Why Reducing Measles, Rubella, and Congenital Rubella Syndrome (CRS) Worldwide Is Important

Photo credit: C. McNab/Measles and Rubella Initiative Despite the availability of a safe, effective, and inexpensive vaccine for more than 40 years, measles remains a leading vaccine-preventable cause of childhood deaths.

The Worldwide Problem

Measles

• Measles is a leading cause of vaccine-preventable deaths among children across the globe. In 2010, measles killed an estimated 139,300 people—nearly 380 deaths per day. The vast majority of measles deaths were among children younger than 5.
• Measles can cause severe health problems, including pneumonia, diarrhea, encephalitis, and corneal scarring, which can lead to blindness.
• In developing countries, measles death rates among young children may reach 10%, and in groups with severe malnutrition, such as people in refugee camps, can be as high as 30%.
• Spread from person to person via large respiratory droplets in the air, measles is one of the most contagious diseases known.
• Millions of children still remain at risk for measles. Unimmunized children are at high risk of contracting measles; malnourished children and those under 5 years of age, especially infants, are most vulnerable to dying from the disease.
• The primary reason that high numbers of measles deaths continue to occur is the failure to deliver at least one dose of measles vaccine to all infants.
• Measles vaccination is one of the most cost-effective health interventions for preventing deaths available today. It costs less than US $1 to vaccinate a child against measles.
• Vaccination campaigns sometimes provide the only contact with healthcare services that children receive in their early years of life. Vaccinations are essential for child survival.
• Progress against measles stalled between 2008 and 2010 when political and financial commitments were insufficient to prevent an increase in the number of unprotected children. During this period, large measles outbreaks occurred in many parts of Africa, Europe, the Middle East, and South-East Asia.

Rubella and Congenital Rubella Syndrome (CRS)

• Rubella, commonly called “German Measles,” affects susceptible children and young adults around the world. This viral disease is transmitted through droplets in coughs and sneezes and is generally mild. If rubella is acquired, particularly in the first trimester of pregnancy, serious consequences can result, including miscarriages, still births, and having infants born with Congenital Rubella Syndrome (CRS). CRS is a constellation of birth defects. Manifestations include blindness, deafness, and heart defects.
• Vaccination has substantially reduced the number of rubella cases in many countries. Endemic transmission of the rubella virus has been interrupted since 2009 in the WHO Region of the Americas (AMR).  Two of the six WHO global regions (AMR and the European Region) have rubella elimination goals.
• Rubella usually occurs in a seasonal pattern, typically with epidemics every 5 to 9 years. However, both the extent and periodic occurrence of rubella epidemics are highly variable in both industrialized and other countries.
• The highest risk for CRS is found in countries with high rates of susceptibility to rubella among women of childbearing age. Widespread rubella vaccination during the last decade, including mass vaccination campaigns in a number of countries, has enabled the elimination of rubella and CRS in the Western Hemisphere and several European countries; however, the current burden of CRS in Africa, South-East Asia, and the Western Pacific regions is still thought to be high. An estimated 112,000 cases of CRS occur annually. Efforts are under way to improve surveillance for rubella and CRS worldwide. 

What do measles and rubella have in common?

• While rubella is sometimes referred to as “German measles,” the rubella and measles viruses are unrelated and are from different virus families.  However, they do have some similarities: both viruses are spread from person to person by respiratory droplets, infection by both can result in fever and skin rash, and both viruses survive only in human hosts. 
• Measles and rubella can be prevented with vaccines that can be delivered together as a combined measles-rubella (“MR”) vaccine or combined with vaccines against mumps (MMR) and varicella (MMRV). A WHO position paper issued in July 2011 noted that the accelerated measles control and elimination strategies currently in use can provide a platform for also advancing rubella and CRS elimination and recommended that countries take this opportunity to introduce the combination vaccines. 

2012–2020 Global Measles and Rubella Strategic Plan

The new 2012–2020 Global Measles & Rubella Strategic Plan describes five core components of a comprehensive measles and rubella elimination strategy:

1. Achieve and maintain high levels of population immunity by providing high vaccination coverage with two doses of measles- and rubella containing vaccines.
2. Monitor disease using effective surveillance and evaluate programmatic efforts to ensure progress.
3. Develop and maintain outbreak preparedness, respond rapidly to outbreaks and manage cases.
4. Communicate and engage to build public confidence and demand for immunization.
5. Perform the research and development needed to support cost-effective operations and improve vaccination and diagnostic tools.