http://bmj.com/cgi/content/full/324/7332/258/a

BMJ 2002;324:258 ( 2 February )

News roundup

End to rubella in US thwarted by unvaccinated, foreign born population

Deborah Josefson Nebraska

Rubella, or German measles, is nearing extinction in the United States, but sporadic outbreaks—mainly among unvaccinated, foreign born residents—still occur, posing new challenges for its eradication, says a report written by investigators from the Centers for Disease Control and Prevention (CDC) (JAMA 2002; 287:464-72).

Before mandatory childhood vaccination against rubella in 1969, congenital rubella was the leading cause of congenital anomalies and preventable childhood deafness in the United States. In 1969, 57 600 cases of rubella and 62 cases of the syndrome were reported. But the number of rubella cases has been steadily dropping. By 1988, 223 rubella cases and just four cases of the syndrome were recorded.

Dr Susan Reef and colleagues from the CDC analysed the incidence and characteristics of rubella and congenital rubella syndrome in the United States from 1990 to 1999 using data submitted to the national notifiable diseases surveillance system and the national congenital rubella syndrome registry. They also performed molecular typing of the viruses to help ascertain their origin. They found three distinct genotypic groups, which they traced to virus isolates common in Mexico, the Caribbean, and Ecuador.

Overall, the researchers found substantial decreases in rubella incidence—from 0.45 cases per 100 000 in 1990 to 0.1 per 100 000 in 1999.

They also found that rubella was occurring mainly in adults, not children. Although there was a preponderance of infections in men, the infections in women were more worrying as more than half of these occurred in women of childbearing years. From 1996 to 1999, 281 young women contracted rubella, of whom 71 were pregnant at the onset of rash.
 
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