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Don't Count Rubella Out Yet

WebMD Health News

March 23, 2000 (Atlanta) -- The CDC had hoped that by the end of this year, it would have chased a disease called rubella out of the country for good. But officials there now say that four rubella outbreaks involving mostly foreign-born workers in 1999 may delay their ambitious goal.

The public health specialists are now recommending the initiation of workplace rubella vaccination programs to eliminate continued rubella cases.

The largest of these rubella outbreaks happened in Nebraska. There were 95 reported cases -- and doubtless many unreported ones. Other 1999 outbreaks occurred in Iowa, North Carolina, and Arkansas.

Detailed analysis of the Nebraska outbreak and a 1998 outbreak in Kansas were reported in a March 24 CDC report. And it shows a pattern: All of the cases of rubella were clustered in industrial settings, mostly food-processing plants, and struck workers from countries that only recently have begun measles-mumps-rubella vaccination.

"We have now identified an at-risk population," CDC epidemiologist Susan Reef, MD, tells WebMD. "The question is, can we go out and vaccinate the right people. These places [food-processing plants] have many foreign-born workers. By vaccinating against rubella in the workplaces, this is one way we can reach this population and progress toward elimination."

Rubella, also known as German measles, is an infectious disease often seen in childhood. It causes a measles-like rash over the face and neck that quickly spreads over the rest of the body. Patients often have fever, body aches, and swollen glands. There is no treatment except bed rest, fluids and fever management.

Successful childhood immunization has completely changed the face of rubella in the U.S. The success of immunization programs has nearly eradicated the disease, but the sporadic outbreaks mean that more work remains to be done.

"I do not think we are going to get down to zero cases this year," says Reef, leader of the CDC's rubella/mumps response team.

Once a disease of children, those at highest risk now are non-immune adults exposed to the disease by infected co-workers. This means continued risk for the most severely affected population, as rubella can cause severe birth defects in the children of women infected during their first trimester of pregnancy. "Our main target is preventing pregnant women from getting infected," Reef says. "This definitely is still an issue."

Reef says the CDC recommends that each state and local health department develop a vaccination strategy to eliminate the risk of outbreaks in non-vaccinated adults. "You have to look at the risk population, where the exposure is, what it will take to stop outbreaks -- each place is unique," she says. "Each place has different issues to address. Sometimes you can have the leaders of the affected communities help you in the process."

But workplace vaccination programs -- particularly in industries that employ foreign-born workers -- are an essential component of eradication. "We must ensure high vaccine coverage in the workplace," Reef says.

Vital Information:

  • The CDC had hoped that its efforts to vaccinate people against rubella would eradicate the disease from the U.S. by the end of this year. But several rubella outbreaks, focusing around people born in countries when there were no vaccinations, mean new strategies need to be developed to protect these vulnerable people.
  • Rubella was once a child's disease, but today it mostly strikes unvaccinated adults. If it strikes a pregnant woman, it can cause severe birth defects in her baby.
  • The CDC says vaccination efforts should concentrate on workplaces that employ a lot of foreign-born workers who may not have been immunized as children.

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