Rubella -- United States, 1979-1982

A record low number of 2,077 rubella cases was reported in the United States for 1981. This was a 47% decline from the 1980 total of 3,904 cases (the previous record low) and an 82% decline from the 1979 total of 11,795 cases. During the first 38 weeks of 1982 (ending September 25), 2,018 cases were reported--a 13% increase from the number of cases reported during the same period in 1981 (Figure 1). This increase was due to a three-fold increase in reported cases from California from 445 cases during the first 38 weeks of 1981 to 1,319 cases during the same period in 1982. Reported cases of rubella from all other states declined by 52% during the first 38 weeks of 1982 as compared with the first 38 weeks of 1981.

The National Congenital Rubella Syndrome Registry (NCRSR) maintained at the Immunization Division, CDC, collects detailed data on clinical signs and laboratory test results on patients reported with congenital rubella syndrome (CRS). Reports of CRS are voluntarily submitted to CDC from local and state health departments. Specific criteria are used for classifying patient data submitted to the NCRSR (1).* *Confirmed cases are those with defects compatible with CRS, and with laboratory confirmation of disease. Compatible cases are those with defects compatible with CSR, but without laboratory confirmation.

Since 1979, the annual provisional total of both confirmed and compatible CRS cases has declined from 53 in 1979 to 17 in 1980 to five in 1981.** This decrease in reported confirmed and compatible CRS cases correlates with the decline in the reported incidence rate of rubella among women of childbearing age.

Age-specific data were available for 1,674 (81%) of the cases reported for 1981. The age-specific incidence rates of rubella have continued to decline for all age groups over the past 3 years. The greatest decline between 1980 and 1981 occurred in the 15- to 19- and 20- to 24-year-old age groups (Table 3), an occurrence first reported in 1980. In 1978 and 1979, 74% of the reported rubella cases were among persons greater than or equal to 15 years old, and the highest rate was in the 15- to 19-year-old age group. In 1981, however, only 37% of the cases were reported among persons greater than or equal to 15 years old, and the highest rate occurred among the 5-year-olds. In 1981, for the first time since age-specific reporting was instituted on a national basis in 1975, the rate among schoolage children 5-9 years old significantly exceeded the rate in 15- to 19-year-olds. Reported by Immunization Br, Center for Prevention Svcs, CDC.

Editorial Note

Editorial Note: The initial recommendation of the Public Health Service Immunization Practices Advisory Committee (ACIP) for rubella control was to vaccinate preschool and elementary school children of both sexes; vaccination of older individuals received only secondary emphasis. This approach caused a dramatic decline in rubella incidence and eliminated the characteristic 6-\to 9-year cycle of epidemic rubella (2). It also resulted in a marked change in the age characteristics for reported rubella patients. **Cases in the CRS registry are reported by date of birth. Data are reported as provisional until at least 3 years have elapsed since year of birth. Data from 73 of the most recent reports with known date of birth and date of report showed that 64 (88%) cases were reported within the first year after birth.

The 1981 and 1982 surveillance data, excluding California, (cases from California generally involved adults in outbreaks at hospitals, universities, and places of employment) continue to show a steady decline in reported cases of rubella to record low levels. Some of this decrease may be due to the Childhood Immunization Initiative that began in 1977, the goal of which was to achieve and maintain immunization levels in excess of 90% for all childhood vaccine-preventable diseases including rubella. Assessment of rubella immunization levels of 3.4 million children entering school (kindergarten and 1st grade) in the 50 states and the District of Columbia showed a level of 96% for the 1981-1982 school year. To ensure continued high immunity levels, all 50 states and the District of Columbia have enacted and enforced rubella-immunization requirements for school entry. The Measles Elimination Initiative, begun in 1978, has also had a major impact on the reduction of rubella incidence, since most of the measles vaccine administered during this program has been given as MMR (combined measles, mumps, rubella vaccine) or MR (combined measles, rubella vaccine). Approximately 75% of the measles vaccine administered in the public sector has been MMR or MR vaccine.

Before rubella vaccine became available in 1969, most reported rubella cases occurred among children 15 years of age. The initial rubella control policy lowered the attack rates for all age groups, but with proportionately greater declines in the 15-year age group. Data on age-specific incidence rates for 1981 show that rates for adolescents and young adults are now lower than those for young children. The greater recent decrease in rubella incidence among adolescents and young adults probably resulted because 1) young children targeted for vaccination during 1969 and the early 1970s have moved into older age groups, and 2) efforts have increased over the past 3-4 years to vaccinate the remaining susceptible adolescents and young adults. In the 5-year age group, 287 (46%) of the 626 reported cases were 1 year of age and thus below the earliest recommended age for vaccination.

Increased efforts to vaccinate adolescents and young adults were prompted by continued reporting of 27-59 cases of CRS per year from 1971 through 1979 (2) and by the knowledge that 10%-25% of adolescents and adults were susceptible to rubella (3-5). In the public sector, where between 40% and 50% of the rubella vaccine is distributed and administered, increasing numbers of doses were given to persons greater than or equal to 15 years of age between 1979 and 1981; 234,000 doses were given in 1979, 325,000 in 1980, and 333,000 in 1981.

The current strategy for rubella control is to vaccinate 1) all infants at approximately 15 months of age in combination with measles and mumps vaccine; 2) all schoolchildren who were not vaccinated in infancy; and 3) susceptible individuals who have left high school, particularly females of childbearing age, military personnel, students and employees of educational and training institutions (such as colleges and universities), and health personnel of both sexes (6).

References

1. CDC. Rubella vaccination during pregnancy--United States, 1971-1981. MMWR 1982;31:477-81.

2. CDC. Rubella surveillance, January 1976-December 1978. Atlanta:CDC, May 1980.

3. Schiff GM, Linnemann CC Jr., Shea L, Trimble S. Rubella surveillance and immunization among college women. Obstet Gynecol 1974;43:143-7.

4. Pollard RB, Edwards EA. Epidemiologic survey of rubella in a military recruit population. Am J Epidemiol 1975;101:431-7.

5. Preblud SR, Gross F, Halsey NA, Hinman, AR, Hermann KL, Koplan JP. Assessment of susceptibility to measles and rubella. JAMA 1982; 247:1134-7.

6. ACIP. Rubella prevention. MMWR 1981;30:37-42,47.

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