History
Rubella was initially thought to be a variant of measles or scarlet fever. It was only in 1814 that this disease was first classified as a separate illness in German-language medical literature.This is how rubella came to be known as “German measles” in English [3].
The term “rubella” was first used in English-language literature in 1866 after it was coined by Henry Veale. “Rubella” is derived from the Latin word “rubellus,” which means “little red” (a reference to the skin coloration caused by the disease). In 1914, Alfred F. Hess discovered that the causative agent of rubella was a virus. He made this determination after establishing that bacteria were not responsible for causing the illness. His observation was confirmed in 1938 by two Japanese scientists, Y. Hiro and S.Tasaka [1].
In 1941, Norman Gregg, an Australian ophthalmologist, was the first person to report the occurrence of congenital cataracts among infants born to women who contracted rubella during the first trimester of their pregnancies. It was the first time CRS was recognized as a distinct illness [1,3].
In 1962, there was a landmark development with regard to rubella. Paul D. Parkman and his colleagues, Thomas H. Weller and Franklin A. Neva, isolated the rubella virus for the first time [3]. This was significant because attenuated rubella virus vaccines were developed shortly after this discovery was made. Subsequently, CRS became a nationally notifiable disease in the US in 1966. Three years later, the first Rubella vaccine was invented by Stanley Plotkin, an American physician. It was called RA27/3 [1,3].
In 1971, the rubella vaccine was combined with the measles and mumps vaccines. The combined measles, mumps, and rubella (MMR) vaccine has been licensed for general use in the US ever since. In 2005, a varicella component was added to the MMR vaccine and licensed in the US. The MMRV vaccine has since become a standard tool in preventing four diseases that were once common among children [3].
WHO has encouraged all member countries to include rubella vaccines in their national immunization programs. In 2003, the Pan American Health Organization (PAHO) set milestones for eradicating rubella in the Americas. In 2009, PAHO’s efforts were successful, and the Americas became the first and the only WHO region to eliminate rubella.
In 2005, the WHO European Region (EUR), which includes 53 member countries, became the second WHO region to set up a goal of eradicating rubella. Despite the fact that all member states have introduced rubella vaccinations into their national programs, this goal has not yet been achieved.
In 2012, The Western Pacific Region (WPR) of WHO sped up its vaccination efforts to eliminate rubella as soon as possible. By 2015, all 36 member countries in the region had introduced RCVs into their national immunization programs. By 2019, vaccination coverage in the region had reached 96%. Australia, Brunei Darussalam, Macao (an administrative region of China), New Zealand, and the Republic of Korea successfully eliminated rubella.
In 2013, the Southeast Asia region (SEAR) became the fourth WHO region to establish a goal of eliminating both rubella and CRS by 2020. By 2016, eight member countries introduced RCVs to their national immunization programs. In 2020, only the Maldives and Sri Lanka were verified to have achieved complete rubella elimination.
By 2019, three other countries, including India, Indonesia, and North Korea, also introduced RCVs into their national programs. These three countries accounted for around 84% of infants in the WHO SEAR region. As of 2020, Bangladesh, Bhutan, Nepal, Sri Lanka, Timor-Leste, Maldives, and Sri Lanka have been verified by WHO as being free of rubella.
Only 16 out of 22 member states of the WHO Eastern Mediterranean Region (EMR), including one geographical area, have introduced RCVs. In 2019, Iran, Bahrain, and Oman were verified to have eliminated Rubella.
Countries belonging to the WHO African Region (AFR), including Cape Verde, Mauritius, and Seychelles, were the first in their region to introduce the rubella vaccine. Between 2012 and 2020, 28 more countries in the region introduced the vaccine even before they began childhood immunization programs.
As of 2020, 84 out of 195 WHO member countries have successfully eradicated rubella, and four more member states have set up rubella elimination goals. Additionally, 173 out of 195 (89%) member countries have included rubella in their immunization programs. But, as per the estimates provided by WHO, over 100,000 infants worldwide are born every year with CRS [4].