A disease that causes devastating birth defects has been virtually wiped out in the Americas.
Rubella is a contagious viral disease that usually causes only a mild infection in children and adults. That may not sound like a serious illness worthy of a decades long fight aimed at eradicating it. But rubella poses a severe danger to the unborn.
If a pregnant woman contracts rubella, there’s a high risk the infection will cause fetal death or congenital rubella syndrome (CRS), marked by birth defects including deafness, cataracts, heart deformities, mental retardation, and liver and spleen problems. In all, there’s a 20 percent chance of damage to the unborn child, especially if the mother is infected with the rubella virus in early pregnancy, according to the National Institutes of Health.
Although there is no specific treatment for rubella, the U.S. and other countries in the Americas are now proof rubella, and its potentially tragic consequences can be prevented through vaccination against the virus. The Americas have become the first areas in the world to be declared free of endemic transmission of rubella (meaning no new cases originate here), according to a Pan American Health Organization/World Health Organization (PAHO/WHO) expert committee.
This makes rubella and CRS the third and fourth diseases to be eradicated from the Americas, following smallpox in 1971 and polio in 1994, thanks to the widespread use of vaccines that prevent these diseases from occurring in the first place.
“All four achievements prove the value of immunization and how important it is to make vaccines available even to the remotest corners of our hemisphere," said Carissa Etienne, director of the PAHO.
To understand the significance of winning the battle against rubella, consider how many people suffered consequences of the disease in the U.S. 50 years ago. A large outbreak in l964 and l965 resulted in 11,000 preterm infant deaths from miscarriages, stillbirths, or pregnancies that were medically terminated due to rubella complications. Another 20,000 U.S. babies were born with birth defects caused by CRS.
But after the introduction of the measles, mumps, and rubella (MMR) vaccine and an effort by doctors and public health leaders to make sure MMR vaccinations were widely administered, the cases of rubella plummeted — both in this country and in other parts of the Americas.
By the late 1990s, the English-speaking Caribbean nations were successfully promoting mass rubella vaccination through public health campaigns aimed at adolescents and adults. In all, some 250 million adolescents and adults in 32 countries and territories were vaccinated against rubella between 1998 and 2008.
The last endemic cases of rubella and CRS were reported in the Americas in 2009. After no evidence of endemic transmission of rubella or CRS showed up during the past five consecutive years (exceeding the three-year requirement for declaring a disease eliminated), officials moved to declare rubella defeated in the Americas.
It’s important to note, however, that rubella has not been wiped out in all areas of the world. WHO estimates 110 000 babies are born with CRS complications every year.
What’s more, there are still a few cases of infections with the virus reported in Canada, Argentina, and the U.S. annually, although these are in people who did not acquire rubella in the Americas. Because infection is still possible as people travel to and from countries where rubella is a problem, it’s important to continue to make sure that you and your children’s vaccinations are up to date.
Rubella, although sometimes called the German measles or “the three day measles,” is not a form of measles. Both diseases produce red rashes, but they are caused by different viruses. And, while rubella is on the run, cases of measles in the U.S. have increased recently, primarily because of unvaccinated youngsters.
In fact, until 2014, measles was thought to have been eliminated in the U.S. for over a decade, but new cases of the viral infection have surged due to areas of low vaccination rates, often because of parental fears that MMR vaccines have serious side effects. In all, the U.S. had more cases of measles last year than in the past two decades, according to Walter Orenstein, MD, and Katherine Seib, MSPH, researchers from the Emory Vaccine Center.
"Despite the overwhelming evidence that vaccines — including the measles. mumps and rubella vaccine — are safe, too many people still believe that greater risk is posed by vaccinating than by not vaccinating," Orenstein and Seib stated.
The truth is that measles, which is a highly contagious disease, can be a serious health threat in all age groups. It can cause hearing loss, pneumonia, and potentially brain-damaging encephalitis (swelling of the brain). For every 1,000 children who contract measles, one or two will die from it, according to the Centers for Disease Control and Prevention.
"The fight against rubella has taken more than 15 years, but it has paid off with what I believe will be one of the most important Pan American public health achievements of the 21st century," said PAHO/WHO director Etienne. "Now it's time to roll up our sleeves and finish the job of eliminating measles as well."
August 18, 2015
Christopher Nystuen, MD, MBA