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.

Reported cases  and incidence (per 100,000 population) of rubella in Canada, 1924 to 2014
Note: Case data from 1924 to 2013 were obtained from the Canadian Notifiable Disease Surveillance System. Case data for 2014 is preliminary and was obtained directly from provincial and territorial ministries of health. Rubella was removed from the notifiable disease list in 1959 and returned in 1969. No data were available from 1959 to 1968. No case data were available for British Columbia from 1969-70; Saskatchewan from 1957-58; Manitoba from 1924-30; Quebec from 1924-27; New Brunswick from 1924-31, 1933-41, 1943, 1945-49, 1951 and 1956-58; Nova Scotia for 1958; Prince Edward Island from 1929-35, 1954-58 and 1969-78; and the Yukon for 1958. Population data were obtained from Statistics Canada July 1 annual estimates.
Figure 1: Text Description
Figure 1 depicts the reported number and incidence rate (per 100,000 population) of rubella cases in Canada from 1924 to 2014.
Until recently, rubella incidence in Canada followed a cyclical pattern, with large peaks occurring every 3 to 6 years. The introduction of the MMR vaccine into Canadian provincial and territorial immunization programs between 1974 and 1983 resulted in a steady decline in reported cases, from an average of 8,042 cases reported annually from 1969 to 1973 (or 37 cases per 100,000 population per year) to an average of 1,524 cases reported annually from 1984 to 1995 (6 cases per 100,000 population per year). After the introduction of a second dose of a MMR-containing vaccine in all provincial and territorial immunization programs from 1996 to 1997, incidence decreased further to an average of 26 cases reported annually from 1998 to 2004 (or 0.08 cases per 100,000 population per year). In 2005, rubella incidence increased to 0.99 cases per 100,000 population in Canada. From 2006 to 2014, between 1 and 13 cases were reported annually (5 cases on average).
The incidence of CRS has followed a similar downward trend to that of rubella (Figure 2). While CRS has been eliminated in Canada, sporadic cases do occur through prenatal infection acquired in endemic areas. There have been no cases of CRS due to a rubella exposure in Canada since 2000. From 1995 to 2005, no more than 3 CRS cases were reported each year in Canada. Most of these were children born to foreign-born women. Since 2006, only 2 cases have been reported, both born to immigrant women who were infected with rubella before arriving in Canada.
Figure 2. Reported cases and incidence (per 100,000 population) of congenital rubella syndrome or infection in Canada, 1979 to 2014.

Reported cases and incidence (per 100,000 population) of congenital rubella syndrome or infection in Canada, 1979 to 2014
Note: Case data from 1979 to 2013 were obtained from the Canadian Notifiable Disease Surveillance System. Case data for 2014 were preliminary and were obtained directly from provincial and territorial ministries of health. CRS was added to the notifiable disease list in 1979. Before 1979, it is possible that some CRS cases were reported in the rubella category. Live birth data obtained from Statistics Canada were used for the denominator in incidence rate calculations.
Figure 2: Text Description
Figure 2 depicts the reported number and incidence rate (per 100,000 population) of CRS cases in Canada from 1979 to 2014.
Reported cases of CRS dropped sharply from 29 cases in 1979 to 1 case in 1981. From 1982 to 1996, 0 to 8 cases were reported each year. From 1995 to 2005, 3 or fewer cases were reported each year. Since 2006, only 2 cases were reported: 1 in 2009 and 1 in 2011.

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.

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