So far this year (as of 15 June 2013) the Polish Institute of Public Health has been notified of 32,196 reported cases of rubella in the country, including two cases in newborns (congenital rubella syndrome). 81 % of the cases are diagnosed in men aged 15-29 years. In the same period last year, more than 3,000 cases were reported.
The outbreak covers the whole of Poland, but most cases are reported from the western part of the country, particularly the counties of Malopolskie and Wielkopolskie. Poland had a similar large outbreak in 2007.
The current outbreak reflects previous vaccination history in Poland which has resulted in a shift of cases from children to young adults. The circulation of rubella virus among adolescents and young adults leads to an increased risk of infection during pregnancy which can cause birth defects (congenital rubella syndrome). In Poland, it is estimated that approximately 10 % of women of childbearing age are susceptible to the disease.
Due to the high vaccination coverage over many years, rubella occurs very rarely in Norway. This year, the Norwegian Institute of Public Health has been notified about 3 cases of rubella. Two of these were adult Polish males who were infected in Poland.
Poles in Norway and others planning to stay in Poland and who have not had, or been vaccinated against, rubella should be vaccinated. Pregnant women who are not vaccinated or have not had a blood sample taken during pregnancy to confirm immunity to rubella should – while the outbreak is in progress – avoid travelling to Poland unless the journey is considered strictly necessary. This is especially important during the first 20 weeks of pregnancy. Pregnant women who choose to travel should be very careful to avoid contact with people with rubella although this can be difficult, since up to half of cases have little or no symptoms.
The vaccine is given as a combined vaccine against measles, mumps and rubella (MMR vaccine). It is not harmful to give the MMR vaccine to people who have previously received one or more doses of any of the components.
In the Norwegian Childhood Immunisation Programme, the first dose of MMR vaccine is administered at 15 months of age. Children between 9 and 15 months old who are going to Poland should be offered the MMR vaccine before travelling. Vaccines given before the child is 12 months are not recognised in the Norwegian programme and should be repeated at 15 months of age.
The vaccine is a live vaccine and should not be given to pregnant women. Pregnancy should be avoided for one month after vaccination.
Physicians should be particularly aware of rubella as a possible diagnosis in travellers with rashes who have been to Poland.
Rubella is usually a mild viral disease caused by the rubella virus, but during pregnancy it can cause miscarriage and severe birth defects, especially with infection in the first 20 weeks. Up to half of those infected have few or no symptoms. The most common symptoms include moderate fever and a rash that spreads from the face to the entire body. The patient may develop enlarged lymph nodes at the back of the neck. Rarely, rubella may cause complications in the form of encephalitis or arthritis. The time from infection to disease (incubation period) is 14-21 days.
Samples from suspected rubella cases should always be taken for laboratory analysis. In addition to a blood test to detect antibodies, samples should also be taken from oral secretions to detect nucleic acids from the rubella virus. These samples should be taken in the course of the first week of illness. Equipment for sampling mouth secretions is available from the NIPH.
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