title: An epidemiological assessment towards elimination of rubella and congenital rubella syndrome in Singapore.
abstract: OBJECTIVE
  In line with regional and global goals for the elimination of rubella and congenital rubella syndrome (CRS), we reviewed the epidemiological situation in Singapore, based on surveillance reports on rubella and CRS, national immunization coverage and seroprevalence surveys. The aim of our review was to identify current gaps and steps taken to achieve the targets set by the World Health Organization (WHO) Western Pacific Regional Office (WPRO).
  
  
  METHODS
  Epidemiological data on clinical and laboratory-confirmed rubella cases, including CRS, notified to the Communicable Diseases Division, Ministry of Health, Singapore, from 2003 to 2013 were collated and analyzed. Vaccination coverage against rubella was obtained from the National Immunization Registry and School Health Services of the Health Promotion Board. The changing prevalence of rubella was determined from periodic serological surveys.
  
  
  RESULTS
  The incidence of indigenous rubella cases per million population decreased from 37.2 in 2008 to 7.6 in 2013 and there had been no indigenous case of CRS in 2012 and 2013. Therapeutic abortions performed due to rubella infections had become uncommon. The annual measles, mumps, and rubella (MMR) vaccination coverage in childhood population remained high ranging from 93% to 96%. The overall susceptibility to rubella in women aged 18-44 years had reduced significantly from 15.8% in 2004 to 11.0% in 2010. The prevalence of IgG antibody against rubella among Singapore children aged 1-17 years was maintained at 87.3% in 2008-2010.
  
  
  CONCLUSIONS
  All available data indicated that Singapore has made good progress towards the elimination of rubella and CRS. It has attained the targets set by the WHO WPRO for 2015. In preparation for verification of rubella elimination, an enhanced surveillance system has been implemented to ensure that all reported cases are laboratory confirmed, and genotyping of rubella virus strains isolated is carried out to provide evidence for interruption of endemic transmission.
authors.affiliation: National Healthcare Group, Singapore; Saw Swee Hock School of Public Health, National University of Singapore, Singapore. Electronic address: ying_xian_chua@nhgp.com.sg.
authors.forename: Ying Xian
authors.initials: YX
authors.lastname: Chua
authors.affiliation: Epidemiology and Disease Control Division, Public Health Group, Ministry of Health, Singapore.
authors.forename: Li Wei
authors.initials: LW
authors.lastname: Ang
authors.affiliation: Communicable Diseases Division, Ministry of Health, Singapore.
authors.forename: Constance
authors.initials: C
authors.lastname: Low
authors.affiliation: Epidemiology and Disease Control Division, Public Health Group, Ministry of Health, Singapore.
authors.forename: Lyn
authors.initials: L
authors.lastname: James
authors.affiliation: Communicable Diseases Division, Ministry of Health, Singapore.
authors.forename: Jeffery L
authors.initials: JL
authors.lastname: Cutter
authors.affiliation: Communicable Diseases Division, Ministry of Health, Singapore; Saw Swee Hock School of Public Health, National University of Singapore, Singapore.
authors.forename: Kee Tai
authors.initials: KT
authors.lastname: Goh
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000914:Antibodies, Viral / Q000097:blood*; D002648:Child; D002675:Child, Preschool; D060740:Disease Eradication; D018563:Disease Notification; D062665:Epidemiological Monitoring; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D022542:Measles-Mumps-Rubella Vaccine / Q000008:administration & dosage*; D008875:Middle Aged; D012409:Rubella / Q000453:epidemiology* / Q000517:prevention & control*; D012412:Rubella virus / Q000276:immunology*; D016036:Seroepidemiologic Studies; D012846:Singapore / Q000453:epidemiology; D014611:Vaccination / Q000706:statistics & numerical data; D055815:Young Adult
chemical_list: D000914:Antibodies, Viral; D022542:Measles-Mumps-Rubella Vaccine
keywords: Epidemiology; Seroprevalence; Surveillance; Therapeutic abortion; Vaccination