How to Prevent Rubella Epidemics and Congenital Rubella Syndrome: Lessons From 42 Years of Longitudinal Epidemiology in Osaka Prefecture, Japan (1982–2023) - Report - MDSpire
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How to Prevent Rubella Epidemics and Congenital Rubella Syndrome: Lessons From 42 Years of Longitudinal Epidemiology in Osaka Prefecture, Japan (1982–2023)
Strategies for Preventing Rubella Outbreaks and CRS: 42 Years in Osaka, Japan
Overview
This study analyzes 42 years of rubella epidemiology in Osaka Prefecture, Japan, highlighting the impact of immunization strategies on rubella and congenital rubella syndrome (CRS) incidence. Despite universal vaccination efforts, rubella outbreaks recurred due to susceptible adult males and imported virus strains, and CRS cases persisted, especially among females with single-dose vaccination history.
Background
Rubella is a contagious viral disease that can cause fetal death or CRS when contracted during pregnancy. Rubella-containing vaccines (RCVs) have been introduced globally to prevent these outcomes, with Japan implementing vaccination since 1977. Initially, Japan targeted adolescent girls for vaccination, later shifting to universal childhood immunization with a two-dose schedule. Despite these efforts, rubella elimination has not been achieved in Japan, partly due to immunization gaps and breakthrough infections.
Data Highlights
Period
Vaccination Strategy
Coverage (%)
Rubella Cases
CRS Incidence
1977–1994
Selective immunization of adolescent girls
27.3–74.0
High
Comparable to 1960s–1980s
1995–2005
Expanded to children aged 12–90 months
14.7–55.9 (transitional groups)
Reduced
Not eliminated
2006–Present
Universal 2-dose schedule at 1 and 5–6 years
Improved coverage
Resurgence in 2012–2013 and 2018–2019
Breakthrough CRS cases reported
Key Findings
Shift from selective to universal immunization significantly reduced rubella cases and increased seroprevalence in children.
Rubella outbreaks in 2012–2013 and 2018–2019 were linked to imported virus strains and susceptible adult males.
CRS incidence remained comparable to historical levels, partly due to spontaneous or artificial fetal deaths.
Breakthrough rubella infections and CRS occurred in females with single-dose vaccination history, indicating incomplete protection.
Closing immunization gaps and implementing a two-dose vaccination schedule are critical to preventing future outbreaks and CRS.
Clinical Implications
Clinicians should be aware that single-dose rubella vaccination may not provide complete protection against rubella or CRS, underscoring the importance of the two-dose schedule. Efforts to identify and vaccinate susceptible adult males, particularly those born before universal immunization, are essential to prevent outbreaks. Continuous surveillance and catch-up immunization programs remain vital components of rubella control.
Conclusion
Despite longstanding vaccination programs, rubella elimination in Japan remains elusive due to immunization gaps and breakthrough infections. Strengthening universal two-dose vaccination and targeting susceptible adults are necessary to prevent future rubella epidemics and CRS cases.
References
Osaka Prefecture Rubella Study Group/2023 -- Strategies for Preventing Rubella Outbreaks and Congenital Rubella Syndrome
