Pregnant women in SA at risk of stillbirths, miscarriages while rubella vaccine remains unavailable in public sector

It is a disease that no one talks about, but new research has revealed that German measles or rubella, which causes miscarriages, stillbirths and birth defects among pregnant women, is putting the lives of thousands of women and children at risk.

According to a new study by the National Institute for Communicable Diseases (NICD), rubella, which is not vaccinated against in the country except in the private sector, has affected at least 6,000 people in SA within a space of five years.

Those living in KwaZulu-Natal are more likely to contract this viral infection, with the number of rubella infections having increased 14-fold between 2016 and 2017.

The Free State had the least number of rubella cases with about 2.5%.

Rubella cases affected mostly children under the age of 10. The national surveillance data from 2015—2019 shows that rubella is seasonal and tends to peak in spring, between September and November.

Rubella affected both males and females similarly with 3,289 females infected while 3,232 were males. The highest burden of cases occurred in 2017 when 2,526 cases were recorded, followed by 1,496 cases in 2019.

Gauteng accounted for about 22% of cases or 1,492 during the period. While most cases were among children aged five years, about 5% were among women of reproductive age. KwaZulu-Natal saw a steep increase in rubella during this period from a mere 53 cases in 2016 to 730 in 2017. The mortality rate was 13% of all cases, and the most common birth defect associated with rubella was congenital heart disease.

Researchers from the NICD said the latest study provides insight into the burden of rubella and congenital rubella syndrome in SA, which could enable the planning of rubella-containing vaccine introduction into the country’s immunisation programme.

They said the latest data “show that rubella and congenital rubella syndrome are significant health concerns in SA”.

In the absence of a public rubella vaccine the infection “may be associated with the build-up of susceptible persons in the population as well as high contact rate”.

“While the five-year surveillance period is short, the national epidemic curve suggests that rubella outbreaks follow a two-year cycle, which is more frequent than the pre-vaccine outbreaks reported in the US, which is every six to nine years, or in Europe, which is every three to five years. Our five-year interval may be too short to clearly depict the frequency of outbreaks at provincial or district level,” the researchers said.

“This data can be used for epidemiological modelling and to inform rubella-containing vaccine immunisation options, such as the inclusion of various age groups, targeting young girls and boys, as well as catch-up campaign strategies,” they wrote in PLOS One

They said rubella outbreaks should be investigated and documented, arguing that the decrease in reported case numbers of congenital rubella syndrome “underscores the urgent need for heightened newborn screening”.

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