Rubella in the United States: toward a strategy for disease control and elimination

More than 25 years have passed since the last rubella epidemic in the United States. The rubella pandemic of 1964–5 demonstrated clearly the extraordinary teratogenic potential of the rubella virus. In the United States alone, it is estimated that more than 12500000 cases of rubella occurred during the winter and spring of 1964–5. Congenital rubella infection occurred in an estimated 30000 pregnancies, 10000 resulting in fetal death or therapeutic abortion and 20000 resulting in infants born with congenital rubella syndrome (CRS) [1]. In contrast, during 1988, only 225 cases of rubella were reported to the Centers for Disease Control (CDC) in Atlanta, the lowest annual total since rubella became a nationally notifiable disease in 1966 [2]. However, in 1989, this downward trend of reported cases was interrupted, with the number of reported rubella cases in the United States increasing nearly twofold, and in 1990, the total increased another threefold (to more than 1000 cases) [3]. Although the 1990 reports represent the highest total since 1982, the overall incidence of rubella in the United States has still declined by more than 98% since 1969, the year rubella vaccine was licensed (Fig. 1).