1 www.eurosurveillance.org Surveillance and outbreak reports Congenital rubella still a public health problem in Italy: analysis of national surveillance data from 2005 to 2013 C Giambi (cristina.giambi@iss.it) 1 , A Filia 1 , M C Rota 1 , M Del Manso 1 , S Declich 1 , G Nacca 1 , E Rizzuto 2 , A Bella 1 , regional contact points for rubella 3 1. Communicable Disease Epidemiology Unit, National Centre for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Rome, Italy 2. Communicable Diseases Unit, Directorate General of Health Prevention, Ministry of Health, Rome, Italy 3. The contact points are listed at the end of the article. Citation style for this article: Giambi C, Filia A, Rota MC, Del Manso M, Declich S, Nacca G, Rizzuto E, Bella A, regional contact points for rubella. Congenital rubella still a public health problem in Italy: analysis of national surveillance data from 2005 to 2013. Euro Surveill. 2015;20(16):pii=21103. Available online: http://www.eurosurveillance.org/ ViewArticle.aspx?ArticleId=21103 Article submitted on 17 November 2014 / published on 23 April 2015 In accordance with the goal of the World Health Organization Regional Office for Europe, the Italian national measles and rubella elimination plan aims to reduce the incidence of congenital rubella cases to less than one case per 100,000 live births by the end of 2015. We report national surveillance data for congenital rubella and rubella in pregnancy from 2005 to 2013. A total of 75 congenital rubella infections were reported; the national annual mean incidence was 1.5/100,000 live births, including probable and confirmed cases according to European Union case definition. Two peaks occurred in 2008 and 2012 (5.0 and 3.6/100,000 respectively). Overall, 160 rubella infections in pregnancy were reported; 69/148 women were multiparous and 38/126 had had a rubella anti- body test before pregnancy. Among reported cases, there were 62 infected newborns, 31 voluntary abor- tions, one stillbirth and one spontaneous abortion. A total of 24 newborns were unclassified and 14 women were lost to follow-up, so underestimation is likely. To improve follow-up of cases, systematic procedures for monitoring infected mothers and children were intro- duced in 2013. To prevent congenital rubella, antibody screening before pregnancy and vaccination of suscep- tible women, including post-partum and post-abortum vaccination, should be promoted. Population cover- age of two doses of measles-mumps-rubella vaccina- tion of ≥ 95% should be maintained and knowledge of health professionals improved. Introduction Rubella is an acute contagious viral illness; if contracted early in pregnancy, it can spread from the mother to her developing baby and result in miscarriage, still- birth or severe birth defects including deafness, blind- ness, cataracts, heart defects and mental retardation (congenital rubella). The risk of fetal malformation var- ies according to the time of onset of maternal infection and is estimated to be 90% for infants born to women infected within the first 10 weeks of pregnancy [1]. Rubella infection can be prevented by a safe and effec- tive vaccine and the main aim of rubella control pro- grammes is to prevent infection in pregnant women. In accordance with the objectives of the World Health Organization (WHO) Regional Office for Europe [2], the Italian national measles and rubella elimination plan aims to eliminate rubella (incidence to less than one case per 1,000,000 live births) and reduce the inci- dence of congenital rubella cases to less than one case per 100,000 live births by the end of 2015 [3]. Congenital rubella prevention relies on maintaining high levels of immunity (≥ 95%) in the general popu- lation and on identifying and immunising suscepti- ble women of childbearing age. This strategy allowed the elimination of rubella in the WHO Region of the Americas, where the last confirmed cases of endemic rubella and congenital rubella syndrome (CRS) were reported in 2009 [4]. In Italy, a monovalent rubella vaccine was first avail- able in 1972; vaccination was initially recommended only for adolescent females. The monovalent vaccine was replaced in the early 1990s by the combined mea- sles-mumps-rubella (MMR) vaccine and in 1999 uni- versal vaccination with one dose of MMR vaccine was included in the national immunisation programme. In 2003, when Italy approved the first national measles and congenital rubella elimination plan, a two-dose schedule was adopted in all regions. Currently, a first dose of MMR vaccine is recommended at the age of 12 to 15 months and a second dose at 5 to 6 years of age. MMR vaccination is also offered free of charge to all susceptible adolescents and adults [5]. Uptake of one dose of MMR vaccine remained below 80% until 2002; uptake increased after implementa- tion of the first national elimination plan (2003–07) and national vaccination coverage assessed in children at 24 months of age was 88% in 2013 [6]. Immunisation coverage of adolescents and adults is not routinely