Rubella Virus Genotypes in the People's Republic of China between 1979 and 2007: a Shift in Endemic Viruses during the 2001 Rubella Epidemic

Abstract

The incidence of rubella cases in China from 1991 to 2007 was reviewed, and the nucleotide sequences from 123 rubella viruses collected during 1999 to 2007 and 4 viral sequences previously reported from 1979 to 1984 were phylogenetically analyzed. Rubella vaccination was not included in national immunization programs in China before 2007. Changes in endemic viruses were compared with incidences of rubella epidemics. The results showed that rubella epidemics occur approximately every 6 to 8 years (1993/1994, 2001, and 2007), and a shift of disease burden to susceptible young adults was observed. The Chinese rubella virus sequences were categorized into 5 of the 13 rubella virus genotypes, 1a, 1E, 1F, 2A, and 2B; cocirculations of these different genotypes were found in China. In Anhui province, a shift in the predominant genotype from 1F and 2B to 1E coincided with the 2001 rubella epidemic. This shift may have occurred throughout China during 2001 to 2007. This study investigated the genotype distribution of rubella viruses in China over a 28-year period to establish an important genetic baseline in China during its prevaccination era.

Could the United States experience rubella outbreaks as a result of vaccine refusal and disease importation?

“…Of the cases for whom vaccination history was available, 10% had received one dose of MMR vaccine and none had received two doses. Since the year 2000, rubella outbreaks have occurred among undervaccinated populations in several countries, including Brazil, 66 China, 67 India 68 and Spain. …”

Analysis of complete genomes of the rubella virus genotypes 1E and 2B which circulated in China, 2000–2013

“…Whole genome sequences of four genotype 1E and seven genotype 2B viruses were previously determined611. In China, the previously endemic RV genotypes were likely 2A and 1F (before 2002) but both were replaced by genotype 1E12. Although genotype 1E is currently detected most frequently, an increasing number of genotype 2B viruses are now detected.…”

“…Although genotype 1E is currently detected most frequently, an increasing number of genotype 2B viruses are now detected. Some of the genotype 2B viruses are believed to be imported, while others are likely due to endemic transmission121314. Analysis based on 739-nt sequences, showed that viruses of genotype 1E from China were genetically distinct from viruses collected elsewhere and could be divided into two distinct clusters, Cluster A (1E-A) and Cluster B (1E-B)13.…”

Emergence and Continuous Evolution of Genotype 1E Rubella Viruses in China

“…The results of molecular epidemiology studies of rubella viruses in China indicate that 5 (1a, 1E, 1F, 2A, and 2B) out of the 13 genotypes have been present in China since 1979, and cocirculation of these different genotypes has been observed (34). Before the introduction of the rubella vaccine into the national immunization program in 2008, rubella epidemics were common.…”

“…According to the rubella surveillance data, rubella epidemics occurred approximately every 6 to 8 years in China. A shift in the predominant genotype from 1F and 2B to 1E coincided with the 2001 rubella epidemic, and 1E subsequently became the most common genotype (34).…”