Selective immunization: protection of the individual.

Area of Science:

• Public Health
• Immunology
• Epidemiology

Background:

• Concerns regarding the duration of vaccine-induced immunity led the UK to adopt selective immunization strategies.
• Selective immunization, proven effective with bacille Calmette-Guérin (BCG) vaccine, provided a practical framework for rubella vaccination programs.

Purpose of the Study:

• To evaluate the effectiveness and evolution of selective rubella immunization in the United Kingdom.
• To understand the impact of selective immunization on rubella incidence and congenital rubella cases.
• To identify factors influencing vaccination acceptance rates and program sustainability.

Main Methods:

• Implementation of a selective immunization program targeting specific age groups and at-risk populations.
• Monitoring of rubella vaccination acceptance rates over time.
• Tracking of congenital rubella cases and pregnancy terminations related to rubella.

Main Results:

• The rubella vaccination program initially targeted girls aged 11-14 years and was extended over 14 years to include susceptible women and other at-risk individuals.
• Vaccination acceptance rates for girls aged 10-14 years significantly increased from 35% in 1972 to 85% in 1982.
• Congenital rubella cases continue to occur, though incidence shows signs of decline. The rate of terminations of pregnancy due to rubella remains high.
• Low measles vaccination rates influenced the decision to maintain the existing selective rubella vaccination scheme over alternative universal preschool vaccination strategies.

Conclusions:

• Selective rubella immunization in the UK has shown increased acceptance but has not eradicated congenital rubella, necessitating ongoing efforts.
• The persistence of rubella cases and high termination rates underscore the need for continued public health interventions.
• A new initiative involving charitable institutions and health authorities aims to further promote rubella vaccination coverage.