Efforts at Rubella Elimination in the United States: The Impact of Hemispheric Rubella Control

Abstract

We examined rubella vaccination trends, rubella surveillance, and disease patterns for the Americas, Mexico, and the United States, to evaluate the impact of hemispheric rubella control on rubella elimination in the United States during 1997-2004. In 1997, 130,375 rubella cases were reported in the Americas, with 38,042 reported in Mexico. Over the next 7 years, a rubella control initiative resulted in the administration of approximately 110 million rubella-containing vaccine doses in Latin America, with 77.7 million doses administered within Mexico. By 2004, the number of reported rubella cases had declined to 3103 in the Americas and 698 in Mexico. Concurrently, the number of rubella cases in the United States fell from 817 during 1997-1999 to <25 cases/year from 2001 onward, with loss of seasonality and geographic clustering, despite no change in vaccination rates. Implementation of rubella control strategies in the Americas, particularly in Mexico, appears to have facilitated rubella elimination in the United States.

Genetic Analysis of Rubella Viruses Found in the United States between 1966 and 2004: Evidence That Indigenous Rubella Viruses Have Been Eliminated

“…Thus, 4 of 5 genotype 1C viruses in 2000 can reasonably be attributed to importations from Latin America. Furthermore, in 2000, most rubella cases in the United States were among persons with epidemiological links to foreign-born Hispanic persons [11,17].…”

“…Implementation of rubella control strategies in the Americas, particularly in Mexico, appears to have facilitated elimination of rubella virus transmission in the United States [17,18,19].…”

“…No major resurgence of rubella has occurred in the United States since 1966, and, thus, there has been no obvious "reset" of the indigenous genotype of rubella virus [12,23]. The period from control to elimination of rubella in the United States differed from the equivalent period for measles, since regional control of rubella in the Americas was just developing [17,22]. Thus, one would expect that a large percentage of rubella importation between approximately 1981 and 2000 would come from a few countries close to the United States.…”

Persistence of Rubella Antibodies after 2 Doses of Measles‐Mumps‐Rubella Vaccine

“…Thus, the relative rarity of disease reports in the United States, although reassuring, may not be conclusive proof of indefinite protection, particularly in an environment of markedly reduced risk of hemispheric importations [9,44].…”

Could the United States experience rubella outbreaks as a result of vaccine refusal and disease importation?

“…22 Meanwhile, other countries in the western Hemisphere implemented rubella vaccination programs, thus reducing the risk of importationassociated rubella in the US. 27 The revised MMR schedule and new immunization programs led to further declines in rubella incidence, from 0.56 cases per 100,000 population in 1991 to 0.06 cases per 100,000 population in 2000. The number of CRS cases per year fell from 47 to 9 in the same period.…”