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Small rise in rubella cases triggers warning

BMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f2935 (Published 07 May 2013) Cite this as: BMJ 2013;346:f2935
  1. Jacqui Wise
  1. 1London

Last year saw the highest number of rubella cases in England and Wales since 1999. Although numbers are still small there is some concern that the disease could start to circulate more widely.

Health Protection Agency figures show that there were 65 laboratory confirmed cases of rubella in England and Wales in 2012,1 up from six confirmed cases in 2011, 12 in 2010, and nine in 2009. Fifty of the 65 cases in 2012 were reported from the south east of England, with most cases among recent immigrants. Data for 2013 are not yet available. The last large outbreak of rubella was in 1996, when close to 4000 cases were reported in England and Wales.

Pat Tookey, who leads the national congenital rubella surveillance programme at University College London’s Institute for Child Health, told the BMJ that the current outbreaks of measles in England and Wales should be seen as a warning about potential future outbreaks of rubella. “Rubella has been at an all time low, but last year there was a real small rise in circulating rubella, although this was mostly imported cases. There is a cohort of underimmunised people who are currently passing through adolescence and are susceptible to rubella as well as measles and mumps,” she said.

She added that she would expect to see a rubella outbreak later than outbreaks of measles and mumps because the rubella component of the combined measles, mumps, and rubella (MMR) vaccine was more effective, and just one dose could provide 98% protection.

“We have not got circulating rubella at the moment, but there is the potential for rubella to start circulating again at some point, and if it does then pregnant women will be at risk and primarily those in migrant groups,” warned Tookey.

Susceptibility to rubella is highest in first generation migrants who may have missed out on routine immunisation and had not acquired natural immunity to the disease. Tookey said that 10% of African and Asian first generation migrants were susceptible to rubella.

In 1970 a rubella vaccination programme was introduced among schoolgirls in the United Kingdom. This was successful in reducing the number of children born with congenital rubella syndrome, but rubella continued to circulate, and any remaining women who were not immunised were often exposed through their own or other young children. The MMR vaccine was introduced in 1988 for all children in the second year of life, with the aim of interrupting circulating rubella. And in 1994 a national MMR vaccine campaign was introduced for 5 year olds, and the schoolgirl vaccination programme was discontinued.

Before rubella vaccine became available, an estimated 200-300 babies were born each year in the UK with congenital rubella syndrome. Now only one or two cases on average are reported to the national congenital rubella surveillance programme.

Joff McGill, spokesman for the charity Sense, which supports people who are deaf and blind, said, “We can’t wait for rubella outbreaks to follow measles . . . We have to act now to protect pregnant women and their unborn babies and to prevent the situation getting worse.” He added, “The large group of unvaccinated young people, along with evidence for increasing susceptibility to rubella in younger woman and in women from ethnic minorities, means immunisation can no longer be a childhood issue.”

However, a spokesperson for Public Health England said that the spread of rubella through the community was very unlikely and that it was less contagious than measles. The spokesperson said, “Pregnant women and women who would like to become pregnant will be at risk of their baby developing congenital rubella syndrome if they are susceptible to rubella. Women who are considering becoming pregnant should make sure that they are up to date with their MMR vaccination or consult with their GP if they are not sure. Those who are already pregnant should wait until after their baby is born to receive the MMR vaccine.”

Public Health Wales was also not overly concerned about rubella, a spokesman said. “Rubella is not circulating, and it is a lot less infectious than measles,” he said. In Wales the measles outbreak centred on Swansea continues to grow.2 Across the whole of Wales the total number of cases is 1170, with 85 people hospitalised. A catch-up vaccination programme is under way, but there are still 43 000 unvaccinated people in the 10-18 year age group.

Notes

Cite this as: BMJ 2013;346:f2935

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