title: Toward rubella elimination in Poland: need for supplemental immunization activities, enhanced surveillance, and further integration with measles elimination efforts.
abstract: BACKGROUND
  All Member States of the World Health Organization (WHO) European Region have endorsed rubella elimination and congenital rubella syndrome (CRS) prevention. However, Poland has continued high levels of reported rubella.
  
  
  METHODS
  We reviewed rubella incidence in Poland since 1966 and analyzed national aggregated surveillance data from the period 2003-2008 and case-based data from 4 provinces from the period 2006-2008. We described CRS cases since 1997 and assessed maternal receipt of vaccine. We reviewed national vaccination coverage from 1992 through 2008.
  
  
  RESULTS
  Since 1966, rubella outbreaks have occurred every 4-6 years in Poland. Aggregate and case-based data from the period 2003-2008 indicate that rubella virus transmission has occurred across wide age ranges (from <1 year to 60 years), with disproportionately higher percentage of cases among adolescent boys. Of 18 children with reported CRS cases from 1997 through 2008, 15 (83%) of their mothers had not been vaccinated. Measles-mumps-rubella dose 1 vaccination coverage ranged from 97% to 99%.
  
  
  CONCLUSIONS
  Poland had the highest incidence of rubella in the WHO European Region in 2007 and 2008. Rubella occurs predominantly in age and sex cohorts historically not included in vaccination recommendations. The risk for CRS continues. To achieve rubella elimination, supplemental immunization activities among adolescent boys are needed, as is integration with measles elimination efforts.
authors.affiliation: Global Immunization Division, National Center for Immunization and Respiratory Diseases, Center for Disease Control and Prevention, Atlanta, Georgia 30333, USA. laz5@cdc.gov
authors.forename: Laura
authors.initials: L
authors.lastname: Zimmerman
authors.forename: Justyna
authors.initials: J
authors.lastname: Rogalska
authors.forename: Kathleen A
authors.initials: KA
authors.lastname: Wannemuehler
authors.forename: Marzena
authors.initials: M
authors.lastname: Haponiuk
authors.forename: Adam
authors.initials: A
authors.lastname: Kosek
authors.forename: Ewa
authors.initials: E
authors.lastname: Pauch
authors.forename: Elzbieta
authors.initials: E
authors.lastname: Plonska
authors.forename: Daniel
authors.initials: D
authors.lastname: Veltze
authors.forename: Miroslaw P
authors.initials: MP
authors.lastname: Czarkowski
authors.forename: Nilesh
authors.initials: N
authors.lastname: Buddh
authors.forename: Susan
authors.initials: S
authors.lastname: Reef
authors.forename: Pawel
authors.initials: P
authors.lastname: Stefanoff
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D004196:Disease Outbreaks; D005260:Female; D006801:Humans; D017589:Immunization Programs; D015994:Incidence; D007223:Infant; D008297:Male; D008457:Measles / Q000453:epidemiology / Q000517:prevention & control*; D022542:Measles-Mumps-Rubella Vaccine / Q000008:administration & dosage; D008875:Middle Aged; D011044:Poland / Q000453:epidemiology; D011159:Population Surveillance; D012409:Rubella / Q000453:epidemiology / Q000517:prevention & control*; D012410:Rubella Syndrome, Congenital / Q000453:epidemiology / Q000517:prevention & control; D012411:Rubella Vaccine / Q000008:administration & dosage*; D014611:Vaccination; D055815:Young Adult
chemical_list: D022542:Measles-Mumps-Rubella Vaccine; D012411:Rubella Vaccine