Control of rubella in Israel: progress and challenge.

Despite a high-compliance school girl rubella immunization program since 1973 and a program for the immunization of women of childbearing age since 1980, sporadic cases of the congenital rubella syndrome (CRS) continue to occur in Israel, particularly following rubella epidemics. At highest risk for a child with CRS are unimmunized Arab women and immigrants from Ethiopia, although CRS has also occurred in infants of immunized non-immigrant women. In order to make progress towards the elimination of congenital rubella, the Israel Ministry of Health has incorporated into its rubella immunization program the intermediate goal of interrupting endemic rubella transmission in the country. To this end, universal rubella vaccination at age one began in 1989, a second dose at age six years was introduced in 1994, inclusion of boys in the program aimed at 12-year-olds began in late 1995, and catch-up campaigns to immunize never-immunized children, boys and girls, are planned. Moreover, women of childbearing age will be encouraged to receive a second dose of rubella vaccine. While the WHO goal of no indigenous CRS by the year 2000 will not be met, it is expected that in the coming decade substantial additional progress towards the elimination of CRS will be made.