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This Strategic Plan 2012–2020 explains how countries, working together with the MR Initiative and its partners, will achieve a world without measles, rubella and congenital rubella syndrome (CRS). The Plan builds on the experience and successes of a decade of accelerated measles control efforts that resulted in a 74% reduction in measles deaths globally between 2000 and 2010 (1). It integrates the newest 2011 World Health Organization (WHO) policy on rubella vaccination which recommends combining measles and rubella control strategies and planning efforts, given the shared surveillance and widespread use of combined measles-rubella vaccine formulations, i.e. measles-rubella (MR) and measles-mumps-rubella (MMR). The Plan presents clear strategies that country immunization managers, working with domestic and international partners, can use as a blueprint to achieve the 2015 and 2020 measles and rubella control and elimination goals. The strategy focuses on the implementation of five core components. 1. Achieve and maintain high levels of population immunity by providing high vaccination coverage with two doses of measles- and rubella-containing vaccines. 2. Monitor disease using effective surveillance, and evaluate programmatic efforts to ensure progress. 3. Develop and maintain outbreak preparedness, respond rapidly to outbreaks and manage cases. 4. Communicate and engage to build public confidence and demand for immunization. 5. Perform the research and development needed to support cost-effective operations and improve vaccination and diagnostic tools. The Plan provides the global context and an assessment of the current state of the world with respect to national, regional and global management of measles and rubella. It outlines guiding principles that provide a foundation for all measles and rubella control efforts, including country ownership, strengthening routine immunization and health systems, ensuring linkages with other health interventions and providing equity in immunization by reaching every child. Given the progress made to date, the plan includes a list of priority countries that require additional support to meet regional and global goals. It also examines key challenges to measles and rubella control and elimination, including: financial risks; high population density and highly mobile populations; weak immunization systems and inaccurate reporting of vaccination coverage; managing perceptions and misperceptions; and conflict and emergency settings. The Plan offers solutions to these challenges, discusses the roles and responsibilities of stakeholders, and provides indicators to monitor and evaluate national, regional and global progress towards the vision and goals. Countries bear the largest responsibility for measles and rubella control and elimination, and they must support sustainable national planning, funding and advocacy to protect their citizens from devastating preventable diseases. The MR Initiative and its five spearheading partners — the American Red Cross, United States Centers for Disease Control and Prevention, United Nations Children's Fund, United Nations Foundation and World Health Organization — endorse this Strategic Plan and will work with countries and international donors on its implementation. As countries work towards attaining national, regional and global measles, rubella and CRS control and elimination goals, they can rely on technical and financial support from the MR Initiative and its partners, including the GAVI Alliance (formerly the Global Alliance for Vaccines and Immunization). To support this Plan, the MR Initiative developed and maintains a Financial Resource Requirements document that it reviews and updates regularly. The MR Initiative recommends that all stakeholders use this Plan and the referenced technical guidance to secure the commitments and actions required for a world free of measles, rubella and CRS. ; Abbreviations and acronyms -- Foreword -- Executive summary -- Introduction -- Vision, goals and milestones -- Global context -- Measles vaccination -- Rubella vaccination -- Laboratory network -- Current WHO global and regional targets -- Potential future WHO global targets -- Recent setbacks and risk of resurgence -- Economic analyses of measles, rubella and CRS control and elimination -- Strategy to eliminate measles, rubella and CRS -- 1. Achieve and maintain high levels of population immunity by providing high vaccination coverage with two doses of measles- and rubella-containing vaccines -- 2. Monitor disease using effective surveillance and evaluate programmatic efforts to ensure progress -- 3. Develop and maintain outbreak preparedness and respond rapidly to outbreaks and manage cases -- 4. Communicate and engage to build public confidence and demand for immunization -- 5. Perform the research and development needed to support cost-effective operations and improve vaccination and diagnostic tools -- Guiding principles to eliminate measles, rubella and CRS -- 1. Country ownership and sustainability -- 2. Routine immunization and health systems strengthening -- 3. Equity -- 4. Linkages -- Challenges to implementing the Strategic Plan -- 1. Financial risks -- 2. High population density and highly mobile populations -- 3. Weak immunization systems and inaccurate reporting of vaccination coverage -- 4. Managing perceptions and misperceptions -- 5. Confiict and emergency settings -- Roles and responsibilities -- 1. National governments -- 2. Global and regional partners -- The Measles and Rubella Initiative -- The GAVI Alliance -- Tracking progress -- Conclusion -- References -- Annex 1. List of measles and rubella priority countries.

Rubella virus is quite significant in Indonesia. This is one of the government's priorities to stop the spread and transfer its distribution solutions. Vaccination is one solution to reduce the spread of the rubella virus. However, the community is still very cloudy with the rubella virus vaccination. Community anxiety about simple information about rubella vaccination is one of the inhibiting factors in reducing the impact of the rubella virus. In this case the role of multimedia technology helps the government in socializing the rubella virus to the public. Using interactive multimedia learning methods. With the presence of multimedia technology it is able to provide a penalty to the public regarding the rubella virus and the vaccination process.

As children born with congenital rubella syndrome during the 1960s reach young adulthood, professionals are seeing additional manifestations of the syndrome. Manifestations include changes in hearing status, ocular pathology (i.e., glaucoma, cataracts), vascular problems, and endocrine disorders (i.e., diabetes mellitus, thyroid disease). Several possibilities have been suggested for the delayed appearance of these further manifestations. The virus's ability to establish persistent infections is suggested, as is the possibility of an autoimmune response to the virus. In view of the fact that delayed manifestations of congenital rubella syndrome have been discovered, the necessity for medical follow-through is apparent. Medical follow-through is required not only for the continuation of informative research, but to safeguard the potential development of every individual with this syndrome.

An outbreak of rubella in April 1996 involved four male British soldiers deployed to Bosnia-Herzegovina. All were helicopter ground crew who were members of the same unit and who periodically travelled to and worked at forward air refuelling stations in Bosnia. There was a potential for spread of the infection to adjacent British units, to troops of other nations in the peacekeeping force, and also to the local civilian population. The British force included 620 female personnel, some of whom may have been non-immune to rubella. One pregnant British servicewoman was repatriated to UK for her own protection. There was a potential health risk, including the possibility of congenital rubella syndrome, in the non-immune wives and partners of deployed male personnel, as a result of contact during the mid-tour home leave of the husbands or partners. The outbreak was monitored through a medical surveillance system known as ARRC 97, and was contained by prompt and rigorous control measures. This outbreak shows the importance of effective surveillance and of good microbiology laboratory support during military operations. The role of immunization against rubella during future military deployments is discussed.

Educators of the deaf were caught unprepared for the numbers and the additional handicaps presented by deaf children in the 1963-65 "bulge." This combined with the assumption of responsibility for many of these children by "regular" education, to produce less than an optimum educational environment. Many are lacking in the attitudes and skills which will be the foundation for future occupational success. More postsecondary programs are not needed, but existing programs, and particularly rehabilitation facilities designed for the severely handicapped, need to be strengthened by personnel competent to offer quality vocational and independent living skills to young deaf adults.

A longitudinal study of 214 rubella-deaf children revealed a low incidence (10%) of neurologic damage among those with normal intelligence, but a high incidence (51%-70%) among those who were mentally retarded or blind. Neurologic damage in the eight deaf of normal intelligence included behavior disorder or Chronic Brain Syndrome in approximately one-third of this small group. Behavioral symptoms associated with these disorders are described.

Within a longitudinal study of children with congenital rubella, 85 Deaf Only adolescents, 85 Deaf Multihandicapped, and 34 Normal controls were studied with respect to impulsivity. The majority of the deaf group had severe or profound hearing loss. Prevalence of impulsivity and self abuse clearly differentiated Deaf Only from Deaf Multihandicapped. In adolescence, one-fifth of the Deaf Only and three-fifths of the Deaf Multihandicapped showed impulsivity; only Deaf Multihandicapped were self abusive. For both the Deaf Only and the Deaf Multihandicapped groups, impulsivity at adolescence was a continuation of this trait from earlier developmental periods. In contrast, self abuse was a transient behavior for the Deaf Only but was persistent for the Deaf Multihandicapped from early childhood. A meaningful discussion of impulsivity in deaf children necessitates differentiation of Deaf Only from Deaf Multihandicapped.

Rubella is a viral infection that may cause fetal death or congenital defects, known as congenital rubella syndrome (CRS), during early pregnancy. The World Health Organization (WHO) recommends that countries assess the burden of rubella and CRS, including the determination of genotypes of circulating viruses. The goal of this study was to identify the genotypes of rubella viruses in the Democratic Republic of the Congo (DRC). Serum or throat swab samples were collected through the measles surveillance system. Sera that tested negative for measles IgM antibody were tested for rubella IgM antibody. Serum collected within 4 days of rash onset and throat swabs were screened by real-time RT-PCR for rubella virus RNA. For positive samples, an amplicon of the E1 glycoprotein gene was amplified by RT-PCR and sequenced. 11733 sera were tested for rubella IgM and 2816 (24%) were positive; 145 (5%) were tested for the presence of rubella RNA by real-time RT-PCR and 10 (7%) were positive. Seventeen throat swabs were analyzed by RT-PCR and three were positive. Sequences were obtained from eight of the positive samples. Phylogenetic analysis showed that the DRC rubella viruses belonged to genotypes 1B, 1E, 1G, and 2B. This report provides the first information on the genotypes of rubella virus circulating in the DRC. These data contribute to a better understanding of rubella burden and the dynamics of rubella virus circulation in Africa. Efforts to establish rubella surveillance in the DRC are needed to support rubella elimination in Africa.

: Rubella-containing vaccines (RCV) are not yet part of the Democratic Republic of the Congo's (DRC) vaccination program; however RCV introduction is planned before 2020. Because documentation of DRC's historical burden of rubella virus infection and congenital rubella syndrome (CRS) has been minimal, estimates of the burden of rubella virus infection and of CRS would help inform the country's strategy for RCV introduction. : A rubella antibody seroprevalence assessment was conducted using serum collected during 2008-2009 from 1605 pregnant women aged 15-46years attending 7 antenatal care sites in 3 of DRC's provinces. Estimates of age- and site-specific rubella antibody seroprevalence, population, and fertility rates were used in catalytic models to estimate the incidence of CRS per 100,000 live births and the number of CRS cases born in 2013 in DRC. : Overall 84% (95% CI 82, 86) of the women tested were estimated to be rubella antibody seropositive. The association between age and estimated antibody seroprevalence, adjusting for study site, was not significant (p=0.10). Differences in overall estimated seroprevalence by study site were observed indicating variation by geographical area (p⩽0.03 for all). Estimated seroprevalence was similar for women declaring residence in urban (84%) versus rural (83%) settings (p=0.67). In 2013 for DRC nationally, the estimated incidence of CRS was 69/100,000 live births (95% CI 0, 186), corresponding to 2886 infants (95% CI 342, 6395) born with CRS. : In the 3 provinces, rubella virus transmission is endemic, and most viral exposure and seroconversion occurs before age 15years. However, approximately 10-20% of the women were susceptible to rubella virus infection and thus at risk for having an infant with CRS. This analysis can guide plans for introduction of RCV in DRC. Per World Health Organization recommendations, introduction of RCV should be accompanied by a campaign targeting all children 9months to 14years of age as well as vaccination of women of child bearing age through routine services.

BACKGROUND: Rubella-containing vaccines (RCV) are not yet part of the Democratic Republic of the Congo's (DRC) vaccination program; however RCV introduction is planned before 2020. Because documentation of DRC's historical burden of rubella virus infection and congenital rubella syndrome (CRS) has been minimal, estimates of the burden of rubella virus infection and of CRS would help inform the country's strategy for RCV introduction. METHODS: A rubella antibody seroprevalence assessment was conducted using serum collected during 2008-2009 from 1605 pregnant women aged 15-46years attending 7 antenatal care sites in 3 of DRC's provinces. Estimates of age- and site-specific rubella antibody seroprevalence, population, and fertility rates were used in catalytic models to estimate the incidence of CRS per 100,000 live births and the number of CRS cases born in 2013 in DRC. RESULTS: Overall 84% (95% CI 82, 86) of the women tested were estimated to be rubella antibody seropositive. The association between age and estimated antibody seroprevalence, adjusting for study site, was not significant (p=0.10). Differences in overall estimated seroprevalence by study site were observed indicating variation by geographical area (p⩽0.03 for all). Estimated seroprevalence was similar for women declaring residence in urban (84%) versus rural (83%) settings (p=0.67). In 2013 for DRC nationally, the estimated incidence of CRS was 69/100,000 live births (95% CI 0, 186), corresponding to 2886 infants (95% CI 342, 6395) born with CRS. CONCLUSIONS: In the 3 provinces, rubella virus transmission is endemic, and most viral exposure and seroconversion occurs before age 15years. However, approximately 10-20% of the women were susceptible to rubella virus infection and thus at risk for having an infant with CRS. This analysis can guide plans for introduction of RCV in DRC. Per World Health Organization recommendations, introduction of RCV should be accompanied by a campaign targeting all children 9months to 14years of age as well as vaccination of women of child bearing age through routine services.

Rubella virus (RV)-specific immunoglobulin G (IgG) antibodies were studied in military recruits undergoing unselected immunization with live attenuated measles, mumps, and rubella virus (MMR) vaccine. Three different whole-RV enzyme immunoassays (EIAs) and an epitope-specific EIA with a synthetic peptide (BCH-178c) representing a heutralization domain on the RV E1 envelope protein were used. Before vaccination, 84.2, 87.7, and 84.5% of the subjects tested (n = 399) were found to be seropositive (> 10 IU/ml or assay equivalent) by the three whole-RV EIAs, respectively, while only 82.5% were seropositive by the BCH-178c EIA. Although prevaccination seropositivity rates were similar for the whole-RV EIAs (sensitivity, 94 to 100%), many sera considered seropositive by the whole-RV EIAs had E1 peptide EIA antibody levels of 10 IU/ml. After vaccination, depending on the assay used, up to 20.6% of initially seropositive individuals exhibited a greater than fourfold increase in RV-specific IgG, while up to 47.3% showed a greater than twofold increase. Increased antibody titers after vaccination (seroboosting) were most frequently associated with low levels of BCH-178c peptide-specific IgG before vaccination. RV protein-specific IgG was also studied by immunoblot assays in a subset (n = 56) of individuals receiving the MMR vaccine. Of these, 89.4 and 91.1% exhibited RV protein (E1, E2, and C protein)-specific IgG before and after vaccination, respectively. Seroboosting (two- to fourfold increase in EIA titers of individuals seropositive by the whole-RV EIA before vaccination) was usually accompanied by a shift in the IgG immunoblot pattern from a single (E1) to multiple (E1-E1, E1-C, or E1-E2-C) specificities, suggesting exposure of new epitopes as a result of ...