Prevention of congenital rubella syndrome

Question 1

How effective has the rubella vaccination program been?

Answer 1

Very effective
15 000 cases per year between 1941 and 1958
40 cases per year 1998 to 2004
300 cases in SW Ontario in 2005 due to reduced immunization
13 cases per year 2006 to 2014
No cases in 2015

Question 2

Why does CRS continue to occur in Canada?

Answer 2

1. Travellers

2. Women who are unimmunized due to being missed, refusal or coming from another country

Question 3

How common is vaccine failure and does vaccine failure contribute to CRS?

Answer 3

Almost 100% of people with rubella vaccine seroconvert

Failure of one dose of rubella vaccine to protect against disease occurs in 10% of cases but is less common now that two doses is standard

Secondary vaccine failure (infection in a previously immune mother) is rare

Question 4

Are there any complications of rubella immunization of seronegative individuals, including women in the postpartum period?

Answer 4

1. Transient acute arthritis or arthralgia 5-10%

No evidence of risk of chronic arthropathies or neurological conditions

No evidence of adverse events from inadvertent immunization in pregnant women but still recommended not to give in pregnancy

Contraindicated in persons with immunodeficiency

Question 5

What are the CPS recommendations to prevent CRS?

Answer 5

1. Immunizing all nonpregnant immigrant and refugee women at their first encounter with the Canadian health care system without checking serology, unless they have documentation of effective vaccination or natural immunity;
2. Continued universal infant immunization to protect recipients and to decrease circulation of the virus;
3. Use of the MMR vaccine rather than the monovalent measles vaccine as the immunizing agent in all immunization programs for measles worldwide to expedite the elimination of rubella;
4. Screening of all pregnant women to determine the need to confirm seropositivity and to enable postpartum immunization of all women found to be susceptible on prenatal screening. Standing orders on the postpartum ward should be implemented (similar to the RhoGam [Ortho-Clinical Diagnostics Inc, USA] standing order in the postpartum period) because they will expedite postpartum immunization. Breastfeeding is not a contraindication to immunization;
5. Screening for immunity and vaccination, if necessary, of all health care personnel, including students in training; and
6. Fully investigating and reporting every case of possible rubella or CRS