We can't afford to be half hearted about vaccination programmes

Papers p 1462

The goal of a rubella vaccine programme is to reduce the occurrence of the congenital rubella syndrome. In this week's BMJ, Panagiotopoulos et al describe the history of the use of rubella vaccine in Greece and show that partial vaccine coverage led to a period in which susceptibility to rubella among childbearing women was actually increased (p 1462).1 Therefore in 1993, an epidemic year for rubella in Greece, the incidence of rubella in childbearing women was higher than in previous epidemics, and the incidence of congenital rubella increased. What lessons can we learn from this failure?

Around the world the effectiveness of rubella vaccine programmes has varied The rubella vaccine, which was first introduced in the United States in 1967, was very effective in reducing the annual number of babies with congenital rubella syndrome from an estimated 20 000 in 1964 to 7 in 1983.2 The US had introduced the vaccine in a three step programme—that is, recommending vaccination of all infants at 12-15 months of age, screening women of child bearing age for rubella immunity, and vaccinating those …