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Indian Pediatr 2015;52: 169 |
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Outbreaks of Rubella Indicate Epidemiological
Shift in Age
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Amitav Banerjee
Department of Community Medicine, Dr DY Patil Medical
College, Hospital and Research Centre,
Pune, Maharashtra, India.
Email: [email protected]
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The report on outbreak of rubella in Chandigarh by Madhanraj, et al.
[1], exposes the inadequate disease surveillance
mechanism for most communicable diseases in our country. Such outbreaks
elicit knee-jerk reactions which are soon forgotten over a period of
time. Diseases like rubella which are mild and self-limiting are likely
to be missed in day-to-day practice. The only serious consequence is in
the first trimester of pregnancy when the infection can lead to
abortions and Congenital Rubella Syndrome (CRS). Because of this serious
complication, we need to beef up the surveillance for rubella in the
community.
Earlier, we published about an outbreak of rubella in
a population of adolescents in a military training centre [2]. Out of
the 163 suspected cases, we confirmed rubella in 117 (72%) by presence
of anti-rubella IgM antibodies. This outbreak, occurring more than a
decade ago, indicates that there is already an epidemiological shift in
susceptible age for rubella towards young adolescents and young adults.
This shift in age may be due to mass use of Measles, Mumps and Rubella
(MMR) vaccination during infancy without any subsequent doses in the
older age groups that makes women of child bearing age susceptible to
rubella during pregnancy which can lead to the dreaded CRS.
All outbreaks of rubella and all cases of CRS should
be investigated and reported in addition to building and maintaining a
robust surveillance system to provide essential inputs for planning and
implementing prevention programs [3]. Two approaches are recommended to
prevent the occurrence of CRS [4]. The first is prevention of CRS only
by immunization of adolescent girls or women of childbearing age. The
other approach is elimination of rubella as well as CRS through
universal immunization of infants and ensuring immunity in women of
child bearing age. We need a well thought- out strategy commensurate to
our resources. As an immediate measure we should aggressively go for
control of CRS by targeting women of child bearing age. We should also
consider mandatory rubella vaccination for all medical and nursing staff
to limit nosocomial spread of rubella to pregnant women in the health
care setting.
References
1. Madhanraj K, Singh N, Gupta M, Singh MP, Ratho RK.
An outbreak of rubella in Chandigarh, India. Indian Pediatr.
2014;51:897-9.
2. Banerjee A, Sahni AK, Gupta RM, Grewal VS, Singh
Z. Outbreak of rubella among cadets in an academy. Medical Journal Armed
Forces India (MJAFI). 2007;63:2:141-3.
3. Sachdeva S, Gupta P. Time to target rubella
elimination. Indian Pediatr. 2014;51:872-4.
4. Duclos P, Reef S. Rubella. In: Control of
Communicable Diseases Manual. Heymann DL (ed). 19th edition. Washington;
American Public Health Association. 2008. p. 529-34.
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