Three Rubella Cases Remind Us of Continued Risk
Apr 01, 2013

Every day a child is born with birth defects.  While most parents are not able to determine the cause of these defects with much certainty, there are cases in which disease and maternal infection are known to contribute to the presence of birth defects in children.
Take for instance the last major rubella epidemic in the United States in 1964-1965.  An estimated 12.5 million rubella virus infections among pregnant women resulted in 11,250 therapeutic or spontaneous abortions, 2,100 neonatal deaths, and 20,000 infants born with Congenital Rubella Syndrome (CRS) which can cause such serious birth defects as deafness, cataracts, cardiac complications and mental retardation.
Thanks to a successful vaccination program in the United States, birth defects caused by rubella infection are almost non-existent.  And in 2004, it was declared that rubella was eliminated in the United States.  So, why is it that a CDC published report, released late last week, included details about three infants born with CRS this past year?
The fact remains that rubella virus continues to circulate in other areas of the world.  As of 2011, while some 130 countries which represent about 41% of the world’s birth cohort include rubella vaccination as part of their childhood immunization programs, rubella elimination has only been achieved in the Americas.  While some regions, such as Europe and the Western Pacific, have established rubella elimination goals, others such as the African, Eastern Mediterranean and South-East Asia Regions have been unable to establish goals due to competing public health priorities.  And sadly, only three countries within the African Region even include rubella vaccine in their recommended childhood immunization programs.
On the one hand, when we consider the lack of rubella vaccination in other areas of the world, it seems impressive that we have only seen three cases of CRS in American born infants last year.  However, these cases should be a warning to parents, pregnant women and public health professionals.  As long as rubella exists, there will always be a chance that it will present itself in a country such as ours where it was once deemed eliminated.
When you consider that there were only three diagnosed cases out of all the babies born in the U.S. last year, these cases may seem of little significance.  However, the data suggests that throughout 2004-1012, there have been 79 cases of rubella and six cases of CRS reported in the United States. All of the these cases appear to have been imported or where from unknown sources, and the most recent cases of CRS in 2012 were all born to mothers who had been in Africa early in their pregnancies.  It is believed that if a woman becomes infected with rubella within the first 10 weeks of pregnancy, her child has as much as an 80% increased risk of suffering birth defects from CRS.  Unfortunately, none of the three mothers had any documentation of vaccination against the virus and sadly all three gave birth to children with severe defects.  And the report indicates that one of the three children died as a result.
So, while rubella remains unlikely in the U.S., these figures remind us that when a disease remains endemic elsewhere in the world, imported cases will continue to be a public health concern.  Residents or foreign visitors entering the United States from rubella-endemic areas can easily introduce the virus to places where it has not been circulating.  Then, when an infant is born with CRS, they can continue to shed infection for several months, potentially exposing and infecting others such as unvaccinated infants in day-care settings or adults who are unable to be vaccinated due to medical conditions.   It’s even possible that clusters of unvaccinated people are at increased risk of disease, as has been seen in the Netherlands and Canada in 2009.
Friday’s report only emphasizes that we must remain vigilant in controlling – and if possible eradicating – vaccine preventable diseases by continuing to immunize ourselves and our children.  In the case of rubella, we can see that immunization anywhere can help reduce the impact of diseases everywhere.

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