Progress Toward Rubella and Congenital Rubella Syndrome Elimination - Worldwide, 2012-2022.

Rubella virus is a leading cause of vaccine-preventable birth defects. Infection during pregnancy can result in miscarriage, fetal death, stillbirth, or a constellation of birth defects, including cataracts, deafness, heart defects, and developmental delay, known as congenital rubella syndrome (CRS). A single dose of rubella-containing vaccine can provide lifelong protection against rubella. The Global Vaccine Action Plan 2011-2020 included a target to achieve elimination of rubella in at least five of the six World Health Organization (WHO) regions by 2020, and rubella elimination is a critical goal of the Immunization Agenda 2030. This report updates a previous report and describes progress toward rubella and CRS elimination during 2012-2022. During 2012-2022, among 194 WHO countries, the number that included rubella-containing vaccine (RCV) in their immunization schedules increased from 132 (68%) to 175 (90%) and the percentage of the world's infants vaccinated against rubella increased from 40% to 68%. Reported rubella cases declined 81%, from 93,816 in 2012 to 17,407 in 2022. Verification of rubella elimination was achieved in 98 (51%) of 194 countries by 2022, an increase from 84 (43%) countries in 2019. Despite significant progress in the introduction of RCV into routine immunization programs worldwide, approximately 25 million infants annually still do not have access to RCV. Nevertheless, even in complex settings, the increasing number of countries that have achieved and sustained rubella elimination demonstrates progress toward global rubella elimination.

Past as Prologue-Use of Rubella Vaccination Program Lessons to Inform COVID-19 Vaccination.

The rapid rollout of vaccines against COVID-19 as a key mitigation strategy to end the global pandemic might be informed by lessons learned from rubella vaccine implementation in response to the global rubella epidemic of 1963-1965. That rubella epidemic led to the development of a rubella vaccine that has been introduced in all but 21 countries worldwide and has led to elimination of rubella in 93 countries. Although widespread introduction and use of rubella vaccines was slower than that for COVID-19 vaccines, the process can provide valuable insights for the continued battle against COVID-19. Experiences from the rubella disease control program highlight the critical and evolving elements of a vaccination program, including clearly delineated goals and strategies, regular data-driven revisions to the program based on disease and vaccine safety surveillance, and evaluations to identify the vaccine most capable of achieving disease control targets.

Progress Toward Rubella and Congenital Rubella Syndrome Control and Elimination - Worldwide, 2012-2020.

Rubella virus is a leading cause of vaccine-preventable birth defects and can cause epidemics. Although rubella virus infection usually produces a mild febrile rash illness in children and adults, infection during pregnancy, especially during the first trimester, can result in miscarriage, fetal death, stillbirth, or an infant born with a constellation of birth defects known as congenital rubella syndrome (CRS). A single dose of rubella-containing vaccine (RCV) can provide lifelong protection against rubella (1). The Global Vaccine Action Plan 2011-2020 (GVAP) included a target to achieve elimination of rubella in at least five of the six World Health Organization (WHO) regions* by 2020 (2), and WHO recommends capitalizing on the accelerated measles elimination activities as an opportunity to introduce RCV (1). This report updates a previous report (3) and summarizes global progress toward control and elimination of rubella and CRS from 2012, when accelerated rubella control activities were initiated, through 2020. Among 194 WHO Member States, the number with RCV in their immunization schedules has increased from 132 (68%) in 2012 to 173 (89%) in 2020; 70% of the world's infants were vaccinated against rubella in 2020. Reported rubella cases declined by 48%, from 94,277 in 2012 to 49,136 in 2019, and decreased further to 10,194 in 2020. Rubella elimination has been verified in 93 (48%) of 194 countries including the entire Region of the Americas (AMR). To increase the equity of protection and make further progress to eliminate rubella, it is important that the 21 countries that have not yet done so should introduce RCV. Likewise, countries that have introduced RCV can achieve and maintain rubella elimination with high vaccination coverage and surveillance for rubella and CRS. Four of six WHO regions have established rubella elimination goals; the two WHO regions that have not yet established an elimination goal (the African [AFR] and Eastern Mediterranean [EMR] regions) have expressed a commitment to rubella elimination and should consider establishing a goal.

Progress Toward Measles Elimination - European Region, 2009-2018.

In 2010, all 53 countries* in the World Health Organization (WHO) European Region (EUR) reconfirmed their commitment to eliminating measles and rubella and congenital rubella syndrome (1); this goal was included as a priority in the European Vaccine Action Plan 2015-2020 (2). The WHO-recommended elimination strategies in EUR include 1) achieving and maintaining ≥95% coverage with 2 doses of measles-containing vaccine (MCV) through routine immunization services; 2) providing measles and rubella vaccination opportunities, including supplementary immunization activities (SIAs), to populations susceptible to measles or rubella; 3) strengthening surveillance by conducting case investigations and confirming suspected cases and outbreaks with laboratory results; and 4) improving the availability and use of evidence for the benefits and risks associated with vaccination (3). This report updates a previous report (4) and describes progress toward measles elimination in EUR during 2009-2018. During 2009-2017, estimated regional coverage with the first MCV dose (MCV1) was 93%-95%, and coverage with the second dose (MCV2) increased from 73% to 90%. In 2017, 30 (57%) countries achieved ≥95% MCV1 coverage, and 15 (28%) achieved ≥95% coverage with both doses. During 2009-2018, >16 million persons were vaccinated during SIAs in 13 (24%) countries. Measles incidence declined to 5.8 per 1 million population in 2016, but increased to 89.5 in 2018, because of large outbreaks in several EUR countries. To achieve measles elimination in EUR, measures are needed to strengthen immunization programs by ensuring ≥95% 2-dose MCV coverage in every district of each country, offering supplemental measles vaccination to susceptible adults, maintaining high-quality surveillance for rapid case detection and confirmation, and ensuring effective outbreak preparedness and response.

Status of rubella and congenital rubella syndrome surveillance, 2005-2009, the World Health Organization European Region.

BACKGROUND: The World Health Organization European Region has a goal for rubella elimination and congenital rubella syndrome (CRS) prevention. Although all Member States recommend a rubella-containing vaccine in their national immunization programs, rubella and CRS continue to occur, and surveillance quality varies throughout the region. METHODS: To describe the status of regional rubella and CRS surveillance and assess progress toward elimination, we reviewed surveillance practices by surveying all 53 Member States and analyzed rubella and CRS surveillance data during 2005-2009. RESULTS: Overall, 41 (91%) of 45 responding Member States have nationwide rubella surveillance, and 39 (87%) have nationwide CRS surveillance. During 2005-2009, rubella cases reported in the region decreased by 94% from 206,359 cases to 11,623 cases. The greatest decrease (99%) was observed in newly independent states of the former Soviet Union. In the rest of the region, high rubella incidence was observed in Poland, Romania, Italy, and San Marino during 2005-2008 and in Poland, Bosnia and Herzegovina, and Austria in 2009. A total of 68 CRS cases were reported during 2005-2009. CONCLUSIONS: As the foundation to achieving and verifying rubella elimination, high-quality rubella and CRS surveillance needs to be implemented and sustained in all Member States.

Influenza vaccination coverage: findings from immunization information systems.

BACKGROUND: Beginning with the 2004-05 influenza season, the Advisory Committee on Immunization Practices (ACIP) strengthened their existing encouragement that children aged 6-23 months receive influenza vaccination by creating a formal recommendation. METHODS: Well-functioning sentinel project immunization information systems (IIS) in Arizona (AIIS) and Michigan (MIIS) were used to calculate vaccination coverage among children aged 6-23 months during the 2004-05 influenza season. We calculated 2 measures of vaccination coverage: a) receipt of 1 or more doses of influenza vaccine September 2004-March 2005 and b) receipt of 2 or more doses (ie, fully vaccinated). We compared the dose administration distribution among children needing 1 and 2 doses and by provider type. Coverage by age and timeliness of vaccine doses entered into the IIS were also analyzed. RESULTS: Influenza vaccination coverage levels among children were 30% and 27% in AIIS and MIIS, respectively, for receipt of 1 or more doses; 13% and 11% of children, respectively, were fully vaccinated. Peaks in dose administration among children needing 1 and 2 doses were similar. There were differences in vaccine administration between public and private providers. Coverage was higher among younger children and over 75% of all influenza vaccine doses were entered into the IIS within 30 days after receipt of vaccine. CONCLUSION: Though almost 1/3 of children received 1 or more doses of vaccine in 2 IIS sentinel projects during the first season of the new recommendation, emphasis needs to be placed on increasing the proportion of children fully vaccinated. IIS data can be used for timely monitoring of vaccination coverage assessments.

Immunization information systems national research and evaluation agenda.

Immunization Information Systems (IIS) are operational in most states and are useful in programmatic and clinical assessments. To ensure that IIS reach their technical and usability potential, and to promote their use, we conducted a Delphi survey to develop a national IIS research and evaluation agenda. Experts with a wide range of IIS knowledge were asked to generate research and evaluation topics that document their utility in achieving and sustaining clinical and public health goals. Topics were then collated by the authors into 13 main categories and were ranked by the survey experts in order of importance. Provider perspectives and needs was ranked as the top research priority. Both data quality and technical data exchange also ranked high, as well as increasing provider participation and IIS cost and cost savings. Lower-ranked research priorities included data sharing between states and factors affecting IIS population-based measurements. Development of an IIS research and evaluation agenda allows policy makers to ensure that their decisions coincide with expert views on national priorities and enables researchers to conduct studies addressing topics recognized as nationally important. It also allows for targeted funding decisions.

PC_Eyewitness: a computerized framework for the administration and practical application of research in eyewitness psychology.

Eyewitness identification evidence is an important aspect of our legal system. Society relies on witnesses to identify suspects whom they have observed during the commission of a crime. Because a witness has only a mental representation of the individual he or she observed, law enforcement must rely on verbal descriptions and identification procedures to document eyewitness evidence. The present article introduces and details a computer program, referred to as PC_Eyewitness (PCE), which can be used in laboratories to conduct research on eyewitness memory. PCE is a modular program written in Visual Basic 6.0 that allows a researcher to present stimuli to a participant, to conduct distractor tasks, to elicit verbal descriptors regarding a target individual, and to present a lineup for the participant to provide an identification response. To illustrate the versatility of the program, several classic studies in the eyewitness literature are recreated in the context of PCE. The program is also shown to have applications in the conduct of field research and for use by law enforcement to administer lineups in everyday practice. PCE is distributed at no cost.

PC_Eyewitness and the sequential superiority effect: computer-based lineup administration.

Computer technology has become an increasingly important tool for conducting eyewitness identifications. In the area of lineup identifications, computerized administration offers several advantages for researchers and law enforcement. PC_Eyewitness is designed specifically to administer lineups. To assess this new lineup technology, two studies were conducted in order to replicate the results of previous studies comparing simultaneous and sequential lineups. One hundred twenty university students participated in each experiment. Experiment 1 used traditional paper-and-pencil lineup administration methods to compare simultaneous to sequential lineups. Experiment 2 used PC_Eyewitness to administer simultaneous and sequential lineups. The results of these studies were compared to the meta-analytic results reported by N. Steblay, J. Dysart, S. Fulero, and R. C. L. Lindsay (2001). No differences were found between paper-and-pencil and PC_Eyewitness lineup administration methods. The core findings of the N. Steblay et al. (2001) meta-analysis were replicated by both administration procedures. These results show that computerized lineup administration using PC_Eyewitness is an effective means for gathering eyewitness identification data.

Development of a rubella vaccination strategy: contribution of a rubella susceptibility study of women of childbearing age in Kyrgyzstan, 2001.

To contribute to the development of a rubella vaccination strategy, we conducted a study to determine age-specific susceptibility among women aged 15-39 years by testing for rubella-specific IgG antibodies. Of 964 women, 13% were found to be susceptible to rubella. Significantly higher susceptibility among women >25 years old was observed. Susceptibility data are important but are not sufficient to develop a vaccination strategy. After considering all available information, we suggested vaccination of women aged <35 years and selective vaccination of older women who were planning pregnancy.