Impact of rubella vaccination on elimination of congenital rubella syndrome in Sri Lanka: progress and challenges.

Rubella infection in pregnancy can lead to pathologies, including miscarriage, stillbirth and congenital rubella syndrome (CRS) in the neonate. Rubella vaccination can prevent all occurrences of CRS. In Sri Lanka, significant outbreaks of CRS occurred in 1994 and 1995, with 275 and 212 reported cases. In 1996, Sri Lanka introduced rubella vaccination for women aged 16-44 years, to stop CRS. Measles-rubella vaccine was introduced into the routine immunization schedule in 2001 and additional campaigns were carried out in 2003 (all 11-15 year olds) and 2004 (all 16-20 year olds). Reported immunization coverage with a single dose of a rubella-containing vaccine has been more than 95% since 2000. Laboratory-supported surveillance for rubella and CRS was started in 1992. Reported rubella cases fell from 364 (incidence 19/million population) in 1999 to 96 cases (incidence 5/million population) in 2002 and further to 12 cases (incidence 0.6/ million population) in 2014. Laboratory-supported CRS surveillance was started in 1990 and the highest number of CRS cases, 275 (incidence 77/100 000 live births), was diagnosed in 1994. Reported CRS cases fell from 22 cases (incidence 7/100 000 live births) in 2002 to 3 cases (incidence <1/100 000 live births) in 2014. Almost 20 years of routine rubella vaccination has resulted in >96% reduction in reported rubella cases and a corresponding >98% reduction in CRS cases. Despite this great achievement, work remains to eliminate rubella and CRS from Sri Lanka.