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Rubella No Longer a Threat in the U.S.

Federal health officials say vaccination has virtually eradicated German measles

MONDAY, March 21, 2005 (HealthDay News) -- Rubella, a major cause of serious birth defects, has been eliminated in the United States, a top federal health official declared on Monday.

"This is a major milestone in the path toward eliminating rubella in other parts of the world, including the Western Hemisphere and other regions that have committed to this very, very important health goal," said Dr. Julie Gerberding, director of the U.S. Centers for Disease Control and Prevention.

Gerberding announced the news at briefing held in conjunction with the 39th annual National Immunization Conference in Washington, D.C.

Rubella, also known as German measles, is an illness caused by a mild though highly contagious virus spread through the air or by close contact with someone who has the infection. Symptoms include a tell-tale red rash on the skin, mild fever and swollen glands. It typically lasts only two or three days, although often there are no symptoms at all.

Rubella's real threat is to women of childbearing age. Babies whose mothers contract rubella during pregnancy can suffer one or more serious birth defects, collectively known as congenital rubella syndrome (CRS), according to the March of Dimes. These problems include eye defects that result in vision loss or blindness, hearing loss, heart defects, mental retardation, and, less frequently, movement disorders. Rubella also can cause miscarriages and stillbirth.

"I'm thrilled at the announcement. I just think it's terrific that it's been determined to be eradicated," said Nancy O'Donnell, coordinator of special projects at the Helen Keller National Center for Deaf-Blind Youths and Adults in Sands Point, N.Y., which provides services to people with CRS.

But O'Donnell also expressed some reservations. "My fear is that the announcement will cause some type of complacency," she said, stressing the need for parents to continue having their children immunized against the disease.

She also worries that Americans will think CRS is history, even though thousands of people still suffer lifelong health effects.

An epidemic in 1964 and 1965 caused an estimated 12.5 million cases of rubella and 20,000 cases of congenital rubella syndrome in the United States, according to the CDC. That outbreak caused thousands of fetal and neonatal deaths and led to the birth of thousands of blind, deaf and mentally retarded children, the agency said.

But with the introduction of a rubella vaccine in 1969 and aggressive public health campaigns, the number of cases has fallen sharply over the years. From 1990 through 1999, only 117 cases of CRS were reported.

Only nine cases were reported in the United States in 2004, and none of them resulted from transmissions within this country, Gerberding said. The cases that arise today occur in mothers infected in their country of origin or in children born in other parts of the world, where vaccination rates are not as high, she said.

To improve rubella protection in the Americas, the United States has been working closely with the Pan American Health Organization (PAHO) and Mexico.

Speaking at the briefing in Washington, D.C., PAHO Director Dr. Mirta Roses Periago noted that the ministers of health in all the counties in the Americas in 2003 resolved to eliminate rubella and congenital rubella syndrome by 2010. Already, there has been significant progress, with less than 2,000 cases last year, a 99 percent decline from recent years, she said.

In the United States, protection against rubella is provided through the combination measles, mumps, rubella (MMR) vaccine, recommended for all children and for adolescents and adults who haven't previously been vaccinated. Currently, about 93 percent of U.S. children under age 2 receive the MMR vaccine, and more than 95 percent are vaccinated against rubella, according to federal statistics.

"The rest of the world has not really had a major impact on rubella yet," said Dr. Adel A.F. Mahmoud, president of the vaccine division of Merck & Co., the sole provider of the MMR vaccine. And with 100,000 cases of CRS reported globally each year, it remains a serious threat.

"What's important, therefore, is to maintain the umbrella of vaccination," he added.

Gerberding also stressed the importance of maintaining vigilance against the disease. "As we say in public health, our network is only as strong as the weakest link, so we have to sustain our commitment to immunization, we have to strengthen all the links in the network and we have to do everything possible to protect the health of children here within our country as well as beyond."

More information

The U.S. Centers for Disease Control and Prevention has more on rubella.

SOURCES: Julie Gerberding, M.D., M.P.H., director, U.S. Centers for Disease Control and Prevention, Atlanta; Mirta Roses Periago, M.D., director, Pan American Health Organization, Washington, D.C.; Adel A.F. Mahmoud, M.D., Ph.D., president, vaccine division, Merck & Co., Whitehouse Station, N.J.; Nancy O'Donnell, coordinator of special projects, Helen Keller National Center for Deaf-Blind Youths and Adults, Sands Point, N.Y.; March of Dimes, White Plains, N.Y.; March 21, 2005, CDC press release; March 21, 2005, teleconference, Washington, D.C.
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