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
CDC. Rubella and congenital rubella--United States, 1980-1983.
MMWR 1983;32:505-9.
CDC. Rubella and congenital rubella--United States, 1983.
MMWR
1984;33:237-42, 247.
Dales LG, Chin J. Public health implications of rubella
antibody
levels in California. Am J Public Health 1982;72:167-72.
Orenstein WA, Bart KJ, Hinman AR, et al. The opportunity and
obligation to eliminate rubella from the United States. JAMA
1984;251:1988-94.
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