Epidemiology and Infection

The seroepidemiology of rubella in western Europe

R. G. PEBODY a1c1, W. J. EDMUNDS a1, M. CONYN-van SPAENDONCK a2, P. OLIN a3, G. BERBERS a2, I. REBIERE a4, H. LECOEUR a5, P. CROVARI a6, I. DAVIDKIN a7, G. GABUTTI a6a8, E. GERIKE a9, C. GIORDANO a6, L. HESKETH a10, A. M. PLESNER a11, M. RAUX a4, M. C. ROTA a12, S. SALMASO a12, A. TISCHER a9, M. VALLE a7 and E. MILLER a1
a1 PHLS Communicable Disease Surveillance Centre, London, UK
a2 National Institute of Public Health and the Environment, Bilthoven, the Netherlands
a3 Swedish Institute of Infectious Disease Control, Stockholm, Sweden
a4 Institut de Veille Sanitaire, Paris, France
a5 Société Medilog, France
a6 Department of Health Sciences – Hygiene and Preventive Medicine Section, Faculty of Medicine, University of Genoa, Italy
a7 National Public Health Institute, Helsinki, Finland
a8 Laboratory of Hygiene, Department of Biology, Faculty of Science, University of Lecce, Italy
a9 Robert Koch Institute, Berlin, Germany
a10 Preston Public Health Laboratory, Preston, UK
a11 Statens Serum Institut, Copenhagen, Denmark
a12 Instituto Superiore di Sanita, Rome, Italy


Most of the countries in western Europe have now implemented mass infant rubella immunization programmes, instead of or in addition to selective vaccination in order to achieve the elimination of congenital rubella syndrome.

The European countries Denmark, England and Wales, Finland, France, Germany, Italy and the Netherlands undertook large, national serological surveys collecting several thousand serum specimens during 1994–8. Antibodies against rubella virus were detected by a variety of enzyme immuno-assays. Comparability of the assay results was achieved by a standardized methodology. The age- and sex-stratified serological results were related to the schedules, coverage of rubella vaccination and the incidence in these countries.

The results show widely differing levels of immunity to rubella both in the general population and in the specific age groups of males and females. A low rate (< 5%) of susceptibles in childhood and adolescents of both sexes was obtained only in Finland and the Netherlands.

Countries such as Italy with only moderate coverage for the infant immunization programme currently have both high susceptibility levels in the general population and in the at-risk population. The likelihood is of continued epidemics of rubella with cases of congenital rubella syndrome. The continued implementation of selective vaccination will help to offset the impact of this ongoing transmission and to protect women on reaching childbearing age.

(Accepted June 3 2000)

c1 Author for correspondence: Immunisation Division, PHLS Communicable Disease Surveillance Centre, London NW9 5EQ, UK. On behalf of the ESEN project.