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?
Does she really think that the benefits of the rabies vaccine don’t outweigh the risks? Does she understand what happens if you get rabies, even if your child has access to nutritious food, clean drinking water, and emergency medical care?
Most of the things on her list of who should not be vaccinated are not true contraindications.
Of course, the one about having a “previous vaccine injury or serious reaction” would likely be a reason to not get that vaccine again, as long as the injury or reaction was really caused by the vaccine.
Are there situations in which the potential benefit of vaccination might not outweigh the vaccines risks?
“Events or conditions listed as precautions should be reviewed carefully. Benefits of and risks for administering a specific vaccine to a person under these circumstances should be considered. If the risk from the vaccine is believed to outweigh the benefit, the vaccine should not be administered. If the benefit of vaccination is believed to outweigh the risk, the vaccine should be administered. Whether and when to administer DTaP to children with proven or suspected underlying neurologic disorders should be decided on a case-by-case basis.”
when you aren’t at risk to get a disease and there is little risk that there will be an outbreak in your community or a return if folks stop vaccinating – that’s why we don’t routinely vaccinate against yellow fever, cholera, and typhoid fever, etc. in the United States
“A total of 654 cases were confirmed, with rash onsets between September 30, 2018 and July 15, 2019. Serious complications included hospitalization (52), intensive unit care (19) and pneumonia (34). Multiple international importations of measles introduced into a community with prevalent delays in vaccination among young children propagated this outbreak.”
2019 Health Alert #26: Update on Measles Outbreak in New York City
Of course not!
The New York State Department of Health advises that on all suspected measles cases, “Viral specimens (nasopharyngeal swaband urine) and serology (IgM and IgG) should be obtained for diagnostic testing and confirmation.”
Were these cases all caused by vaccine strain measles, as Larry Palevesky suggests?
Although anti-vax folks often focus on the measles strain when there is an outbreak, all it really helps you do is figure out where the imported cases came from.
Even though health officials didn’t tell us the specific strains involved in the outbreaks, guess what, they did tell us the sources of the outbreak, so it is basically the same thing.
The cases were imported from Israel, UK, and Ukraine.
And the CDC has told us that “All measles cases this year have been caused by measles wild-type D8 or B3.”
“We have to stop blaming, accusing, targeting, ostracizing, condemning unvaccinated children as a health risk, which would then make this subject completely moot.”
What else do we know about the measles outbreak in Brooklyn?
it began in October 2018 “with an unvaccinated child from Brooklyn who acquired measles in Israel”
it included 15 neighborhoods in Brooklyn, with most concentrated in Williamsburg, Borough Park, and Sunset Park
the majority of cases were in children, including at least 91 cases in infants less than 12 months old
the great majority of cases were unvaccinated, with only 27 cases fully vaccinated with two doses of MMR
there were 52 hospitalizations, including 16 ICU admissions
And the outbreak cost over $6 million to control!
The Rockland County measles outbreak ended in late September and is also said to have cost over $6 million to control.
So why do they think they are a hoax?
“There were over 800 kids who the New York State and New York City Department of Health have said were confirmed cases of measles. The real question is, were these really confirmed as per the CDC recommendations. We do not have that data. In fact, anecdotally, New York State told the physicians not to do the tests.”
Is this about the strains again? Is this about the fact that once you know you are in the middle of a huge measles outbreak, you might be able to start diagnosing kids clinically?
“New York State lied when they said that there were confirmed cases. We don’t know what kind of illnesses the kids had. And there’s a set of papers in the literature that specifically state that if the children are found by analysis to have a measles virus infection that is consistent with a side effect of the vaccine, it is important for the Department of Health to alert the public that it was a vaccine strain that caused the outbreak, because a vaccine strain illness should not be equated with a public health emergency. [Applause]”
Yes, it is about the strains…
“So the reality is that when there is a vaccine strain measles outbreak, meaning that the vaccine itself was not properly attenuated, meaning it was more active and virulent than just simply giving an antibody response in the body, when that occurs an outbreak is almost always very very close to the vest, meaning that would explain why it was only seen in two communities out of 62. And if New York state had done the proper testing of the vaccine to see if it was too virulent and of the children who had the measles infection to see what type of measles virus they had, then in all likelihood this was a vaccine strain measles infection which is known to be a side effect of the vaccine and not a public health emergency.”
Is any of that true?
Since we have never had an outbreak of measles from an MMR vaccine that wasn’t properly attenuated, I’m guessing no, it isn’t. Also remember that to control the outbreak, they gave lots and lots of MMR vaccine to unvaccinated folks in those communities…
What about his explanation for why we only saw outbreaks in Brooklyn and Rockland Counties? Well, for one thing, we didn’t. Other areas of New York and of course, around the country have seen a rise in measles. And the outbreaks in Brooklyn and Rockland Counties were caused when unvaccinated folks traveled to Israel, UK, and Ukraine and returned to an area with low immunization rates. They weren’t caused by a bad batch or mutant strains of measles in the MMR vaccine.
“So the New York State Department of Health failed to do their job and instead they lied and said the cases were confirmed and they didn’t do their due diligence to actually evaluate all the possible reasons that an outbreak could have occurred. It’s very strange that two communities where there are lots of people moving through those communities that are non-Jewish, that are outside of the state that are coming through and why just those communities got the illness. That should have raised the red flag that something else was going on and your state failed us.”
That translates into about 500,000 reported cases each year. Technically, it was likely closer to about 4 million cases in the United States each year, but either way, we know that lots of people got measles.
Then we got a measles vaccine and not surprisingly, cases of measles dropped. Except for a small uptick from 1989 to 1991, we were on our way to eliminating measles.
And we did, in 2000, when the endemic spread of measles was eliminated in the United States. From then on, all measles cases were imported.
In 2004, we had an historic low of just 37 measles cases in the United States!
And from 2000 to 2012, we averaged just 87 measles cases each year, which is far below the US average of 283 cases we are now seeing.
No, measles never completely left. It was not eradicated.
But it is certainly making a comeback and soaring to levels that we haven’t seen since 1992!
Just think about it… We had 37 cases of measles in 2004 and this year, we often had 37 cases in a single week!