How to prevent rubella epidemics and congenital rubella syndrome: lessons from 42 years of longitudinal epidemiology in Osaka Prefecture, Japan (1982-2023)

Daiki Kanbayashi; Takako Kurata; Yuko Kaida; Tatsuya Miyoshi; Fumika Okayama; Tetsuo Kase; Jun Komano; Kazuo Takahashi; Kazuyoshi Ikuta; Kazushi Motomura

doi:10.1093/infdis/jiae402

How to prevent rubella epidemics and congenital rubella syndrome: lessons from 42 years of longitudinal epidemiology in Osaka Prefecture, Japan (1982-2023)

J Infect Dis. 2024 Aug 14:jiae402. doi: 10.1093/infdis/jiae402. Online ahead of print.

Authors

Affiliations

¹ Division of Microbiology, Virology Section, Osaka Institute of Public Health, 1-3-3, Nakamichi, Higashinari-ku, Osaka-shi, Osaka, 537-0025, Japan.
² Laboratory Section, Fujiidera Public Health Center of Osaka Prefectural Government, 1-8-36, Fujiidera, Fujiidera-shi, Osaka, 583-0024, Japan.
³ Sakai City Institute of Public Health, 3-2-8, Kaino-cho Higashi, Sakai-ku, Sakai-shi, Osaka, 590-0953, Japan.
⁴ Department of Public Health, Osaka Metropolitan University Graduate School of Medicine, 1-4-3, Asahi-machi, Abeno-ku, Osaka-shi, Osaka, 545-8585, Japan.
⁵ Department of Microbiology and Infection Control, Faculty of Pharmacy, Osaka Medical and Pharmaceutical University, 4-20-1, Nasahara, Takatsuki-shi, Osaka, 569-1041, Japan.
⁶ International University of Health and Welfare, 2600-1, Kitakanemaru, Otawara-shi, Tochigi, 324-8501, Japan.
⁷ Research Institute for Microbial Diseases, Osaka University, 3-1, Yamadaoka, Suita-shi, Osaka, 565-0871, Japan.
⁸ Division of Public Health, Osaka Institute of Public Health, 1-3-3, Nakamichi, Higashinari-ku, Osaka-shi, Osaka, 537-0025, Japan.

PMID: 39141594
DOI: 10.1093/infdis/jiae402

Abstract

Background: Despite the introduction of rubella-containing vaccine into routine immunization in 1977, rubella has not been eliminated in Japan. This study aimed to validate the immunization strategy and to highlight the crucial elements of elimination program.

Methods: We scrutinized cases of rubella and congenital rubella syndrome (CRS). Additionally, we analyzed the national vaccination coverage, seroprevalence, and number of maternal rubella-related spontaneous or artificial fetal deaths.

Results: The shift from selective to universal immunization significantly reduced rubella cases coupled with increased seroprevalence in children. However, rubella resurged in 2012-2013 and 2018-2019, which was virologically and serologically confirmed to be associated with imported rubella virus (RuV) and susceptible males. Although the disease burden of CRS may have been suppressed in the past by the large number of spontaneous or artificial fetal deaths, the incidence rate of CRS was comparable to that of the 1960s to 1980s. Cases of breakthrough infection and CRS were identified in females who were considered to have a history of single-dose vaccination.

Conclusions: Even with universal immunization, future epidemics and severe outcomes cannot be prevented unless immunization gaps are closed. Furthermore, CRS and breakthrough infection are not completely prevented by single-dose vaccination, indicating the need for second-dose vaccination.

Keywords: artificial fetal death; breakthrough infection; congenital rubella syndrome; immunization program; primary infection; rubella; rubella containing vaccine; seroprevalence; spontaneous fetal death; surveillance.

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