RUBELLA – SHOULD IT BE A PRIORITY IN THE NATIONAL IMMUNIZATION PROGRAMMES?
AbstractRubella is a mild infection of childhood and young adults with 75% of cases occurring in age group 15–45 years. In unvaccinated populations, rubella usually occurs in spring with epidemics in 6–9 years cycles. Rubella has devastating effects on growing foetus if contracted by women in the first trimester of pregnancy. Perinatal infection of Rubella contributes to 2–3% of all congenital anomalies. Over the past three decades many resource risk countries have introduced universal or selective immunization programs against rubella with evidence that such interventions reduce the incidence of congenital rubella syndrome. In Pakistan the schedules of the Expanded Program on Immunization (EPI) do not include immunization against rubella and evidence is needed to estimate the risk of congenital rubella with a view to start immunization programmes to combat the menace of Congenital Rubella Syndrome (CRS). Logistically it is easy to add rubella vaccine to the already existing EPI schedules as measles is given on 9th and 15 month with little implications for cost, resulting in great reduction in CRS.
Cutts FT, Metcalf CJE, Lessler J, Grenfell BT. Rubella vaccination: must not be business as usual (correspondence). Lancet 2012; 380:217-8.
Smith S. Infectious diseases. In: Marcdante KJ, Kliegman RM, Jenson HB, Behrman RE, editors. Nelson essentials of pediatrics. 6th ed. Philadelphia: Saunders, Elsevier 2011; p. 370–1.
Imam H, Yasmin M, Ahsan CR, Nessa J. Pregnant Women in and Around Dhaka City: Are Their Children at Risk of Developing Congenital Rubella Syndrome? Indian J Microbiol 2010; 50:443–8.
Avery K, Hancock E, Selvage D, Tsang A. Vaccine preventable diseases. In: New Mexico department of health. Infectious diseases in New Mexico 2011 annual report. Santa Fe, New Mexico: New Mexico department of health, 2012; p.14.
Plotkin SA. Elimination of Rubella in the United States. The History of Rubella and Rubella Vaccination leading to Elimination. Clin Infect Dis 2006;43: S164–8.
Uysal A, Taner CE, Cu¨ce M, Atalay S, Go¨l B, Ko¨se S, et al. Cytomegalovirus and rubella seroprevalence in pregnant women in Izmir/Turkey: follow-up and results of pregnancy outcome. Arch Gynecol Obstet 2012; 286:605–8.
Gowen Jr CW. Fetal and neonatal medicine. In: Marcdante KJ, Kliegman RM, Jenson HB, Behrman RE, editors. Nelson essentials of pediatrics. 6th ed. Philadelphia: Saunders, Elsevier 2011; p. 260.
Lambert SR. Congenital rubella syndrome: the end is in sight. Br J Ophthalmol 2007; 91(11): 1418–9.
Beger BE, Navar-Boggan AM, Omer SB. Congenital rubella syndrome and autism spectrum disorders prevented by rubella vaccination – United States, 2000-2010. BMC Public Health 2011;11:340.
Robert S, Duszak, OD. Congenital rubella syndrome - major review. Optometry 2009; 80:36–43.
American Academy of Pediatrics. Rubella. In: Pickering LK, editor. Red Book: 2006 Report of the committee on infectious diseases. 27th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2003: p. 574–9.
Morice A, Ulloa-Gutierrrez R, Avila-Augero ML. Congenital rubella syndrome: progress and future challenges. Expert Rev Vaccines 2009; 8:323–31.
Reef SE. Rubella. In: Wallace RB, editor. Wallace/Maxy-Rosenau-Last public health & preventive medicine. 15th ed. New York: Mc-Graw Hill, 2008; p.108–10.
Iqbal A, Bokhari SR. Occurrence of rubella antibody IgG in general population. Mother & Child. 1997;35:17–22.
Quddusi H, Sultana H, Sajid KM, Sabih D, Akhtar MS. Seroprevalence of rubella antibodies among women of reproductive age: A study at Nishtar Hospital Multan. Ann King Edward Med Coll 2006;12:519–20.
Adil MM, Zubair M, Alam AY, Raja KS. Identification of seronegative pregnant women eligible for immunization against rubella. Rawal Med J 2005;30:22–4.
Salim M. Rubella serology of adolescent schoolgirls of Abbottabad city. [M.Phil, Community Medicine Thesis] University of Health Sciences Lahore, Pakistan; 2009.
Sadighi J, Eftekhar H, Mohammad K. Congenital rubella syndrome in Iran. BMC Infect Dis 2005;5:44.
Dewan P, Gupta P. Burden of congenital rubella syndrome (CRS) in India: a systematic review. Indian Pediatr 2012;49:377–99.