Epidemiology

Before the licensure of rubella vaccine, rubella usually occurred in a seasonal pattern, with epidemics at 5- to 9-year intervals.[2] The incidence of endemic rubella in unimmunized populations was highest in preschool and young school-age children. As part of the Global Vaccine Action Plan, the World Health Organization reports that progress is being made toward rubella elimination.[2] Among 194 WHO Member States, 173 (90%) included rubella-containing vaccine in their immunization schedules in 2022, an increase from 132 (68%) in 2012, and 68% of the world's infants were vaccinated against rubella in 2022.[3]​ Reported rubella cases declined by 48%, from 94,277 in 2012 to 49,136 in 2019, and decreased further to 10,194 in 2020. The elimination of endemic rubella in the US was announced in 2004.[4] At present, fewer than 10 people per year in the US are reported as having rubella infection, and since 2012, all those with rubella infections had evidence of becoming infected while living or traveling outside the US.[5][6] Most cases now affect adolescents and young adults.[7] In 2015, the Pan American Health Organization determined that endemic transmission of rubella in the Americas had been eliminated.[8] In the World Health Organization European Region, rubella incidence declined from 234.9 cases per million population in 2005 to 0.7 cases per million by 2019.[9]

Endemic rubella and congenital rubella syndrome, however, remain a global health problem, primarily of South East Asia and Africa. Outbreaks have been reported in countries where vaccination rates are suboptimal.[10] Globally, more than 100,000 infants are born each year with congenital rubella syndrome.[11]​ The risk to unimmunized travelers to areas where rubella remains endemic may be high.

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