title: Rubella in Israel after the MMR vaccine: elimination or containment?
abstract: Since 1996, after the full institution of the two-dose measles, mumps, and rubella vaccine (MMR) regimen in Israel, rubella incidence has declined dramatically and has remained extremely low. Cyclical outbreaks ended; the two brief outbreaks that did occur were quickly contained; and epidemiological data indicate that the disease is practically absent from the country. But similar steep declines in the incidence of measles and mumps, the two other MMR-preventable diseases, were followed by major outbreaks in 2007 and 2010. Epidemiological analyses show that undervaccination of subgroups within the Jewish ultra-orthodox population, both in Israel and abroad, and virus importation into Israel, continue to be risk factors for all three MMR-preventable diseases. Israel's public health system, therefore, should focus on a policy of containment: improve MMR coverage among undervaccinated subgroups and assure that virus importation is no longer a risk. Then the goal of rubella elimination will become feasible. We discuss how the Israeli experience may contribute to the World Health Organization Initiative to eliminate simultaneously measles and rubella.
authors: Division of Epidemiology, Ministry of Health, 2 Ben Tabai St, Jerusalem, Israel. Emilia.anis@moh.health.gov.il
authors: Emilia
authors: E
authors: Anis
authors: Itamar
authors: I
authors: Grotto
authors: Larisa
authors: L
authors: Moerman
authors: Ehud
authors: E
authors: Kaliner
authors: Bruce
authors: B
authors: Warshavsky
authors: Paul E
authors: PE
authors: Slater
authors: Boaz
authors: B
authors: Lev
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D004196:Disease Outbreaks; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007557:Israel / Q000453:epidemiology; D008297:Male; D022542:Measles-Mumps-Rubella Vaccine / Q000008:administration & dosage*; D008875:Middle Aged; D012067:Religion; D012307:Risk Factors; D012409:Rubella / Q000453:epidemiology* / Q000517:prevention & control*; D014944:World Health Organization; D055815:Young Adult
chemical_list: D022542:Measles-Mumps-Rubella Vaccine