The opportunity and obligation to eliminate rubella from the United States.

The licensure of rubella vaccines in the United States in 1969 offered the opportunity to prevent the devastating consequences of congenital rubella infection, including miscarriages, therapeutic abortions, and congenital rubella syndrome (CRS), with its average lifetime cost of more than $220,000 per case. With the widespread use of vaccine, rubella transmission in the United States has been reduced to record low levels. Epidemics of rubella and CRS, previously reported every six to nine years, have not occurred, and since 1980, following decreases of rubella incidence rates in the postpubertal population, the endemic incidence rates of CRS have also begun to decrease. We have both the opportunity and the obligation to hasten elimination by (1) ensuring that susceptible females of childbearing age are vaccinated, (2) initiating and/or enforcing existing legislation requiring proof of rubella immunity for all children enrolled in schools, (3) intensifying surveillance for both acquired rubella and CRS, and (4) aggressively controlling rubella outbreaks.