Ear Hustle

Rubella Has Been Eliminated From the Americas, Health Officials Say


Rubella, a disease with terrible consequences for unborn children, has finally been eliminated from the Americas, a scientific panel set up by global health authorities announced Wednesday.

The disease, also known as German measles, once infected millions of people in the Western Hemisphere. In a 1964-65 outbreak in the United States, 11,000 fetuses were miscarried, died in the womb or were aborted, and 20,000 babies were born with defects.

“Although it has taken some 15 years, the fight against rubella has paid off,” said Dr. Carissa F. Etienne, director of the Pan American Health Organization, which made the announcement in conjunction with the United States Centers for Disease Control and Prevention, Unicef and the United Nations Foundation. “Now, with rubella under our belt, we need to roll up our sleeves and finish the job of eliminating measles, as well.”

The Americas region is the first World Health Organization region to eliminate rubella. The European region — which includes Eastern Europe, Russia and Central Asia — hopes to follow next.


Some regions are still not close enough to set firm target dates, so there is no chance that the disease will be eliminated worldwide before 2020, said Dr. Susan E. Reef, team lead for rubella at the C.D.C.’s global immunization division, who joined in the announcement.

Around the world, about 120,000 children are born each year with severe birth defects attributed to rubella.

Two other diseases were first eliminated in the Americas: smallpox in 1971, and polio in 1994. Smallpox is now eliminated worldwide. Polio is nearly gone, but has clung on stubbornly for decades; almost all remaining cases originate in Pakistan.

Although rubella usually produces only a relatively mild rash and fever in children and adults, it is devastating to fetuses in the first trimester; many are born deaf, blind from cataracts and with severe permanent brain damage.

The last endemic case in the Americas was confirmed in Argentina in 2009.

It took six more years to declare the disease eliminated because its symptoms are harder to detect than, for example, polio, which causes paralysis, or smallpox or measles, which cause intense, easily diagnosable rashes.

Public health authorities had to review 165 million records and do 1.3 million checks to see if any communities had rubella cases. All recent cases had to be genetically tested at the C.D.C. to confirm that they were caused by known imported strains of the virus, not by quietly circulating domestic ones.

As with measles, there is no cure for rubella, but the disease is prevented by a very effective vaccine. In the United States, the shot usually contains three vaccines and is known as M.M.R., for measles, mumps and rubella.

Measles cases in the United States have surged recently because some parents who believe, contrary to scientific evidence, that the measles vaccine causes autism do not let their children receive the shot.

Endemic measles was eliminated from the hemisphere in 2002, but imported cases can surge in pockets of unvaccinated children, as happened last year in an outbreak that began at Disneyland in California.

Rubella is less contagious than measles, and the vaccine for it is somewhat more effective, so the rare imported cases have not spread as rapidly.

The rubella vaccine was first developed in 1969 by Dr. Maurice Hilleman, a prolific vaccine inventor.

In 1964-65, a strain of the virus from Europe caused an epidemic of an estimated 12.5 million cases across the country. Of the 20,000 infected infants born alive, 2,100 died soon after birth, 12,000 were deaf, 3,580 were blind, and 1,800 had permanent mental disabilities.

Perhaps the most famous American rubella victim was the actress Gene Tierney. In 1943, newly pregnant, she volunteered to be in a show at the Hollywood Canteen, a film-industry nightclub for American troops. She caught the disease that night, and her daughter Daria was born weighing only three pounds, deaf, with cataracts and with brain damage so severe that she never learned to speak.

According to Ms. Tierney’s biography, two years later, at a tennis match, she met a fan, a former member of the Marine Corps Women’s Reserve, who said she had slipped out of a rubella quarantine to go to the Canteen that night.

“Everyone told me I shouldn’t go, but I just had to,” Ms. Tierney recalled the woman telling her. “You were always my favorite.”

Ms. Tierney wrote that she was too stunned to answer.

Agatha Christie used that story as a plot device in “The Mirror Crack’d From Side to Side.” In it, an actress murders the woman whose thoughtlessness destroyed her child.

The campaign to eliminate rubella in the Americas was formally declared by the Pan American Health Organization in 2003, but many countries had long suppressed their outbreaks through various campaigns.

The island nations of the Caribbean began with a pilot program in the Bahamas in 1997, said Dr. Karen Lewis-Bell, a Jamaica-based Pan American Health Organization adviser.

By that time, most children were protected by vaccinations given in school, but many adult men were not because earlier campaigns had focused on vaccinating only girls starting at age 10 because they were in the highest-risk group.

Vaccination teams set up tables at shopping malls, construction sites, union halls, bus stops where workers returned from field labor, high schools, universities and any place where unvaccinated men could be reached.

By then, the campaign was conducted largely with M.M.R. shots, and men were told that the rubella component would protect their unborn children, and that the mumps component would prevent mumps complications, which in post-pubescent men include painful swollen testicles and sterility.

Not only did the men line up for the shot, “but they brought their wives and girlfriends to construction sites to get it,” Dr. Lewis-Bell said.

As with all disease elimination campaigns, there were regular setbacks.

For example, by 2006, confirmed cases in the Americas had dropped to fewer than 3,000. But in 2007, a surge in Argentina, Brazil and Chile pushed the hemisphere’s count over 13,000. Most cases were in teenage boys and young men who had been skipped for vaccinations, as they previously had been in the Caribbean.

In the United States and Canada, routine childhood shots are relied on to prevent measles, rubella and mumps, but local mass vaccination campaigns are rolled out whenever there is a measles outbreak, and rubella protection increases as a consequence.

Since 2003, many other countries in the hemisphere have held an annual vaccination week in which as many as 60 million people may be vaccinated. This year’s began on Saturday.

Limited rubella outbreaks are still common in other wealthy countries. Japan had 15,000 cases in 2013.

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