Rubella epidemic and the rubella vaccine

Rubella was long taken for a variant of measles or scarlet fever. It was first described as a separate disease in German medical writing in 1814, which is why it was called German measles. In 1941, after a widespread epidemic the year before, the Australian ophthalmologist Norman Gregg reported cataracts in infants whose mothers had caught it in pregnancy. Infection in pregnancy can cause miscarriage or stillbirth, and the children who survive may have congenital rubella syndrome: deafness, cataracts, glaucoma and other eye damage, and heart defects.

The virus was isolated in 1962 by two groups working independently, Paul Parkman and colleagues, and Thomas Weller and Franklin Neva. A worldwide pandemic ran from 1962 to 1965. In the United States in 1964 and 1965 there were an estimated 12.5 million cases, with 2,000 cases of encephalitis, 11,250 therapeutic or spontaneous abortions, 2,100 deaths of newborns and 20,000 infants born with congenital rubella syndrome. Of those children, 11,000 were deaf, 3,500 blind and 1,800 intellectually disabled. Some of the abortions were performed after women were told of the risks of rubella in pregnancy.

Live attenuated rubella vaccines were licensed in the United States in 1969. Maurice Hilleman developed one from virus obtained from Paul Parkman and Harry Meyer of the Division of Biologics Standards, and it went into the combined measles, mumps and rubella vaccine licensed in 1971. In 1979 the RA27/3 strain developed by Stanley Plotkin, already used in Europe, replaced it in the United States.

Reported cases fell sharply after 1969. Outbreaks after the vaccine arrived led to recommendations to vaccinate susceptible women after puberty, adolescents, military recruits and college students. Endemic rubella and congenital rubella syndrome were declared eliminated from the United States in 2004, and endemic transmission in the Americas stopped in 2009. All nine cases of the syndrome reported in the United States from 2004 to 2014 were linked to importation or had no known source.