Rubella Under Control – Don’t Drop Your Guard

In October 2004, an independent panel of authorities determined that rubella (three-day or German measles) is no longer endemic in the US. This means there was no continuous US-acquired “chain of transmission” for at least one year. The conclusion was based on:
 1) fewer than 25 cases were reported in the US each year since 2001; 2) vaccination levels are 95% or better in the school-aged population; 3) over 90% of the total population are protected; and 4) outbreaks can be adequately determined. Eliminating new cases of rubella and congenital rubella syndrome (CRS) is one of the national health objectives for 2010.

This article outlined milestones in vaccine development and distribution and the impact on incidence. The first live, attenuated virus vaccines were approved in 1969 and the first campaign was to prevent CRS by targeting young children who could transmit the viral illness to pregnant women. Rubella infection during the first trimester of pregnancy can cause fetal or neonatal death or CRS - multiple birth defects, including blindness, heart defects and hearing impairment. Upon finding that up to 20% of the adult population was susceptible to infection, CDC instituted efforts in 1978 to vaccinate non-pregnant women as young as 15 years. Intensive programs, known as Childhood Immunization Initiatives, maintained high vaccination rates among pre-school and school-age children. When case information included country of origin beginning in 1998, emphasis was given to vaccinating foreign-born adults.

Since 2001, the number of cases yearly dropped to nine in 2004. From 2001-2004, four cases of congenital rubella syndrome were reported; of these, three of the mothers were born outside of the US. Foreign-born persons who developed rubella came from countries where rubella vaccination had not been or was only recently implemented.

The US should continue to: 1) maintain high vaccination levels among children; 2) ensure vaccination for women of childbearing age, especially those born outside the US; 3) monitor for cases of rubella and CRS; and 4) respond rapidly to any outbreak.

(Centers for Disease Control and Prevention. MMWR 2005; 54 (Early Release):1-4)

Comments: Most school nurses have never seen CRS. My first nursing position in 1968 was in a residential school for the blind with several students being “deaf-blind” due to prenatal rubella exposure – I know CRS first hand and want no other mother or child to experience that risk. School nurses are the community’s front line for continued success. —J.O.