While we rarely hear about rubella anymore, like most other vaccine-preventable diseases, the last case of rubella in the United States was a lot more recent than you probably imagine.
Although endemic rubella and congenital rubella syndrome were declared eliminated in 2004, like measles, we still have cases each year.
When Was the Last Case of Rubella in the United States?
To be sure, rubella is far less common that it used to be.
Remember the rubella epidemics of the 1960s, when rubella caused 2,100 neonatal deaths and 20,000 infants to be born with congenital rubella syndrome?
How about the rubella outbreaks in the early 1990s, when rubella caused 13 deaths and 77 cases of congenital rubella syndrome?
“Rubella is a leading cause of vaccine-preventable birth defects. Although rubella virus infection usually causes a mild febrile rash illness in children and adults, infection during pregnancy, especially during the first trimester, can result in miscarriage, fetal death, stillbirth, or a constellation of birth defects known as congenital rubella syndrome (CRS).”
Grant et al on Progress Toward Rubella and Congenital Rubella Syndrome Control and Elimination — Worldwide, 2000–2018
One of our problems today is that most people don’t remember these epidemics and outbreaks, so they don’t understand how important it is for everyone to be vaccinated and protected.
They have no idea how fortunate they are that these diseases no longer make routine headlines.
We will see more rubella and congenital rubella syndrome.
While we do see some congenital rubella cases now, they are all women who were exposed to rubella outside the United States when they were pregnant.
“During 2001–2004, four CRS cases were reported to CDC; the mothers of three of the children were born outside the United States.”
Achievements in Public Health: Elimination of Rubella and Congenital Rubella Syndrome — United States, 1969–2004
Again, since the endemic spread of rubella was declared eliminated in 2004, cases since then are import related. People who aren’t immune get exposed to rubella when they are traveling to areas of the world where rubella is more common and return. Fortunately, since rubella isn’t as contagious as measles, these cases don’t usually cause big outbreaks.
So when was the last case of rubella and congenital rubella syndrome in the United States that wasn’t imported from outside the United States?
In our age of social media, we have gotten used to hearing from the Surgeon General and most everyone else in our government.
Folks likely weren’t as used to this back in the early part of the 20th Century.
Surgeon General Letter to All State Health Officers
At the time, because of a return of smallpox, H.S. Cumming wrote this letter:
To all State Health Officers:
The neglect of vaccination in many districts of certain sections of the United States has led to a recrudescence of smallpox, with the corresponding suffering experienced by its victims and a wholly unnecessary sacrifice of human lives in the years 1922 and 1923 amounting to 967 known deaths from smallpox and possibly a number of others which were not reported. During the first six months of 1924 an additional toll of at least 200 human lives has been taken every one of which deaths could have been prevented by vaccination and revaccination.
The increasing number of cases of smallpox and the continued spread of this disease from city to city and from State to State will, if not checked, not only augment the number of victims but may bring about a condition which would seriously interfere with the movements of passengers on trains steamers, automobiles, and other carriers. It is conceivable that this interference might be of a degree that would involve the expenditure of hundreds of thousands of dollars in quarantine, a contingency which might easily be avoided provided our people can be induced to protect themselves by vaccination and revaccination.
The Public Health Service is being importuned at the present time to exercise its authority in enforcing interstate quarantine to prevent the migration of the unvaccinated when there is danger that these persons may have been exposed to smallpox.
It is particularly desirable that the Federal Government may not be forced to interfere in interstate travel and it is earnestly hoped that the authorities of all States, counties, municipalities, or other units of government will immediately begin campaigns to secure the vaccination or revaccination of all persons who have not been recently successfully vaccinated particularly in those States where smallpox is prevalent.
Vaccination and revaccination being a perfect protection against smallpox it might be argued that protection against the disease is a matter which should be left to the discretion of the individual, but there is no more reason for leaving the defense against an enemy of the State, such as smallpox is, to the discretion of the individual, than there would be in leaving the defense of the State against an armed invading force to the individual. These enemies are equally dangerous. Furthermore there are a large number of persons who are otherwise good citizens who because of indifference, carelessness, and lack of information, and oftentimes because of having been deceived by false propaganda and deliberate misinformation, either fail or refuse to protect themselves and their trusting but helpless children until it is too late. These same children of misinformed or irresponsible parents being too young to judge for themselves are entitled to the protection of the State and certainly the State is derelict in its duties if it allows such unprotected children to be exposed to smallpox.
Respectfully HS CUMMING Surgeon General
The response to the foregoing letter has been very gratifying. At the same time, much still remains to be done in the way of vaccination and revaccination of our nonimmune population if a recrudescence of this disease is to be forestalled.
Does any of that surprise you?
Talk of “enforcing interstate quarantine?”
People being deceived by “false propaganda and deliberate misinformation?”