Rubella No Longer Major Public Health Threat in the United States

A major public health milestone has been achieved in the United States - the rubella virus, a major cause of serious birth defects such as deafness and blindness, also known as congenital rubella syndrome (CRS), is no longer considered to be a major public health threat in the United States, Dr. Julie Gerberding, director, Centers for Disease Control and Prevention announced at the National Immunization Conference today in Washington, DC.

“The elimination of rubella in the United States is a tremendous step in protecting the health and well being of pregnant women and infants,” said Dr. Gerberding. “A disease that once seriously harmed tens of thousands of infants is no longer a major health threat, thanks to a safe and effective vaccine and successful immunization programs across the country. We should take pride in this accomplishment, and also recognize that we must maintain our vigilance or we can see a resurgence of disease.”

Currently about 93 percent of the nation’s children under age two are vaccinated against measles, mumps and rubella, according to the CDC’s National Immunization Survey. More than 95 percent of the nation’s children are vaccinated against rubella by the time they enter school. “The importance of continuing vaccination cannot be emphasized enough, “said Dr. Steve Cochi, Acting Director, CDC’s National Immunization Program. “Cases of rubella continue to be brought into the country by worldwide travelers and because of bordering countries where the disease is active.”

During 1964 and 1965 a rubella epidemic in the United States caused an estimated 12.5 million cases of rubella and 20,000 cases of congenital rubella syndrome (CRS) which led to more than 11,600 babies born deaf, 11,250 fetal deaths, 2,100 neonatal deaths, 3,580 babies born blind and 1,800 babies born mentally retarded.

Since reporting of rubella began in 1966, the largest number of rubella cases reported was in 1969 with 57,686 cases. Following vaccine licensure in 1969 and development of a rubella vaccination program to prevent rubella infection during pregnancy, rubella incidence fell rapidly. By 1983, fewer than 1,000 cases were reported per year.

In 1989, CDC established a rubella elimination goal despite a resurgence in rubella and measles cases during the measles epidemic from 1989-1991, reported rubella cases in the 1990s declined to all-time low numbers. From 1990 through 1999, only 117 cases of CRS were reported, 66 of these babies were born in 1990 and 1991. In 2001, for the first time in history, less than 100 cases were reported in the United States. In 2003, there were only eight rubella cases and one CRS case reported in the United States. In 2004, there were only nine rubella cases reported in the United States.

Since the mid-1990s, the United States has worked closely with the Pan American Health Organization (PAHO) and Mexico to improve rubella control in the Americas. Those efforts have resulted in dramatic reductions of rubella in many nations of the Americas. In September 2003, ministers of health of all countries in the Americas resolved to eliminate rubella and CRS by 2010.

Last fall, an independent panel including internationally recognized immunization experts from academia, the Council for State and Territorial Epidemiologists (CSTE), the Advisory Committee on Immunization Practices (ACIP), the American Academy of Pediatrics (AAP), the American Academy of Family Physicians (AAFP), the Pan American Health Organization (PAHO), Mexico and the CDC concluded that rubella virus in no longer endemic in the United States.

Rubella is prevented through vaccination. Rubella vaccine is recommended for all children and for adolescents and adults without documented evidence of immunity. It is especially important to verify that all women of child-bearing age are immune to rubella before they get pregnant.

Although it is available as a single preparation, it is recommended that rubella vaccine be given as MMR vaccine (protecting against measles, mumps and rubella). The first dose of MMR should be given on or after the first birthday; the recommended range is from 12-15 months. The second dose is usually given when the child is 4-6 years old, or before he or she enters kindergarten or first grade. Maintaining high coverage and rubella population immunity in the United States among children and adults will be important to maintain the benefits of achieving rubella elimination.