Rubella elimination, the Canadian experience

Surveillance and outbreak data were reviewed to demonstrate interruption and elimination of indigenous rubella virus transmission in Canada. Rubella elimination was defined as (1) the interruption of endemic transmission and (2) failure to reestablish endemic transmission within 12 months following importation. Data indicate that indigenous transmission of rubella has been interrupted following effective immunization strategies and sustained high vaccine coverage. However, a 2005 outbreak of rubella, following importation into a community that opposes immunization, demonstrates that multiple chains of transmission can be reestablished where pockets of low vaccine coverage exist. While there has been no evidence of indigenous circulation of rubella viruses since the 2005 outbreak, population groups with low vaccine coverage remain at risk following disease importation. Awareness and targeted response strategies for these populations, particularly in response to risks for importation, are important to ensure rapid detection, reporting, and effective interruption of transmission.