Progress Toward Rubella and Congenital Rubella Syndrome Elimination — Worldwide, 2012–2022

Results

Immunization Activities

In 2022, RCV had been introduced in 175 (90%) of 194 countries,^††† a 33% increase compared with the 132 (68%) countries that offered RCV in 2012 (Figure 1). All countries in the Region of the Americas (AMR), the European Region (EUR), the South-East Asia Region (SEAR), and the Western Pacific Region (WPR) have introduced RCV. In the two remaining regions, RCV has been introduced in 32 (68%) of 47 countries in the African Region (AFR) and 17 (81%) of 21 countries in the Eastern Mediterranean Region (EMR) (Table).

The introduction of RCV within low- and lower-middle–income countries has increased steadily over time (Figure 2). In 2012, RCV had been introduced in only 11% of 36 low-income countries and 50% of 46 lower-middle–income countries; however, by 2022, RCV introduction had increased to include 13 (50%) of 26 low-income countries and 51 (94%) of 54 lower-middle–income countries.

According to the WHO/UNICEF Estimates of National Immunization Coverage, coverage with the first dose of RCV globally among infants increased from 40% in 2012 to 68% in 2022, with wide regional variation (range = 36% [AFR]–93% [EUR]) (Table). In 2022, rubella vaccination coverage was 27% in low-income countries, 70% in lower-middle–income countries, 88% in upper-middle–income countries, and 93% in high-income countries. Excluding those countries that have not yet introduced RCV, 2022 coverage was 82% in low-income countries, 81% in lower-middle–income countries, 86% in upper-middle–income countries, and 94% in high-income countries.

Surveillance Activities and Reported Rubella and CRS Incidence

The number of countries reporting rubella cases, including the reporting of zero cases, increased from 166 (86%) in 2012 to 169 (87%) in 2019. During the COVID-19 pandemic, the number of countries reporting cases declined to 144 (74%) in 2020, and then increased slightly to 149 (77%) in 2022, but overall, remained below 2012 levels (Table). The number of countries reporting CRS cases remained constant at 123 (63%) in 2012 and 2019 but increased to 133 (69%) in 2022.

Compared with the 93,816 rubella cases reported in 2012, reported rubella cases declined 48%, to 48,559 in 2019, and decreased further to 17,407 in 2022 (Table). Reported CRS cases increased from 301 in 2012 to 418 in 2019 and 1,527 in 2022, primarily as the result of initiation of CRS surveillance and reporting in several populous countries (Afghanistan, Bangladesh, India, Indonesia, and Pakistan) since 2012.

During 2012–2022, a total of 5,722 rubella sequences from 45 countries were reported to the Rubella Virus Nucleotide Surveillance database in the Global Measles Rubella Laboratory Network. Among these, 3,295 (58%) were genotype 1E, and 2,395 (42%) were genotype 2B. However, 67% and 24% of the sequences were from China and Japan, respectively, highlighting the need to enhance global virologic surveillance for rubella (Min-hsin Chen, CDC, personal communication, 2024).

Progress Toward Elimination

Five WHO regions now have rubella and CRS regional elimination goals; AFR established a goal in 2021 (8). Although EMR has yet to set an elimination goal, the region has committed to achieving elimination (4). The AMR commission verified that the entire region had eliminated rubella and CRS in 2015; verification commissions in AFR, EMR, EUR, SEAR, and WPR assess rubella elimination status on a country-by-country basis. The number of countries in which elimination of endemic rubella has been verified has increased from 84 in 2019 to 98 countries in 2022: none in AFR, 35 (100%) in AMR, four (19%) of 21 in EMR, 50 (94%) of 53 in EUR, four (36%) of 11 in SEAR, and five (19%) of 27 in WPR.