The Maldives and Sri Lanka were verified yesterday for having eliminated Rubella (German Measles), making them the first two countries in the WHO South-East Asia Region to achieve measles and rubella elimination ahead of the 2023 target.
“Protecting all children against these deadly and debilitating diseases is an important step in our endeavour to achieve healthier population and health for all,” said Dr. Poonam Khetrapal Singh, Regional Director, the WHO South-East Asia Region, congratulating the Maldives and Sri Lanka on their achievement.
The announcement was made after the fifth meeting of the South-East Asia Regional Verification Commission for Measles and Rubella Elimination, held virtually. The Commission comprises 11 independent international experts in the fields of epidemiology, virology and public health. A country is verified as having eliminated measles and rubella when there is no evidence of endemic transmission of the measles and rubella viruses for over three years in the presence of a well-performing surveillance system.
The Maldives reported last endemic case of measles in 2009 and of rubella in October 2015, while Sri Lanka reported last endemic case of measles in May 2016 and of rubella in March 2017.
Vaccine
For the first time, more than half of all the world’s infants are protected against the debilitating rubella virus, according to a new study by the World Health Organization (WHO) and the United States Centers for Disease Control and Prevention (CDC). Worldwide, more than 80 countries have eliminated the disease. This progress has been achieved through broadening access to the safe and highly effective rubella vaccine – especially across lower-income countries. This vaccine has been shown to prevent more than 95% of rubella infections.
Coming at a time when the entire world is grappling with the COVID-19 pandemic, this success is encouraging and demonstrates the importance of joint efforts, Dr. Khetrapal Singh said, lauding the Ministries of Health, health workforce, partners, and most importantly the communities, who together contributed to this public health achievement.
The Regional Director commended Member countries’ efforts to deliver life-saving vaccines to children even while battling the pandemic. “Though mass vaccination activities have been postponed in several countries, it is encouraging to see that efforts are underway to resume them at the soonest,” she said.
COVID-19 impact
In a global survey, more than half of all countries reported moderate-to-severe disruptions or a total suspension of vaccination services in March and April. Preliminary information from the Region suggests both immunization coverage and surveillance have been impacted. However, countries in the WHO South-East Asia Region have been making concerted efforts to resume immunization and surveillance activities and plug gaps that have arisen due to the COVID-19 pandemic.
In recent years, all countries in the region introduced two doses of measles-containing vaccine and at least one dose of rubella-containing vaccine in their routine immunization programme. First-dose coverage of measles-containing vaccine is now 88 percent and the second-dose coverage is 76 percent. Since 2017, nearly 500 million additional children have been vaccinated with measles and rubella-containing vaccines. Surveillance for measles and rubella has been strengthened further.
“We cannot allow for our progress towards measles and rubella elimination to be put on hold or reversed. We must achieve our 2023 target,” the Regional Director said, adding that the WHO is committed to supporting Member countries and partners to fully revive immunization and surveillance activities and to refine the strategic, operational and policy guidelines that will facilitate progress towards our goal.
“Now more than ever, we must pull together to realize our vision of a region in which no child suffers or dies from disease as easily prevented as measles; where no pregnant woman loses her unborn baby due to a virus as avoidable as rubella; and where no neonate is born with a heart ailment or loss of hearing owing to a tragedy as needless as in-utero rubella infection,” Dr. Khetrapal Singh said.
Member countries of the WHO South-East Asia Region, in September last year, had set 2023 as the target for elimination of measles and rubella, revising the goal of the flagship programme that since 2014 had focused on measles elimination and rubella control.
Bhutan, DPR Korea and Timor-Leste are other countries in the region who have eliminated measles.
For the majority of children and adults, rubella – also known as German measles – is a mild infection, causing little more than a mild fever and a rash. However, it brings immense health risks if a woman contracts it when she is pregnant. Ninty-percent of women who get rubella early in pregnancy will pass it on to their unborn babies.
Rubella infection early in pregnancy can lead to miscarriage, stillbirth or Congenital Rubella Syndrome (CRS) in the baby – a condition that includes severe birth defects and lifelong disability, like vision and hearing impairments and heart defects. Deafness occurs in about two-thirds of all those born with CRS.
In many countries, thanks to vaccination, rubella and CRS have become diseases of the past. As the example of measles reminds us, however, vaccine-preventable diseases can quickly resurface wherever people are unvaccinated.
“There is no room for complacency. Even in countries that have eliminated the disease, the job is not yet done. The only way to ensure protection against rubella is to make sure that all children are vaccinated against it, alongside surveillance systems that are strong enough to quickly detect cases and respond rapidly to stop the spread - especially to pregnant women.” says Dr. Shalini Desai, an expert in rubella at the WHO and author of the report.
And, rubella can be devastating. Prior to the introduction of the vaccine, the United States experienced a major outbreak in 1964 with 12.5 million infections, causing more than 20,000 cases of CRS and over 11,000 miscarriages and stillbirths. Rubella has since been eliminated from the United States, but severe outbreaks recur elsewhere – including, most recently, Japan in 2018-19.
Globally, it is estimated that around 100,000 children are born with CRS every year.
COVID-19 protection
Scientists from Lithuania and Kurdistan have come up with a hypothesis that the traditional childhood vaccines against measles, mumps, and rubella (MMR) may be able to protect children from Coronavirus 2019 (COVID-19). Their theory is based on the discovered sequence similarity of the 30 amino acid residues between glycoproteins of SARS-CoV-2, measles, and rubella viruses.
Rimantas Kodzius, professor, Panevezys Faculty of Technology and Business, Kaunas Technology University, is one of the scientists who developed this hypothesis, and he and a small team of scientists wrote a paper on the subject.
“The antibodies produced in children due to the MMR vaccine could recognize some protein parts (epitopes) on the SARS-CoV-2 spike proteins,” Kodzius said. “These antibodies, particularly in the epithelial layer of respiratory airways, block binding, and entering the virus into the cells.”
Kodzius and his fellow group of scientists were inspired by the immunological principle based on the antibody cross-reaction recognizing antigens in two different microbes. They wanted to look for homology sequence in SARS-CoV-2 and the viruses that commonly are prevented by vaccination during childhood. It was discovered that 30 amino acid residues share similarities between the Spike (S) glycoprotein of the SARS-CoV-2 virus and the Fusion glycoprotein of Measles virus as well as with the envelope glycoprotein of the rubella virus.
According to recent studies, the levels of antibodies against MMR vaccination may persist for 15 to 20 years. Theoretically, the same protection against COVID-19 could last that long.
Kodzius and the team of investigators acknowledged much more is needed to support their hypothesis. Research including testing purified spike protein of SARS-CoV-2 against the polyclonal and monoclonal antibodies of measles and rubella viruses in vivo and in vitro is required in order to support their hypothesis.
In terms of medical science’s approach to COVID-19, researchers have been actively looking at existing therapies or medications, so it appears to be par from the course with the MMR vaccine theory. For example, remdesivir, which was developed for Ebola but did not prove to be efficacious, is a treatment being studied and used for COVID-19 patients.
While not understood yet, it appears children and adolescents are not affected by COVID-19 in the same way as adults. In data looking at young patients from China and South Korea, the disease is less common and milder in children younger than 10 years of age. In another newly released European study, a similar pattern was found. This same study reported the mortality rate for children with the virus is very low.
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