The Singapore Ministry of Health reported Friday that the World Health Organization (WHO) has recognized the city-state for meeting all its criteria for rubella elimination. This was made possible because of our robust national immunization program, established system of disease surveillance, and swift contact tracing and public health response to cases.
Rubella elimination is an indication that disease spread is low and well controlled. Singapore has met all elimination criteria set by WHO. These are:
i. Documented interruption of endemic rubella virus transmission for a period of at least 36 months from the last endemic case;
ii. Presence of verifiable, high quality surveillance; and
iii. Genotyping evidence that supports interrupted transmission.
Immunization continues to be the best way to protect children from vaccine-preventable disease like rubella. Singapore has put in place a robust system to ensure high vaccination coverage in children.
Under the National Childhood Immunization Schedule (NCIS), young children receive two doses of rubella vaccine available in the form of measles, mumps and rubella (MMR) vaccine, at 12 months old and 15 months old respectively. Vaccinations in the NCIS are available free to all Singaporean children at Community Health Assist Scheme (CHAS) General Practitioner (GP) clinics and polyclinics.
MMR vaccination coverage is closely monitored and measures are in place to encourage uptake at various touch points. This has resulted in high vaccination coverage in children aged two years and older, contributing to a high level of immunity against rubella in the community. As such, Singapore’s rubella incidence rate has remained stable at less than 2 per 100,000 population over the last 10 years (2012 to 2022).
The Ministry of Health (MOH) has also set up a system of surveillance and response actions for doctors to report rubella cases promptly to control disease spread. Rubella is a legally notifiable disease in Singapore. Doctors are required to notify a suspect case upon clinical diagnosis and all notified cases of rubella are investigated by MOH in a timely manner. The contacts are also followed up on their health, and advised to seek medical treatment if unwell, and to get their MMR vaccination if they have not done so.
As pregnant women who are not immune to rubella are at risk of severe complications such as miscarriage, stillbirth or birth defects in fetus (known as congenital rubella syndrome) if infected, they will be monitored for their birth outcome, and babies born to women infected with rubella during pregnancy are evaluated for infection and congenital rubella syndrome.
Even with these measures, we can continue to expect to have sporadic cases and small family clusters of rubella because the disease is highly transmissible among unvaccinated individuals. Adults who have not been vaccinated previously or do not have documented immunity against rubella are also recommended to receive MMR vaccination under the National Adult Immunization Schedule.
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