Surveillance of rubella
Find out how rubella is monitored.
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How does Canada monitor rubella?
Rubella, congenital rubella infection (CRI) and congenital rubella syndrome (CRS) are notifiable diseases or conditions in all provinces and territories in Canada. Cases are reported by health care providers to local public health units if the patient:
- presents with symptoms and are laboratory-confirmed
- have a known link to a laboratory-confirmed case
Rubella, CRI and CRS cases are sent by local public health units to provincial and territorial departments of health. Cases that meet the national case definition are reported to the Canadian Notifiable Disease Surveillance System.
National enhanced surveillance of rubella, CRI and CRS is conducted through the Canadian Measles/Rubella Surveillance System. This system involves weekly collection of enhanced rubella, CRI and CRS data from 10 provinces and territories. This allows for timely monitoring of rubella, CRS and CRI in Canada.
The other 3 provinces and territories are currently participating in a pilot surveillance system. The Measles and Rubella Surveillance (MARS) pilot was implemented in May 2011. MARS is a web-based surveillance application that supports real-time notification of rubella, CRI and CRS case investigations to stakeholders within:
- rubella laboratory and epidemiology at PHAC
- provinces and territories
Deaths from rubella, CRI and CRS are also monitored nationally. Mortality data are obtained from the Statistics Canada Canadian Vital Statistics Death Database. The database collects demographic and cause of death information every year from provincial and territorial registries.
Rubella, CRI and CRS cases are summarized annually in the Canadian Notifiable Disease Surveillance System. The Measles and Rubella Weekly Monitoring Report summarizes information collected through the other surveillance systems on a weekly basis.
Epidemiology of rubella and CRI/CRS in Canada
In Canada, routine infant immunization programs have resulted in sustained high rates of immunity to the rubella virus. These programs have also helped to eliminate the transmission of indigenous rubella infection. Before the widespread use of rubella-containing vaccines in Canada, the incidence of rubella cases followed a cyclical pattern with large peaks every 3 to 6 years (Figure 1).
The introduction of the MMR vaccine into provincial and territorial immunization programs between 1974 and 1983 caused a steady decline in reported cases. From 1969 to 1973, there was an average of 8,042 cases reported annually (37 cases per 100,000 population per year). This was reduced to an annual average of 1,524 cases (6 cases per 100,000 population per year) from 1984 to 1995.
A second dose of the MMR vaccine was introduced in provincial and territorial immunization programs between 1996 and 1997. This was part of the national measles elimination strategy and resulted in a further decrease in incidence to an annual average of 26 cases reported from 1998 to 2004 (0.08 cases per 100,000 population per year).
In 2005, the national incidence rate increased to 0.99 cases per 100,000 population. A large outbreak in an unvaccinated community in southwestern Ontario resulted in over 300 cases. This outbreak accounted for the vast majority of rubella cases that year. No cases of CRS occurred as a result of the outbreak. Spread of the virus was limited to the unvaccinated community.
In 2005, PAHO's regional elimination goal for rubella was adopted. Since then, no new cases of indigenous rubella have been reported. All subsequent cases have been sporadic and associated with disease importation. From 2006 to 2014, between 1 and 13 cases were reported annually (5 cases on average).
Figure 1. Reported cases and incidence (per 100,000 population) of rubella in Canada, 1924 to 2014.
Figure 1: Text Description
Figure 2: Text Description
Disease distribution (global)
Rubella occurs throughout the world. However, over the last decade, rubella vaccination programs have greatly reduced incidence rates in many industrialized countries.
According to the World Health Organization, by the end of 2013, 137 countries had introduced rubella vaccines into their national immunization schedules. This is up from 65 countries in 1996. Countries without comprehensive rubella vaccination programs generally experience periods of low infection rates followed by epidemics every 4 to 8 years.
In 2003, the Pan American Health Organization (PAHO) established a goal to eliminate indigenous rubella and CRS from the Americas by 2010. The Americas have experienced a reduction of 99.99% of confirmed rubella and CRS cases between 1998 and 2013. Canada has not reported a case of indigenous rubella since 2005.
For more information
- Case Definitions for Diseases under National Surveillance: Rubella, 2009
- Surveillance systems
- Notifiable Diseases On-line
- For health professionals
- Measles and rubella weekly monitoring report
- Elimination of Measles, Rubella and Congenital Rubella Syndrome in Canada: Documentation and Verification Report - Executive Summary
- “Rubella Elimination, the Canadian Experience”
- Canadian National Report on Immunization, 2006 (Section 4.10 – Rubella)
- Canadian National Report on Immunization, 2006 (Section 4.11 – Congenital Rubella Syndrome and Congenital Rubella Infection)
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