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, Julie Gerberding, MD, MPH, director of the Centers for Disease Control and Prevention (CDC) announced at the National Immunization Conference today in Washington, D.C.
"The elimination of rubella in the
Currently about 93 percent of the nation's children under age 2 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 of the 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
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, the 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
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 to 15 months. The
second dose is usually given when the child is 4 to 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