Abstract
BACKGROUND: Since rubella was incorporated into the national disease surveillance system in 2004, rubella incidence has changed dramatically. This study analyzed the impact of immunization strategies on the age-specific and sex-specific incidence of rubella in China from 2004 to 2023 to inform efforts to accelerate rubella elimination. METHODS: Annual rubella-containing vaccine (RCV) coverage levels, reported rubella cases and incidence, and vaccination status of cases were obtained from the National Immunization Program Information Management System, the National Notifiable Diseases Reporting System, and the Measles Surveillance System, and used to describe temporal trends. Incidence trends and annual percent changes (APC) by age group and sex were estimated using joinpoint regression. RESULTS: In 2008, RCV coverage was 51.5% for the first dose and 39.0% for the second dose, increasing to and stabilizing at 95% or above for both doses by 2012. There were 584,758 cases of rubella reported in China during 2004-2023. Joinpoint regression showed that rubella incidence initially increased, peaked in 2008, and then decreased (APC(2004-2008)=47.12%, APC(2008-2023)=-18.95%, P<0.05). Adolescents, aged 10-19 years, accounted for 67.8% of cases at a peak incidence in 2019 (APC(2016-2019)=103.70%, APC(2016-2019)=-89.76%, P<0.05); 77.8% of cases had no or unknown RCV history. CONCLUSIONS: The decrease in rubella incidence is closely associated with vaccination. Nationwide inclusion of RCV significantly impacted on the prevention and control of rubella. Targeted measures to address immunization gaps and maintain high surveillance sensitivity are necessary to promote rubella elimination.