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Current Trends Rubella and Congenital Rubella Syndrome -- United States, 1983-1984

Rubella: During the first 33 weeks of 1984, a provisional total of 500 cases of rubella has been reported to CDC; this is a 33% decline from the 745 cases reported during the same period of 1983. To date, 16 states are reported free of rubella.

In 1983, a provisional total of 970 rubella cases was reported to CDC. This is a 58% decrease over the 1982 total of 2,325 cases and the lowest reported number of cases since rubella became a nationally notifiable disease in 1966 (Figures 4 and 5). The 1983 incidence rate of 0.4 cases per 100,000 population is a 54% decline from the previous all-time low incidence rate in 1981 of 0.9/100,000 (Table 1) and a 98% decline from 1969, the year of rubella vaccine licensure.

Thirteen states and the District of Columbia reported no rubella cases in 1983, compared to seven states and the District of Columbia in 1982. The number of counties reporting rubella continued to decline from 366 (11.7%) in 1982 to 284 (9.0%) in 1983.

Compared to both 1981 and 1982, the 1983 age-specific incidence rates decreased for all ages (Table 1). Children under 5 years of age continued to have the highest reported incidence rate (1.8 cases/100,000 population) and accounted for one-third of the 1983 cases for which ages were known. The increased incidence rate for persons 15 years of age or older noted from 1981 (0.4 cases/100,000 population) to 1982 (0.8/100,000) was reversed in 1983 (0.2/100,000). This age group accounted for 44% of cases for which ages were known in 1983, compared with 62% in 1982.

Congenital Rubella Syndrome (CRS): Three CRS cases were reported to the MMWR and the National Congenital Rubella Syndrome Register (NCRSR) in 1984. All were from California, and all are confirmed cases, based on the NCRSR criteria (1,2). Two of these infants were born in 1984, and one, in 1983. This brings to six the 1983 provisional number of confirmed and compatible cases reported to the NCRSR, compared to 11 for 1982, 10 for 1981, 14 for 1980, and 57 for 1979. Reported by Div of Immunization, Center for Prevention Svcs, CDC.

Editorial Note

Editorial Note: Since licensure in 1969, over 123 million doses of rubella vaccine have been distributed in the United States. During that time, rubella occurrence decreased by 90% or more in all age groups (1) (Figure 6). Since initial implementation of the U.S. rubella vaccination program focused on controlling rubella in preschool-aged and young school-aged children, declines in rubella occurrence were greatest for persons under 15 years of age. Although epidemic rubella and CRS were prevented, endemic CRS remained problematic, since rubella among childbearing-aged females was not adequately controlled. Because of intensified efforts to identify and vaccinate susceptible persons of childbearing age, the reported incidence rate in the postpubertal population has recently declined. Since 1979, the decline in incidence rates for persons 15 years of age or older has been associated with a significant decline in CRS occurrence (Figure 4). However, the occurrence of widespread rubella outbreaks in postpubertal populations, as recently as 1982, is evidence that the potential for increased rubella and subsequent CRS still exists (1,3).

The current approach to controlling rubella and CRS can eventually lead to elimination, although this process may take 10-30 years and result in the birth of infants with preventable CRS (4). Expanded efforts to vaccinate susceptible postpubertal women can hasten the elimination of rubella and CRS (4,5). A concerted effort by both the private and public sectors will be needed to effectively reach this population.

References

  1. CDC. Rubella and congenital rubella--United States, 1980-1983. MMWR 1983;32:505-9.

  2. CDC. Rubella and congenital rubella--United States, 1983. MMWR 1984;33:237-42, 247.

  3. Dales LG, Chin J. Public health implications of rubella antibody levels in California. Am J Public Health 1982;72:167-72.

  4. Orenstein WA, Bart KJ, Hinman AR, et al. The opportunity and obligation to eliminate rubella from the United States. JAMA 1984;251:1988-94.

  5. ACIP. Rubella prevention. MMWR 1984 33;301-10, 315-8.



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