Before the licensure of rubella vaccine, rubella usually occurred in a seasonal pattern, with epidemics at 5- to 9-year intervals.[2]World Health Organization. Rubella vaccines: WHO position paper – July 2020 – Note de synthèse: position de l’OMS concernant les vaccins antirubéoleux. 2020 [internet publication].
https://apps.who.int/iris/handle/10665/332952
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]World Health Organization. Rubella vaccines: WHO position paper – July 2020 – Note de synthèse: position de l’OMS concernant les vaccins antirubéoleux. 2020 [internet publication].
https://apps.who.int/iris/handle/10665/332952
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]Ou AC, Zimmerman LA, Alexander JP Jr, et al. Progress toward rubella and congenital rubella syndrome elimination - worldwide, 2012-2022. MMWR Morb Mortal Wkly Rep. 2024 Feb 29;73(8):162-7.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10907039
http://www.ncbi.nlm.nih.gov/pubmed/38421933?tool=bestpractice.com
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]Centers for Disease Control and Prevention. Achievements in public health: elimination of rubella and congenital rubella syndrome - United States, 1969-2004. Morb Mortal Wkly Rep. 2005 Mar 25;54(11):279-82.
http://www.ncbi.nlm.nih.gov/pubmed/15788995?tool=bestpractice.com
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]Centers for Disease Control and Prevention. Rubella (German measles, three-day measles). Dec 2020 [internet publication].
https://www.cdc.gov/rubella/index.html
[6]Papania MJ, Wallace GS, Rota PA, et al. Elimination of endemic measles, rubella, and congenital rubella syndrome from the Western hemisphere: the US experience. JAMA Pediatr. 2014 Feb;168(2):148-55.
https://archpedi.jamanetwork.com/article.aspx?articleid=1787786
http://www.ncbi.nlm.nih.gov/pubmed/24311021?tool=bestpractice.com
Most cases now affect adolescents and young adults.[7]Lanzieri T, Haber P, Icenogle JP, et al. Rubella. In: Hamborsky J, Kroger A, Wolfe C, eds. CDC The Pink Book: Epidemiology and prevention of vaccine-preventable diseases. Aug 2021 [internet publication].
https://www.cdc.gov/vaccines/pubs/pinkbook/rubella.html
In 2015, the Pan American Health Organization determined that endemic transmission of rubella in the Americas had been eliminated.[8]Pan American Health Organization; World Health Organization. Elimination of rubella and congenital rubella syndrome in the Americas. Fact Sheet 2015. Apr 2015 [internet publication].
https://www.paho.org/hq/index.php?option=com_content&view=category&layout=blog&id=831&Itemid=761&lang=en
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]O'Connor P, Jankovic D, Zimmerman L, et al. Progress toward rubella elimination - World Health Organization European Region, 2005-2019. MMWR Morb Mortal Wkly Rep. 2021 Jun 11;70(23):833-9.
https://www.cdc.gov/mmwr/volumes/70/wr/mm7023a1.htm?s_cid=mm7023a1_w
http://www.ncbi.nlm.nih.gov/pubmed/34111057?tool=bestpractice.com
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]Centers for Disease Control and Prevention (CDC). Nationwide rubella epidemic--Japan, 2013. MMWR Morb Mortal Wkly Rep. 2013 Jun 14;62(23):457-62.
https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6223a1.htm
http://www.ncbi.nlm.nih.gov/pubmed/23760185?tool=bestpractice.com
Globally, more than 100,000 infants are born each year with congenital rubella syndrome.[11]Centers for Disease Control and Prevention. CDC Yellow Book 2024. Section 5: travel-associated infections and diseases - rubella. May 2023 [internet publication].
https://wwwnc.cdc.gov/travel/yellowbook/2024/infections-diseases/rubella
The risk to unimmunized travelers to areas where rubella remains endemic may be high.