title: Rubella outbreak in the Netherlands, 2004-2005: high burden of congenital infection and spread to Canada.
abstract: BACKGROUND
  In The Netherlands and Canada the measles, mumps, rubella vaccine coverage is high. In 2004 a rubella outbreak started in the Netherlands in a population subgroup with low coverage, with subsequent spread to Canada.
  
  
  METHODS
  We examined data on rubella cases in the Netherlands and Canada reported between September 2004 and July 2005. In The Netherlands we established enhanced surveillance for congenital rubella while in Canada we carried out a cohort study to estimate vaccine effectiveness.
  
  
  RESULTS
  In The Netherlands and Canada, 387 and 309 rubella cases were reported, respectively. Of these, 97% were in unvaccinated individuals of orthodox protestant denomination. Reported consequences of rubella in pregnancy were 2 fetal deaths and 14 infants with congenital infection. Of the latter, 11 had clinical defects including deafness in all but eye defects in none. The estimated vaccine effectiveness was 99.3% (95% CI: 95.3%-99.9%). Closely related strains of rubella virus genotype 1G were found in Dutch and Canadian cases.
  
  
  CONCLUSIONS
  A large rubella outbreak occurred in The Netherlands with spread to Canada in a population subgroup with religious objections to vaccination. Its major public health importance was due to the high burden of congenital disease, international spread and implications for measles and rubella surveillance and elimination. Congenital deafness occurred more frequently and eye defects less frequently than expected. The estimated rubella vaccine effectiveness was very high. Our results demonstrate the risks associated with heterogeneity in rubella vaccine coverage. High rubella vaccine coverage in all population subgroups and sensitive surveillance are crucial for elimination of rubella and CRS.
authors.affiliation: Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), The Netherlands. susan.hahne@rivm.nl
authors.forename: Susan
authors.initials: S
authors.lastname: Hahné
authors.forename: Jeannette
authors.initials: J
authors.lastname: Macey
authors.forename: Rob
authors.initials: R
authors.lastname: van Binnendijk
authors.forename: Robert
authors.initials: R
authors.lastname: Kohl
authors.forename: Sharon
authors.initials: S
authors.lastname: Dolman
authors.forename: Ytje
authors.initials: Y
authors.lastname: van der Veen
authors.forename: Graham
authors.initials: G
authors.lastname: Tipples
authors.forename: Helma
authors.initials: H
authors.lastname: Ruijs
authors.forename: Tony
authors.initials: T
authors.lastname: Mazzulli
authors.forename: Aura
authors.initials: A
authors.lastname: Timen
authors.forename: Anton
authors.initials: A
authors.lastname: van Loon
authors.forename: Hester
authors.initials: H
authors.lastname: de Melker
mesh_terms: D000293:Adolescent; D000328:Adult; D002170:Canada / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D004196:Disease Outbreaks; D004363:Drug Utilization / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D011247:Pregnancy; D012067:Religion; D012409:Rubella / Q000453:epidemiology*; D012411:Rubella Vaccine / Q000008:administration & dosage*; D012412:Rubella virus / Q000302:isolation & purification; D055815:Young Adult
chemical_list: D012411:Rubella Vaccine