Measles and rubella

Measles is a highly contagious viral disease. It remains an important cause of death among young children globally, despite the availability of a safe and effective vaccine.

Rubella is a contagious viral infection that occurs most often in children and young adults. The virus is the leading vaccine-preventable cause of birth defects. Rubella infection in pregnant women may cause fetal death or congenital defects known as congenital rubella syndrome.

Over the past decade, measles and rubella cases have decreased dramatically in the Region, as millions of babies and young children have been reached with measles- and rubella-containing vaccines. However, outbreaks have occurred among children and adults in several countries, and children have missed routine immunizations due to health service disruptions and postponements of immunization campaigns during the pandemic.

In 2017, the Regional Committee endorsed the new Regional Strategy and Plan of Action for Measles and Rubella Elimination in the Western Pacific, and urged Member States to eliminate rubella as soon as possible, and for each Member State to set individual target dates for rubella elimination. Eight countries and areas measles-free and seven have stopped transmission of rubella.

Measles cases have gone up by 32% in the Western Pacific from 2021 to 2022 due to decreases in measles vaccinations during the COVID-19 pandemic.

Measles is transmitted via droplets from the nose, mouth or throat of infected persons. Initial symptoms, which usually appear 10–12 days after infection, include high fever, a runny nose, bloodshot eyes, and tiny white spots on the inside of the mouth. Several days later, a rash develops, starting on the face and upper neck and gradually spreading downwards. The most serious complications include blindness, encephalitis (an infection that causes brain swelling), severe diarrhoea and related dehydration, and severe respiratory infections such as pneumonia.

Rubella is transmitted by airborne droplets when infected people sneeze or cough. In children, initial symptoms include rash, low fever (<39°C), nausea and mild conjunctivitis. The rash, which occurs in 50–80% of cases, usually starts on the face and neck before progressing down the body, and lasts 1–3 days. Swollen lymph glands behind the ears and in the neck are the most characteristic clinical feature. Infected adults, more commonly women, may develop arthritis and painful joints that usually last from 3–10 days. Once a person is infected, the rubella virus spreads throughout the body in about 5-7 days. Symptoms usually appear 2 to 3 weeks after exposure. The most infectious period is usually 1–5 days after the appearance of the rash.

When a woman is infected with the rubella virus early in pregnancy, she has a 90% chance of passing the virus on to her fetus. This can cause the death of the fetus, or it may cause congenital rubella syndrome. Infants with congenital rubella syndrome may excrete the virus for a year or more.

There is no specific antiviral treatment for measles or rubella, but the diseases are preventable by vaccination

Measles and rubella can be prevented through safe, effective and inexpensive vaccines. Rubella vaccines are available either in monovalent formulation (a vaccine directed at only one pathogen) or more commonly in combinations with other vaccines such as with vaccines against measles (MR), measles and mumps (MMR), or measles, mumps and varicella (MMRV).

Reaching all children with 2 doses of measles vaccine, either alone, or in a measles-rubella (MR), measles-mumps-rubella (MMR), or measles-mumps-rubella-varicella (MMRV) combination, should be the standard for all national immunization programmes. 

Routine measles and rubella vaccination for children, combined with mass immunization campaigns in countries with low routine coverage, are key public health strategies to eliminate measles and rubella.