Rapid communications Ongoing outbreak of rubella among young male adults in Poland: increased risk of congenital rubella infections

rubella cases (55.2 per 100,000 inhabitants), the highest number since 2007. Some 81% of cases were among 15–29 year-old males. This outbreak reflects the history of immunisation policies – selective vaccination of adolescent girls since 1989, then universal two-dose measles-mumps-rubella vaccination, since 2004. The extent of virus circulation among adults increases the risk of congenital rubella infections and jeopardises the World Health Organization Regional Office for Europe 2015 elimination goal. From January to April 2013, physicians in Poland notified 21,283 rubella cases (55.2 per 100,000 inhabitants) [1], a near 10-fold increase compared with the 2,224 cases (5.8 per 100,000 inhabitants) reported during the corresponding period of 2012 (Figure 1). Physicians use the European Union (EU) case definitions for rubella and congenital rubella syndrome (CRS) [2]. They report each rubella case to the local health department, providing demographic information, International Classification of Diseases (ICD)-10 code [3], case classification and vaccination status. Every two weeks, local health departments report the number of cases notified in their area to the provincial health departments that aggregate data, which they forward to the National Institute of Public Health – National Institute of Hygiene. Every month, local health departments prepare aggregated reports with more detailed data including the number of cases by age group, sex, vaccination status and case classification. Physicians report CRS cases to the local health departments. Local health departments investigate CRS cases and send individual reports to the National Institute of Public Health – National Institute of Hygiene. There is no routine active case finding search for CRS cases, nor has active CRS surveillance been implemented to date. We describe here this country-wide rubella outbreak by person, place and time and propose implementation of preventive measures. We calculated reported rates per 100,000 inhabitants, dividing the number of rubella reported cases by midyear census estimates [4]. The reported rates of rubella varied substantially between provinces (median: 51.2 per 100,000 inhabitants; range: 7.4–151.1 per 100,000 inhabitants). The majority of cases were reported from three provinces in the southeast of the country (n=8,659; 41%), bordering Ukraine, Belarus and Slovakia, and five provinces in the northwest (n=7,997; 38%), two of which border Germany (Figure 2). The male to female ratio was 10:1. The most affected groups were persons who were male aged 15–19 years were both more pronounced among males 10 years of age and older, especially in the first four months of 2013 (Figure 3). Vaccination …