Travel Health Advisory Update : May 10, 2005 The Public Health Agency of Canada is monitoring an ongoing outbreak of rubella in a religious community in the Netherlands. Since September 01, 2004, the Netherlands have recorded 299 lab confirmed cases of rubella including 22 cases in pregnant women. This represents a sharp increase when compared to the annual average of five cases from 2000 to 2003. Of the infected, only one had been vaccinated against rubella in the past; most cases (93%) had declined vaccination on the basis of religious beliefs. The geographic region where rubella cases have been reported, which bisects the country from the south-west towards the north-east, can be viewed at the following site. In the Netherlands, vaccination against rubella began in 1974 and was initially provided uniquely to girls at 11-years of age as a means to prevent congenital rubella syndrome (CRS). CRS can result in severe birth defects and occurs in up to 90% of infants born to mothers infected with rubella in their first trimester of pregnancy. In 1987, vaccination was expanded to include all children aged 14-months and 9 years, as part of the combined vaccination against measles, mumps and rubella (MMR). Source: Eurosurveillance, Netherlands Centre for Infectious Disease, the National Institute for Public Health and Environment ( Netherlands ) Rubella, also known as German measles, is caused by a virus. Symptoms are usually mild in children, most often causing a fever, however, it is a more serious disease in adults. The widespread rash associated with rubella occurs in only about ½ of the cases. For additional information on the prevention and treatment of rubella, consult the Public Health Agency of Canada's Disease Information Backgrounder on Rubella. Recommendations Vaccine preventable diseases, such as Rubella, are found worldwide, including in developed countries. For all international travel, regardless of destination, travellers should ensure that their routine (childhood) immunizations -- including diphtheria, whooping cough (pertussis), tetanus, polio, measles, mumps and rubella -- are up to date. The National Advisory Committee on Immunization recommends vaccination of all children at 12 months of age with a combined vaccine against measles, mumps and rubella (MMR) followed by a booster dose at either 18 months of age or at 4 to 6 years of age. As a reminder… The Public Health Agency of Canada routinely recommends that Canadian international travellers seek the advice of their personal physician or travel clinic prior to international travel, regardless of destination, for an individual risk assessment to determine their individual health risks and their need for vaccination, preventative medication and personal protective measures. The Public Health Agency of Canada recommends, as well, that travellers who become sick or feel unwell on their return to Canada should seek a medical assessment with their personal physician. Travellers should inform their physician, without being asked, that they have been travelling or living outside of Canada, and where they have been. For more information: To view "Immunizations recommended for travel outside of Canada " To view the Canadian Immunization Guide by the National Advisory Committee on Immunization Update May 10, 2005
