Situation of Rubella in Spain in the Elimination Phase. Rubella and Congenital Rubella Syndrome, 1997-2007

Summary: Objective: To analyze the situation and evolution of rubella and congenital rubella syndrome in Spain and to evaluate the objective of elimination proposed by the World Health Organization for the European Region. Methods: Analysis of the evolution of rubella incidence and vaccination coverages (l980 and 2007). Morbidity data were obtained from the National Epidemiological Surveillance Network and mortality and population data from the National Institute of Statistics. Results: In 1979, a policy of selective rubella vaccination was introduced in Spain, targeting 11-year-old girls. In 1981, immunisation with the measles-mumps-rubella vaccine was introduced, at 15 months of age and a second dose was introduced in 1995. Vaccination coverages since 1999 exceed 95% for the first dose and 90% for the second. The incidence of rubella has fallen drastically to < 1/100,000 since 2000 in all regions. Only small outbreaks or clusters have been detected, except for one large outbreak in Madrid that affected young adult males and fertile women from countries with low vaccination coverages. Since 1997, 13 cases of congenital rubella syndrome have been detected. Conclusions: The situation in Spain favours the elimination of rubella. However, pockets of susceptible subjects remain, mainly young adult males and immigrants, who have increased substantially in numbers in the last decade. Fertile women with high birth rates from countries with a high rubella incidence have a high risk of congenital rubella syndrome.