Rubella virus is no longer a major public health threat in this country, but U.S. clinicians should remain vigilant in their vaccination efforts, according to Julie Gerberding, M.D., director of the Centers for Disease Control and Prevention.
In 2004, only nine cases of rubella were reported in the United States. These cases were in mothers who became infected in their respective countries of origin and who then brought the virus to the United States, and in children who were born to families from other parts of the world, Dr. Gerberding said during a media advisory on rubella sponsored by the Centers for Disease Control and Prevention.
“This is a major milestone in the path toward eliminating rubella in other parts of the world, including the Western hemisphere and other regions that have committed [to] this very important health goal,” she said.
Despite the achievement, Dr. Gerberding advised clinicians in the United States and elsewhere to remain vigilant about vaccinating children. “Because we are at constant risk for reintroduction of the virus from other parts of the world, we cannot afford to relax our emphasis on immunization now,” she remarked.
“This is exactly the time when we need to strengthen our emphasis on immunization even further,” Dr. Gerberding added.
Vaccination is also recommended for adolescents and adults without documented evidence of immunity—especially expectant mothers.
Thirty years ago, a rubella epidemic in the United States caused an estimated 12.5 million cases of rubella and 20,000 cases of congenital rubella syndrome, which caused thousands of fetal deaths and left scores more babies deaf, blind, and mentally challenged.
The incidence of rubella in the United States declined sharply after the rubella vaccine was licensed in 1969. By 1983, fewer than 1,000 cases were reported per year, and 2001 marked the first year in which fewer than 100 cases were reported.
Dr. Gerberding credited the current success to “the wonderful people in the immunization communities across the United States who have been working hard to vaccinate children.”
She added that “there is amazing progress under way in other parts of the Western hemisphere, but there are still parts of the world where immunization is not common enough to prevent children from developing congenital rubella syndrome.”
Even though rubella vaccine is available as a single preparation, the CDC recommends that it be given as an MMR vaccine.
The first dose should be given on or after the first birthday, and the second dose should be given between the ages of 4 and 6 years, or when the child starts kindergarten or first grade.
In 2003, the ministers of health of all countries in the Americas resolved to eliminate rubella and congenital rubella syndrome by 2010. Mirta Roses Periago, M.D., who directs the Pan American Health Organization, reported that there were about 1,600 cases of rubella in the Americas in 2004.
“Most of the countries in the region have incorporated the [MMR] vaccine, but many others are catching up in terms of deciding to immunize the population,” Dr. Periago said during the media advisory. “The success is also opening the possibility for improving the access to other populations for influenza, for the [human] papillomavirus vaccine, and the HIV-AIDS vaccine.”
Despite the claims of studies published in the late 1990s that suggest an association between MMR and the development of autism and other developmental problems in children, Dr. Gerberding said, “right now there is no evidence of autism or other harm associated with the MMR vaccine in the area of developmental delays or disabilities. The evidence indicates that this is a safe and effective vaccine. It saves lives. It also protects children now and will protect them as they become adults.”