{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T05:08:06Z","timestamp":1784696886790,"version":"3.55.0"},"reference-count":40,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2022,7,27]],"date-time":"2022-07-27T00:00:00Z","timestamp":1658880000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"World Health Organization (WHO)"},{"name":"Catholic University of Health and Allied Sciences (CUHAS)"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Vaccines"],"abstract":"<jats:p>Rubella virus (RV) infection in susceptible women during the first trimester of pregnancy is associated with congenital Rubella syndrome (CRS). In countries where a vaccination program is implemented, active case surveillance is emphasized. This report documents the magnitude of active cases before and after vaccine implementation in Tanzania. A total of 8750 children and adolescents with signs and symptoms of RV infection were tested for Rubella IgM antibodies between 2013 and 2019 using enzyme immunoassay followed by descriptive analysis. The median age of participants was 3.8 (IQR: 2\u20136.4) years. About half (4867; 55.6%) of the participants were aged 1\u20135 years. The prevalence of RV active cases was 534 (32.6%, 95% CI: 30.2\u201334.9) and 219 (3.2%, 95% CI: 2.7\u20133.6) before and after vaccine implementation, respectively. Before vaccination, the highest prevalence was recorded in Pemba (78.6%) and the lowest was reported in Geita (15.6%), whereas, after vaccination, the prevalence ranged between 0.5% in Iringa and 6.5% in Pemba. Overall, &gt;50% of the regions had a &gt;90% reduction in active cases. The significant reduction in active cases after vaccine implementation in Tanzania underscores the need to sustain high vaccination coverage to prevent active infections and eventually eliminate CRS, which is the main goal of Rubella vaccine implementation.<\/jats:p>","DOI":"10.3390\/vaccines10081188","type":"journal-article","created":{"date-parts":[[2022,7,29]],"date-time":"2022-07-29T01:41:16Z","timestamp":1659058876000},"page":"1188","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Reduction in Rubella Virus Active Cases among Children and Adolescents after Rubella Vaccine Implementation in Tanzania: A Call for Sustained High Vaccination Coverage"],"prefix":"10.3390","volume":"10","author":[{"given":"Fausta","family":"Michael","sequence":"first","affiliation":[{"name":"Ministry of Health, Immunization and Vaccine Development Program, Dodoma P.O. Box 743, Tanzania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariam M.","family":"Mirambo","sequence":"additional","affiliation":[{"name":"Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza P.O. Box 1464, Tanzania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dafrossa","family":"Lyimo","sequence":"additional","affiliation":[{"name":"Ministry of Health, Immunization and Vaccine Development Program, Dodoma P.O. Box 743, Tanzania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Furaha","family":"Kyesi","sequence":"additional","affiliation":[{"name":"Ministry of Health, Immunization and Vaccine Development Program, Dodoma P.O. Box 743, Tanzania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3472-9620","authenticated-orcid":false,"given":"Delfina R.","family":"Msanga","sequence":"additional","affiliation":[{"name":"Department of Pediatrics and Child Health, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza P.O. Box 1464, Tanzania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georgina","family":"Joachim","sequence":"additional","affiliation":[{"name":"Ministry of Health, Immunization and Vaccine Development Program, Dodoma P.O. Box 743, Tanzania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Honest","family":"Nyaki","sequence":"additional","affiliation":[{"name":"Ministry of Health, Immunization and Vaccine Development Program, Dodoma P.O. Box 743, Tanzania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Magodi","sequence":"additional","affiliation":[{"name":"Ministry of Health, Immunization and Vaccine Development Program, Dodoma P.O. Box 743, Tanzania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Delphius","family":"Mujuni","sequence":"additional","affiliation":[{"name":"Ministry of Health, Immunization and Vaccine Development Program, Dodoma P.O. Box 743, Tanzania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florian","family":"Tinuga","sequence":"additional","affiliation":[{"name":"Ministry of Health, Immunization and Vaccine Development Program, Dodoma P.O. Box 743, Tanzania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ngwegwe","family":"Bulula","sequence":"additional","affiliation":[{"name":"Ministry of Health, Immunization and Vaccine Development Program, Dodoma P.O. Box 743, Tanzania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bonaventura","family":"Nestory","sequence":"additional","affiliation":[{"name":"Ministry of Health, Immunization and Vaccine Development Program, Dodoma P.O. Box 743, Tanzania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dhamira","family":"Mongi","sequence":"additional","affiliation":[{"name":"Ministry of Health, Immunization and Vaccine Development Program, Dodoma P.O. Box 743, Tanzania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed","family":"Makuwani","sequence":"additional","affiliation":[{"name":"Ministry of Health, Immunization and Vaccine Development Program, Dodoma P.O. Box 743, Tanzania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Betina","family":"Katembo","sequence":"additional","affiliation":[{"name":"National Public Health Laboratory, Dar es Salaam P.O. Box 9083, Tanzania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William","family":"Mwengee","sequence":"additional","affiliation":[{"name":"World Health Organization, Country Office, Dar es Salaam P.O. Box 9292, Tanzania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alex","family":"Mphuru","sequence":"additional","affiliation":[{"name":"United Nations Children\u2019s Fund (UNICEF), Country Office, Dar es Salaam P.O. Box 4076, Tanzania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5813-4579","authenticated-orcid":false,"given":"Nassor","family":"Mohamed","sequence":"additional","affiliation":[{"name":"Immunization Center, John Snow Inc. (JSI), 2733 Crystal Dr 4th Floor, Arlington, VA 22202, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Kayabu","sequence":"additional","affiliation":[{"name":"Management and Development for Health (MDH), Dar es Salaam P.O Box 79810, Tanzania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helmut","family":"Nyawale","sequence":"additional","affiliation":[{"name":"Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza P.O. Box 1464, Tanzania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eveline T.","family":"Konje","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics, School of Public Health, Catholic University of Health and Allied Sciences, Mwanza P.O. Box 1464, Tanzania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7526-6271","authenticated-orcid":false,"given":"Stephen E.","family":"Mshana","sequence":"additional","affiliation":[{"name":"Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza P.O. Box 1464, Tanzania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,7,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1016\/j.jviromet.2005.06.003","article-title":"Assessment of IgM enzyme immunoassay and IgG avidity assay for distinguishing between primary and secondary immune response to rubella vaccine","volume":"130","author":"Hamkar","year":"2005","journal-title":"J. Virol. Methods"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/1743-422X-8-244","article-title":"Sero-survey of rubella IgM antibodies among children in Jos, Nigeria","volume":"8","author":"Junaid","year":"2011","journal-title":"Virol. J."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1890","DOI":"10.1086\/497607","article-title":"Reducing the global burden of congenital rubella syndrome: Report of the World Health Organization Steering Committee on Research Related to Measles and Rubella Vaccines and Vaccination, June 2004","volume":"192","author":"Best","year":"2005","journal-title":"J. Infect. Dis."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"3","DOI":"10.4103\/2008-7802.198914","article-title":"Rubella seromarkers and determinants of infection among tanzanian children and adolescents in prevaccination Era: Are we in the right track?","volume":"8","author":"Mirambo","year":"2017","journal-title":"Int. J. Prevent. Med."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Mirambo, M.M., Majigo, M., Scana, S.D., Mushi, M.F., Aboud, S., Gro\u00df, U., Kidenya, B.R., and Mshana, S.E. (2018). Rubella natural immunity among adolescent girls in Tanzania: The need to vaccinate child bearing aged women. BMC Women\u2019s Health, 18.","DOI":"10.1186\/s12905-017-0505-9"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Kombich, J.J., Muchai, P.C., Tukei, P., and Borus, P.K. (2009). Rubella seroprevalence among primary and pre-primary school pupils at Moi\u2019s Bridge location, Uasin Gishu District, Kenya. BMC Public Health, 9.","DOI":"10.1186\/1471-2458-9-269"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1016\/j.ijid.2018.10.020","article-title":"Adverse pregnancy outcomes among pregnant women with acute Rubella infections in Mwanza city, Tanzania","volume":"78","author":"Mirambo","year":"2019","journal-title":"Int. J. Infect. Dis."},{"key":"ref_8","unstructured":"WHO (2011). Position paper on rubella vaccines. Weekly Epidemiological Record, WHO. Available online: https:\/\/www.who.int\/publications\/i\/item\/WER8629."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s13052-016-0264-5","article-title":"Serological evidence of acute rubella infection among under-fives in Mwanza: A threat to increasing rates of congenital rubella syndrome in Tanzania","volume":"42","author":"Mirambo","year":"2016","journal-title":"Italian J. Pediatr."},{"key":"ref_10","unstructured":"Gershon, A.A., Hotez, P.J., and Katz, S. (2004). Infectious Diseases of Children, Mosby. [11th ed.]."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1016\/S0168-7069(06)15005-3","article-title":"Rubella epidemiology: Surveillance to monitor and evaluate congenital rubella prevention strategies","volume":"15","author":"Peckham","year":"2006","journal-title":"Rubella Viruses"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1017\/S0950268800048627","article-title":"Congenital cataract following German measles in the mother, 1941","volume":"107","author":"Gregg","year":"1991","journal-title":"Epidemiol. Infect."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"321","DOI":"10.3109\/inf.1983.15.issue-4.01","article-title":"Outcome of rubella during pregnancy with special reference to the 17th\u201324th weeks of gestation","volume":"15","author":"Grillner","year":"1983","journal-title":"Scand. J. Infect. Dis."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Horstmann, D.M. (1976). Rubella. Viral Infections of Humans, Springer.","DOI":"10.1007\/978-1-4613-3988-5_19"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1734","DOI":"10.1128\/CVI.00332-10","article-title":"Multiplex detection of IgM and IgG class antibodies to Toxoplasma gondii, rubella virus, and cytomegalovirus using a novel multiplex flow immunoassay","volume":"17","author":"Binnicker","year":"2010","journal-title":"Clin. Vaccine Immunol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1159\/000024931","article-title":"Rubella virus genome diagnosis during pregnancy and mechanism of congenital rubella","volume":"41","author":"Katow","year":"1999","journal-title":"Intervirology"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"450","DOI":"10.1007\/s12098-009-0312-x","article-title":"Antenatal diagnostic problem of congenital rubella","volume":"77","author":"Shah","year":"2010","journal-title":"Ind. J. Pediatrics"},{"key":"ref_18","first-page":"451","article-title":"Prevalence of rubella and cytomegalovirus antibodies among pregnant women in northern Turkey","volume":"31","author":"Uyar","year":"2008","journal-title":"New Microbiol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"810","DOI":"10.1016\/S1995-7645(12)60148-5","article-title":"Seroprevalence of toxoplasmosis and rubella in pregnant women attending antenatal private clinic at Ouagadougou, Burkina Faso","volume":"5","author":"Linguissi","year":"2012","journal-title":"Asian Pac. J. Trop. Med."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Mwambe, B., Mirambo, M.M., Mshana, S.E., Massinde, A.N., Kidenya, B.R., Michael, D., Morona, D., Majinge, C., and Gro\u00df, U. (2014). Sero-positivity rate of rubella and associated factors among pregnant women attending antenatal care in Mwanza, Tanzania. BMC Preg. Childbirth, 14.","DOI":"10.1186\/1471-2393-14-95"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"140","DOI":"10.4103\/1119-3077.84002","article-title":"Seroprevalence survey of rubella infection in pregnancy at the University of Benin Teaching Hospital, Benin City, Nigeria","volume":"14","author":"Onakewhor","year":"2011","journal-title":"Niger. J. Clin. Pract."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Mirambo, M.M., Majigo, M., Aboud, S., Gro\u00df, U., and Mshana, S.E. (2015). Serological makers of rubella infection in Africa in the pre vaccination era: A systematic review. BMC Res. Notes, 8.","DOI":"10.1186\/s13104-015-1711-x"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"530","DOI":"10.1093\/eurpub\/ckw259","article-title":"Global seroprevalence of rubella among pregnant and childbearing age women: A meta-analysis","volume":"27","author":"Pandolfi","year":"2017","journal-title":"Eur. J. Public Health"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"9141","DOI":"10.1016\/j.vaccine.2011.09.104","article-title":"Rubella revisited: Where are we on the road to disease elimination in Central Europe?","volume":"29","author":"Usonis","year":"2011","journal-title":"Vaccine"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"49","DOI":"10.24248\/easci.v1i1.13","article-title":"Congenital Zika Virus Infection Paradigm: What is in the Wardrobe? A Narrative Review","volume":"1","author":"Mirambo","year":"2019","journal-title":"East Afr. Sci."},{"key":"ref_26","first-page":"373","article-title":"Clinical presentations of parvovirus B19 infection","volume":"75","author":"Servey","year":"2007","journal-title":"Am. Fam. Phys."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Babigumira, J.B., Morgan, I., and Levin, A. (2013). Health economics of rubella: A systematic review to assess the value of rubella vaccination. BMC Public Health, 13.","DOI":"10.1186\/1471-2458-13-406"},{"key":"ref_28","first-page":"306","article-title":"Rubella vaccines: WHO position paper\u2013July 2020\u2013Note de synth\u00e8se: Position de l\u2019OMS concernant les vaccins antirub\u00e9oleux","volume":"Volume 95","year":"2020","journal-title":"Weekly Epidemiological Record=Relev\u00e9 \u00c9pid\u00e9miologique Hebdomadaire"},{"key":"ref_29","unstructured":"MCSP (2019). Maternal and Child survival Program. Immunization MCSP Tanzania Program, MCSP. USAID."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"145","DOI":"10.29245\/2578-3009\/2018\/si.1122","article-title":"Congenital rubella syndrome in the African region\u2014Data from sentinel surveillance","volume":"2","author":"Masresha","year":"2018","journal-title":"J. Immunol. Sci."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"559","DOI":"10.1111\/j.1365-3156.2006.01577.x","article-title":"Antenatal rubella serosurvey in Maputo, Mozambique","volume":"11","author":"Barreto","year":"2006","journal-title":"Trop. Med. Int. Health"},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Tahita, M.C., H\u00fcbschen, J.M., Tarnagda, Z., Ernest, D., Charpentier, E., Kremer, J.R., Muller, C.P., and Ouedraogo, J.B. (2013). Rubella seroprevalence among pregnant women in Burkina Faso. BMC Infect. Dis., 13.","DOI":"10.1186\/1471-2334-13-164"},{"key":"ref_33","unstructured":"Sasita, S., Urio, S., Mohamed, S., Mghamba, J., and Mmbuji, P. (2022, June 22). Rubella Outbreak in Tanga City, Tanzania. Available online: http:\/\/repository.eac.int\/bitstream\/handle\/11671\/584\/EAIDSNet%20Bulletin%20June-Sept%20Issue%202011.pdf?sequence=1."},{"key":"ref_34","unstructured":"Kadigi, D.M. (2008). A Measles and Rubella Laboratory Based Surveillance Report in Tanzania. [Master\u2019s Thesis, Muhimbili University of Health and Allied Sciences]."},{"key":"ref_35","unstructured":"WHO (2017). Surveillance Guide for Vaccine-Preventable Diseases in the WHO South-East Asia Region, WHO. Available online: https:\/\/apps.who.int\/iris\/handle\/10665\/277459."},{"key":"ref_36","unstructured":"WHO (2015). African Regional Guidelines for Measles and Rubella Surveillance, WHO. Available online: https:\/\/www.afro.who.int\/sites\/default\/files\/2017-06\/who-african-regional-measles-and-rubella-surveillance-guidelines_updated-draft-version-april-2015_1.pdf."},{"key":"ref_37","unstructured":"WHO (2020). Annual Status Update on Measles and Rubella Elimination 2018, WHO."},{"key":"ref_38","unstructured":"UHSA (2021). Laboratory Confirmed Cases of Measles, Rubella And Mumps, Agency UHS."},{"key":"ref_39","unstructured":"WHO\/UNICEF (2021). United Republic of Tanzania, Measles Vaccination Coverage, WHO\/UNICEF."},{"key":"ref_40","unstructured":"Mirambo, M.M., Hokororo, A., Mrutu, N.B., Majigo, M., Aboud, S., Gro\u03b2, U., and Mshana, S.E. (2016). Strategic immunization to control rubella and congenital rubella syndrome in Tanzania. Policy Brief, Catholic University of Health and Allied Sciences. Available online: https:\/\/www.bugando.ac.tz\/schools\/microbiology\/assets\/document\/MIRAMBO_RUBELLA_PB_2016.pdf."}],"container-title":["Vaccines"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-393X\/10\/8\/1188\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T23:57:10Z","timestamp":1760140630000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-393X\/10\/8\/1188"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,7,27]]},"references-count":40,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2022,8]]}},"alternative-id":["vaccines10081188"],"URL":"https:\/\/doi.org\/10.3390\/vaccines10081188","relation":{},"ISSN":["2076-393X"],"issn-type":[{"value":"2076-393X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,7,27]]}}}