• The World Health Organisation (WHO) announced that Nepal has eliminated rubella as a public health problem.

• Rubella, which is commonly known as German measles, is a highly contagious viral infection.

• Nepal is the sixth country in WHO South-East Asia to achieve rubella elimination.

• Nepal introduced rubella-containing vaccine in its immunisation programme in 2012 with a nationwide campaign for age group 9 months to 15 years. A second dose of rubella-containing vaccine was added to the routine immunisation schedule in 2016.

• Four national campaigns with rubella vaccines in 2012, 2016, 2020, and 2024, helped increase access, despite major public health emergencies such as the COVID-19 pandemic and earthquakes in 2015 and 2023. By 2024, Nepal achieved over 95% coverage for at least one dose of rubella vaccine.

• Innovative strategies such as observing ‘immunisation month’, outreach to vaccinate missed children, and motivation for the districts to be declared ‘fully immunised’, provided further impetus to elimination efforts.

• To further strengthen surveillance, Nepal recently introduced a robust laboratory testing algorithm, the first in the WHO South-East Asia Region to do so.

• Prioritising elimination of measles and rubella as public health problems in WHO South-East Asia by 2026, Bhutan, North Korea, Maldives, and Timor-Leste have eliminated measles, and Bhutan, North Korea, Maldives, Sri Lanka, Timor-Leste, and now Nepal, have eliminated rubella.

Rubella

• Rubella is a highly contagious disease caused by a virus. 

• The rubella virus, a togavirus of the genus Rubivirus, is an enveloped single-stranded RNA virus with a single serotype that does not cross-react with other togaviruses. 

• It spreads easily when an infected person coughs or sneezes. Most children and adults who get rubella have a mild fever and rash.

• When a woman is infected with the rubella virus early in pregnancy, she has a 90 per cent chance of passing the virus on to her fetus. 

• There were an estimated 17,865 cases of rubella in 78 countries in 2022, despite the availability of a safe and cost-effective vaccine.

Symptoms

• In children, the disease is usually mild, with symptoms including a rash, low fever, nausea and mild conjunctivitis. 

• The rash, which occurs in 50-80 per cent of cases, lasts 1-3 days and usually starts on the face and neck before progressing down the body. 

• Swollen lymph glands behind the ears and in the neck are the most characteristic clinical features. 

• Infected adults, more commonly women, may develop arthritis and painful joints that usually last from 3-10 days.

• Rubella in pregnancy, especially during the first trimester, can result in miscarriage, fetal death, stillbirth, or infants with congenital malformations, known as congenital rubella syndrome (CRS).

• Children with CRS can suffer hearing impairments, eye and heart defects and other lifelong disabilities, including autism, diabetes mellitus and thyroid dysfunction — many of which require costly therapy, surgeries and other expensive care.

Vaccination

• Rubella is preventable with safe and cost-effective vaccines.

• The rubella vaccine is a live attenuated strain, and a single dose gives more than 95 per cent long-lasting immunity, which is similar to that induced by natural infection.

• Rubella vaccines are available either in monovalent formulation (a vaccine directed at only one pathogen) or more commonly in combinations with other vaccines such as with vaccines against measles (MR), measles and mumps (MMR), or measles, mumps and varicella (MMRV).