Rubella immunization strategies in Canada

Rubella vaccine was introduced in Canada in 1969. Immunization practices and vaccine coverage varied from province to province. In the 1970s the Canadian National Advisory Committee on Immunization endorsed both the policy of mass vaccination--in combination with measles and mumps vaccines--for infants, which seven provinces followed, and that of selective immunization of prepubertal girls, which three provinces followed. In 1982, the Committee advocated a comprehensive policy that incorporated the best features of the two policies and also increased the emphasis on immunization of susceptible adolescent and adult women. As of 1983, in all provinces the vaccine has been routinely administered to infants 12-15 months old; in seven, also to prepubertal girls. After the introduction of rubella vaccine, rubella incidence declined markedly, but the endemic level of rubella incidence remained unchanged. Congenital rubella syndrome (CRS) was added to the federal list of notifiable diseases only in 1979. Sixty-seven CRS cases were reported by five provinces from 1979 to 1983, during which a trend of declining CRS incidence rates (per 100,000 live births) was indicated. However, the numbers of cases are too small to draw definite conclusions regarding the impact of immunization programs.