How Japan managed to eliminate rubella... for nowーNHK WORLD-JAPAN NEWS

Key Concepts

• Rubella (German Measles): A viral disease posing significant risk to developing fetuses, potentially causing Congenital Rubella Syndrome (CRS).
• Congenital Rubella Syndrome (CRS): A condition resulting from maternal Rubella infection during pregnancy, leading to severe birth defects affecting eyes, ears, heart, and other organs.
• Vaccination: The most effective method of preventing Rubella and CRS.
• Herd Immunity: Protection conferred upon unvaccinated individuals when a sufficiently high percentage of the population is immune, reducing disease spread.
• Routine Immunization: Regularly scheduled vaccinations, typically administered during childhood.

Japan’s Rubella Elimination: A Story of Advocacy and Public Health

Introduction

In September of last year, the World Health Organization (WHO) declared Japan successful in eliminating Rubella, a viral disease with devastating consequences for pregnant women and their unborn children. This achievement is directly linked to a concerted immunization effort spurred by the tireless advocacy of individuals and families deeply affected by the virus.

The Personal Cost of Rubella: Kani Kayo’s Story

Kani Kayo, a 71-year-old woman, exemplifies the human cost of Rubella. She contracted the disease while pregnant with her daughter, Taiko, who was born with severe impairments to her eyes, ears, and heart due to Congenital Rubella Syndrome (CRS). Taiko tragically passed away at the age of 18. Before her death, Taiko left a final message for her parents, which became a powerful motivator for Kani’s activism. As Kani stated, “We felt we had to do our best just like she did and that's what has kept us going.” The risk of CRS is particularly acute during the first trimester of pregnancy, and a significant challenge is that approximately one-third of Rubella infections are asymptomatic, allowing for unwitting transmission.

Shifting Immunization Strategies: Addressing the Male Vulnerability

Historically, Japan’s immunization programs focused primarily on vaccinating women against Rubella. This approach inadvertently left a large proportion of the male population unvaccinated, contributing to the continued spread of the disease. The consequences of this became starkly apparent during a Rubella epidemic between 2012 and 2013, which resulted in 45 diagnoses of CRS, tragically leading to the deaths of 11 infants. Data revealed that approximately 80% of patients during previous outbreaks were men, highlighting the critical need to expand vaccination efforts.

Advocacy and Policy Change: The Role of Parent Associations

Recognizing the gap in immunization coverage, Kani Kayo established an association of parents raising children with disabilities caused by Rubella in 2013. This association actively campaigned for broader vaccination access, taking their message directly to the public. Their efforts culminated in the implementation of new measures in 2019, including free antibody tests and Rubella vaccinations for individuals lacking sufficient immunity. These initiatives led to a dramatic reduction in Rubella infections, falling from over 14,000 cases in 2013 to around 10 by 2021.

Continued Vigilance: The Threat of Re-introduction

Despite the WHO’s declaration of elimination, Kani Kayo emphasizes the ongoing importance of vaccination. She warns that Rubella can be re-introduced from overseas, potentially triggering future outbreaks and a resurgence of CRS cases. Her statement, “Reubella has been eliminated for now, but the virus can still be brought in from overseas. If it spreads again, we'll see further outbreaks and more children born with congenital reubella syndrome. That's why I want to keep getting the word out,” underscores the need for sustained public health vigilance.

Global Context and Challenges

NHK World’s Matu Gayasco highlighted the deeply personal nature of the campaign, noting that Kani was inspired by witnessing the experiences of other mothers whose children would have been the same age as her daughter, Taiko, had she survived. He also pointed out the difficult choices faced by pregnant women in Japan upon diagnosis with Rubella – the option of abortion versus risking severe birth defects.

Professor Takashima Yoshihiko of Osaka University, a former leader of the WHO’s program on vaccine-preventable diseases, explained that global efforts to eliminate Rubella have been underway since 2010. However, dozens to hundreds of CRS cases are still reported annually in numerous countries. He specifically noted that the COVID-19 pandemic (2020-2023) caused a decline in routine childhood vaccination coverage, increasing the risk of future outbreaks.

The Importance of Universal Vaccination

Takashima emphasized that while routine vaccination is typically focused on children, adults are often excluded. This creates a vulnerability, as Rubella frequently spreads among adults rather than children. He concluded that extending vaccination coverage to all generations is crucial for protecting future generations worldwide.

Conclusion

Japan’s success in eliminating Rubella is a testament to the power of advocacy, driven by the personal experiences of those affected by the disease. The shift in immunization strategy to include men, coupled with increased access to vaccination and antibody testing, proved instrumental in achieving this milestone. However, maintaining this achievement requires continued vigilance, sustained vaccination efforts, and a global commitment to protecting vulnerable populations from the devastating consequences of Rubella and CRS.