≥95% coverage is needed to prevent outbreaks. Before and after the educational intervention, participants were asked to report their level of concern about their child contracting measles. We calculated adjusted predicted percentages from logistic regression models to evaluate changes in concern about risk pre- and post-intervention and to assess factors associated with concern about measles.ResultsAmong the 493 participants, 92.7% reported vaccinating their child with MMR, though one third were not familiar with HI. Prior to receiving information, those knowledgeable about HI were significantly more likely to be concerned about their child getting measles (predicted percentage 80.2% [95% CI: 75.7–84.6]) than those who were unfamiliar with HI (predicted percentage 69.8% [95% CI: 62.1–77.5]), P-value for the difference = 0.027. Participants believed that MMR vaccination was, on average, 9.0% [95% CI: 6.9–11.0] lower than the actual coverage in their local area.ConclusionInformation about HI and local vaccination coverage rates did not impact parental concern about their child being at risk for getting measles. Overall, parents learned that local MMR vaccination rates were higher than they had expected.Disclosures All authors: No reported disclosures.

Perspectives on the Measles, Mumps and Rubella Vaccination among Somali Mothers in Stockholm.

Background: Vaccination hesitancy and skepticism among parents hinders progress in achieving full vaccination coverage. Swedish measles, mumps and rubella (MMR) vaccine coverage is high however some areas with low vaccination coverage risk outbreaks. This study aimed to explore factors influencing the decision of Somali parents living in the Rinkeby and Tensta districts of Stockholm, Sweden, on whether or not to vaccinate their children with the measles, mumps and rubella (MMR) vaccine. Method: Participants were 13 mothers of at least one child aged 18 months to 5 years, who were recruited using snowball sampling. In-depth interviews were conducted in Somali and Swedish languages and the data generated was analysed using qualitative content analysis. Both written and verbal informed consent were obtained from participants. Results: Seven of the mothers had not vaccinated their youngest child at the time of the study and decided to postpone the vaccination until their child became older (delayers). The other six mothers had vaccinated their child for MMR at the appointed time (timely vaccinators). The analysis of the data revealed two main themes: (1) barriers to vaccinate on time, included issues surrounding fear of the child not speaking and unpleasant encounters with nurses and (2) facilitating factors to vaccinate on time, included heeding vaccinating parents’ advice, trust in nurses and trust in God. The mothers who had vaccinated their children had a positive impact in influencing other mothers to also vaccinate. Conclusions: Fear, based on the perceived risk that vaccination will lead to autism, among Somali mothers in Tensta and Rinkeby is evident and influenced by the opinions of friends and relatives. Child Healthcare Center nurses are important in the decision-making process regarding acceptance of MMR vaccination. There is a need to address mothers’ concerns regarding vaccine safety while improving the approach of nurses as they address these concerns.

Różyczka w Polsce w 2016 roku

Rubella is the disease subject to the elimination programme coordinated by the World Health Organization (WHO). Generally, rubella is an infection of mild course among children but in the case of pregnant women, who are not immunized, the probability of the occurrence of severe congenital abnormalities (congenital rubella syndrome) may amount to 95%. The strategy of the countries belonging to the WHO European Region is directed to the interruption of the rubella virus transmission in the environment in order to prevent the cases of congenital rubella syndrome (CRS). OBJECTIVES. The aims of the present article are to analyze the epidemiological situation of rubella in Poland in 2016 and to discuss the rubella vaccination coverage. The epidemiological situation of rubella in Poland was analyzed on the basis of publications: “Infectious diseases and poisonings in Poland in 2016” and “Vaccinations in Poland in 2016”. In 2016, there was a decrease in the number of rubella cases - with registered 1 105 cases (in 2015 – 2 027 cases) - and a decline in incidence (from 5.3 per 100 000 to 2,9). The highest incidence rate, regardless of gender and the environment, was observed among children aged 0-4 years (27.9 per 100,000). The incidence of rubella in boys and men was identical 2.9. In 2016, no cases of congenital rubella syndrome were registered. In 2016, there was a decrease in the number of rubella cases. In Poland Rubella is reported exclusively on the basis of the clinical picture. The proportion of laboratory tests confirming/excluding rubella infection is still very low in Poland.

Measles rubella campaign: coverage among slum children of Udupi municipality area in Karnataka

Background: Poor coverage of measles vaccine and shift in the age of incidence of rubella towards adolescents and young adults with low rubella vaccination coverage leads to outbreaks of congenital rubella syndrome and measles in India. Therefore the Government of India has decided to administer measles rubella vaccine to all children from 9 months to 15 years of age in campaign mode to eliminate measles and control rubella. The aims and objectives of the study were to assess the coverage of measles rubella vaccination among the slum children of Udupi Municipality area following the MR campaign.Methods: A community based cross sectional study was conducted for a period of one month among parents of beneficiary children in 312 households of the study population.Results: Study targeted 350 families in 14 localities of which 312 families were covered consisting 578 children. Amongst them 560 (97%) were immunized and 28 (5%) of them had minor side effects. Fever (89%) was the most common side effect. Among those who were not vaccinated 18 (3%) nearly half of them (44%) were not aware of ongoing campaign and 22% as per physician’s advice.Conclusions: In the present study, coverage of MR vaccine was 97% and 88.1% (275) of the families studied knew about the MR campaign while only 267 (85.6%) actually received the MR vaccine.

A Microneedle Patch for Measles and Rubella Vaccination Is Immunogenic and Protective in Infant Rhesus Macaques.

New methods to increase measles and rubella (MR) vaccination coverage are needed to achieve global and regional MR elimination goals. Here, we developed microneedle (MN) patches designed to administer MR vaccine by minimally trained personnel, leave no biohazardous sharps waste, remove the need for vaccine reconstitution, and provide thermostability outside the cold chain. This study evaluated the immunogenicity of MN patches delivering MR vaccine to infant rhesus macaques. Protective titers of measles neutralizing antibodies (>120 mIU/mL) were detected in 100% of macaques in the MN group and 75% of macaques in the subcutaneous (SC) injection group. Rubella neutralizing antibody titers were >10 IU/mL for all groups. All macaques in the MN group were protected from challenge with wild-type measles virus, whereas 75% were protected in the SC group. However, vaccination by the MN or SC route was unable to generate protective immune responses to measles in infant macaques pretreated with measles immunoglobulin to simulate maternal antibody. These results show, for the first time, that MR vaccine delivered by MN patch generated protective titers of neutralizing antibodies to both measles and rubella in infant rhesus macaques and afforded complete protection from measles virus challenge.

Rubella seroprevalence among pregnant women in Beijing, China

BackgroundRubella infection in pregnant women can result in serious effects, such as miscarriages, stillbirths, and congenital rubella syndrome (CRS). However, very little is known about the rubella seroprevalence among pregnant women in China.MethodsThis is a cross-sectional and hospital-based study. From June 2016 through March 2017, a total of 324 serum samples from healthy pregnant women were collected in the Shunyi Women and Children’s Hospital of Beijing Children’s Hospital. Rubella-specific IgG antibody was determined by ELISA (Euroimmun, Lübeck, Germany) kits. International assigned cut-off values of ≥10 IU/ml were used to assess the percentage of pregnant women with protective IgG concentrations.ResultsThe total rate of protected individuals was 83.3% (95% CI: 78.9%–87.0%). The protective rates of pregnant women in 17–26 years group, 27–36 years group and 37–46 years group were 84.0% (95% CI: 75.3%–90.1%), 81.9% (95% CI: 74.9%–87.4%) and 84.9% (95% CI: 75.8%–90.9%) respectively. No significant difference in protective rates among the three age groups was found (P = 0.83). There were also no statistically significant correlations between protective rates and gravidity (P = 0.84), parity (P = 0.84), birth place (P = 0.16), residence area (P = 0.58), education (P = 0.40) or occupation (P = 0.65).ConclusionsDespite the generally low vaccination coverage for rubella, most of Chinese pregnant women had potent rubella immunity. However, at least 16.7% of pregnant women were susceptible to rubella, which suggested rubella immunization in Chinese women at or before child-bearing age.

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

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.

The web and public confidence in MMR vaccination in Italy.

Measles, mumps and rubella (MMR) vaccination coverage in Italy has been decreasing starting from 2012 and, at the present, none of the Italian regions has achieved the goal of 95% coverage target. A decision of the Court of Justice of Rimini in March 2012 that awarded vaccine-injury compensation for a case of autism has been indicated as a probable trigger event leading to a reduction of vaccine confidence in Italy. The aim of the study was to explore the relationship between MMR vaccination coverage to online search trends and social network activity on the topic "autism and MMR vaccine", during the period 2010-2015. A significant inverse correlation was found between MMR vaccination coverage and Internet search activity, tweets and Facebook posts. New media might have played a role in spreading misinformation. Media monitoring could be useful to assess the level of vaccine hesitancy and to plan and target effective information campaigns.

Epidemiological study of rubella outbreaks in Rajasthan, India

Background: Rubella is one of the major causes of significant morbidity and congenital deformities in India. Rubella immunization is yet to be formally introduced in National Immunization schedule across the country. Strong surveillance system for rubella is the key for prevention and control of congenital rubella syndrome. The outbreaks of rubella in Rajasthan in 2014 were investigated. The objective was to study the socio demographic profile of rubella outbreak in RajasthanMethods: The data of the AFP cum measles and rubella surveillance project of Rajasthan was used for analysis. This is an analytical, cross sectional study where 2 districts of Rajasthan having confirmed rubella outbreak in 2014 were included. A total of 101 laboratory plus epidemiologically linked rubella cases were considered. Statistical analysis: Percentages, proportions and Chi square test were applied.Results: In three outbreaks, 101 cases were of rubella (laboratory confirmed + epidemiologically confirmed). Maximum numbers (around 53%) of cases were from the age group 1-4 years and 54.5% male child. The disease starts in early age (4 months) and affected up to the age group of 27 years.Conclusions: There was an outbreak of rubella cases in one district and mixed outbreak in second one. Currently rubella vaccination coverage is zero. Considering the currently available knowledge and reports, it is well justified that CRS can be controlled by effective immunization program and inclusion of rubella vaccination in the national immunization program of India is much awaited. Rubella vaccination is a cost effective measure and it can very easily piggy back Measles vaccine.

Inferring rubella outbreak risk from seroprevalence data in Belgium

Rubella is usually a mild disease for which infections often pass by unnoticed. In approximately 50% of the cases, there are no or only few clinical symptoms. However, rubella contracted during early pregnancy could lead to spontaneous abortion, to central nervous system defects, or to one of a range of other serious and debilitating conditions in a newborn such as the congenital rubella syndrome. Before the introduction of mass vaccination, rubella was a common childhood infection occurring all over the world. However, since the introduction of rubella antigen-containing vaccines, the incidence of rubella has declined dramatically in high-income countries. Recent large-scale mumps outbreaks, one of the components in the combined measles-mumps-rubella vaccine, occurring in countries throughout Europe with high vaccination coverage, provide evidence of pathogen-specific waning of vaccine-induced immunity and primary vaccine failure. In addition, recent measles outbreaks affecting populations with suboptimal vaccination coverages stress the importance of maintaining high vaccination coverages. In this paper, we focus on the assessment of rubella outbreak risk using a previously developed method to identify geographic regions of high outbreak potential. The methodology relies on 2006 rubella seroprevalence data and vaccination coverage data from Belgium and information on primary and secondary vaccine failure obtained from extensive literature reviews. We estimated the rubella outbreak risk in Belgium to be low, however maintaining high levels of immunisation and surveillance are of utmost importance to avoid future outbreaks.