CONTROL OF RUBELLA AND CONGENITAL-RUBELLA SYNDROME (CRS) IN DEVELOPING-COUNTRIES .2. VACCINATION AGAINST RUBELLA

In 1995-96 we conducted a review of rubella immunization strategies. W orldwide, 78 countries (more than one-third) reported a national polic y of using rubella vaccine. This was closely related to country econom ic status. Based on the United Nations country classification, rubella vaccine is used in 92% of industrialized countries, 36% of those with economies-in-transition, and 28% of developing countries. Cases of co ngenital rubella syndrome (CRS) may be prevented as follows: by provid ing direct protection to women and/or schoolgirls (a selective vaccina tion strategy); by vaccinating boys and girls to provide indirect prot ection by reducing the transmission of rubella virus (a childhood vacc ination strategy); or by a combination of these approaches (a combined strategy). A combined strategy was most commonly reported (60% of cou ntries); seven countries (9%) reported a selective strategy; and 24 co untries (31%) reported only childhood immunization. Experience has sho wn that it is essential to include vaccination of women of childbearin g age in any rubella control strategy. Childhood vaccination alone may pose a risk of an increase in CRS cases. Although many countries have introduced rubella vaccine, few report any data on the impact of vacc ination. Countries using rubella vaccine need to establish surveillanc e for rubella and CRS and monitor coverage in each of the target group s.