This paper examines the epidemiology of rubella disease in Ethiopia using data from the measles case-based surveillance system, analyzing 992 confirmed rubella cases from 2004–2009. The authors discuss the critical public health gap created by Ethiopia's lack of dedicated rubella surveillance and vaccination programs, and explore the serious consequences of congenital rubella syndrome (CRS)—including developmental delays, deafness, and cardiac defects—that result from maternal infection. The paper contextualizes Ethiopia's rubella burden within global child mortality trends and vaccine-hesitancy movements, arguing that strengthened surveillance systems and susceptibility profiling are essential to reduce preventable birth defects and protect vulnerable populations.
One of the top 10 global health issues identified by Intra-Health International in 2013 is helping children live longer. According to the 2012 UNICEF report Committing to Child Survival: A Promise Renewed, the number of child deaths has decreased in many countries across the globe ("Intra-Health," 2013). Child mortality rates have decreased nearly 50 percent from a 1990 figure of 12 million under-five deaths to a 2011 figure of 6.9 million. If the child mortality rate could be reduced to just 20 child deaths per 1,000 live births in every country by 2035, a minimum of 45 million children could be saved ("Intra-Health," 2013). Recommendations from the Child Survival Call to Action hosted by USAID point to the need for better and more systematic collection of health sector data, as well as better implementation of high-impact interventions to tackle the major causes of newborn and child mortality ("Intra-Health," 2013).
Recent outbreaks of measles in the continental United States indicate an increasing complacency in developed countries about the communicable diseases of childhood and a growing body of misinformed people who distrust the safety of vaccinations. The challenges posed by these conflating influences create decision-making dilemmas for parents, educators, and healthcare workers. The situation also requires conversations about values clarification, particularly regarding religion-based exemptions for requiring children to receive immunizations before attending public school. Issues related to the suppression, eradication, and management of childhood infectious disease must be clearly identified and appropriate resolutions generated and implemented.
Rubella is a particularly insidious disease because it is easily spread, often appears mild, but is associated with serious birth defects. A cluster of birth defects known as congenital rubella syndrome (CRS) occurs in children born to mothers who were infected with rubella, particularly during the first trimester of pregnancy.
Mitiku, et al. (2011) analyzed rubella cases that had been reported to the measles case-based surveillance system during the period from 2004 through 2009. A sample of 8,212 specimens was tested for the rubella immunoglobulin M (IgM). Of these, 992 or 12.1 percent tested positive for rubella IgM. The age distribution of the rubella-positive cases spanned ages 3 months to 44 years. Notably, a majority of the rubella-positive cases—94.7 percent—were children younger than 15 years of age. As expected given the infectious nature of rubella, the incidence rate of rubella-positive cases was higher in urban areas at 19.4 percent than in rural areas at 11.6 percent.
The researchers noted that Ethiopia does not include rubella vaccine in its infant vaccination schedule, nor does it operate a surveillance program to monitor rubella or congenital rubella syndrome. However, Ethiopia has established a measles case-based surveillance system that includes laboratory testing for measles-specific and rubella-specific antibodies.
An important variable that may result in underidentification of rubella is that the disease may present without a rash or fever in an estimated 50 percent of patients, thereby often occurring on a subclinical basis. Mitiku, et al. (2011) asserted that a comprehensive surveillance system needs to be adopted in Ethiopia, which would include the establishment of sentinel surveillance for congenital rubella syndrome. Importantly, the researchers called for studies to define the susceptibility profile in women and school-aged children of childbearing age.
The recommendations resulting from the Mitiku, et al. (2011) research would be combined with appropriately robust strategies to control rubella in Ethiopia. Adopting these measures would strengthen the nation's ability to reduce the prevalence of preventable birth defects found in congenital rubella syndrome. Fewer children would be born with birth defects such as developmental delay, autism, sensorineural deafness, heart defects, craniofacial abnormalities, and various ophthalmic defects, including cataracts, glaucoma, microphtalmia, and chorioretinitis.
Although the article reviewed herein describes research conducted in Ethiopia, the continual movement of people between countries and the existence of heavily trafficked ports in coastal states establish that what happens in Ethiopia is a concern for people across the globe. This is true for any nation struggling to control infectious childhood disease. Strengthening Ethiopia's surveillance and vaccination infrastructure would protect not only Ethiopian children but also contribute to global disease prevention and maternal health outcomes.
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