Volume 197 - Issue 10
Rubella vaccination success in Australia: no time for complacency
Authors: Teresa M Ballestas and Suzanne P McEvoy
Med J Aust 2012; 197 (10): 551-552. || doi: 10.5694/mja12.11198
Published online: 19 November 2012
Published online: 19 November 2012
To the Editor: A major achievement of the National Immunisation Program is the progress towards elimination of congenital rubella syndrome and interruption of endemic rubella transmission in Australia.1 However, some population subgroups remain at risk of rubella infection. We describe a workplace outbreak in Perth in 2011.
Between 30 June and 6 July 2011, three employees of the same organisation working in an open area on a single ...
To the Editor: A major achievement of the National Immunisation Program is the progress towards elimination of congenital rubella syndrome and interruption of endemic rubella transmission in Australia.1 However, some population subgroups remain at risk of rubella infection. We describe a workplace outbreak in Perth in 2011.
Between 30 June and 6 July 2011, three employees of the same organisation working in an open area on a single floor, with an estimated 170 staff, developed fever, malaise and a body rash. All tested positive for rubella IgM antibodies. As the incubation period for rubella ranges from 12 to 21 days,2 these patients were considered to have been infected contemporaneously and most likely from a single unidentified point source within the workplace. A subsequent wave of three cases with rash onset between 17 July and 20 July was identified on the same floor of the building. No relevant travel history was identified.
Of the six patients, five were men and four were Australian-born. Their ages ranged from 31 to 56 years. One patient reported one previous measles–mumps–rubella (MMR) vaccination; one patient was unvaccinated; and four patients did not know their vaccination status. However, based on date of birth and male sex,3 it was considered unlikely that they had been vaccinated.
For each patient, the public health unit (PHU) followed up household, social and workplace contacts, and contacts at their general practitioners’ surgeries. PHU staff liaised with the occupational health and safety representative at the workplace to distribute fact sheets about rubella and to advise unvaccinated, non-pregnant staff to obtain an MMR vaccination. Surveillance for rash illness was undertaken.
Reassuringly, all nine identified pregnant contacts had been tested previously by their doctors and had rubella IgG antibody levels above the 10 IU/mL cut-off recommended by the World Health Organization.2
This outbreak is a good reminder that a proportion of Australian men remain at risk of rubella infection. Characteristically, these men were born before 1977, before the introduction of rubella vaccination for boys.1,3 Given the pool of non-immune men and the occasional ingress of rubella from overseas, confirmation of rubella immunity remains important for women planning a pregnancy.
Competing interests
No relevant disclosures.
References
- Song N, Gao Z, Wood JG, et al. Current epidemiology of rubella and congenital rubella syndrome in Australia: progress towards elimination. Vaccine 2012; 30: 4073-4078. 0_CBBFAAHA
- World Health Organization. The immunological basis for immunisation series. Module 11: rubella. Geneva: WHO, 2008. 0_CBBJHCFH
- Gidding HF, Burgess MA, Kempe AE. A short history of vaccination in Australia. Med J Aust 2001; 174: 37-40. 0_i1142873