Editing Rubella (section)

==Epidemiology==
Rubella occurs worldwide. The virus tends to peak during the spring in countries with temperate climates. Before the vaccine against rubella was introduced in 1969, widespread outbreaks usually occurred every 6–9 years in the United States and 3–5 years in [[Europe]], mostly affecting children in the 5–9 year old age group.<ref name="pmid11798368">{{cite journal |vauthors=Reef SE, Frey TK, Theall K, et al. |title=The changing epidemiology of rubella in the 1990s: on the verge of elimination and new challenges for control and prevention|journal= [[JAMA]]|volume=287|issue=4|pages=464–72|year=2002|pmid=11798368|doi=10.1001/jama.287.4.464|doi-access=free}}</ref> Since the introduction of vaccine, occurrences have become rare in those countries with high uptake rates.{{citation needed|date=June 2021}}

Vaccination has interrupted the transmission of rubella in the [[Americas]]: no endemic case has been observed since February 2009.<ref>{{cite web |url=http://new.paho.org/hq/index.php?option=com_docman&task=cat_view&gid=2010&Itemid=673 |title= Rubella Watch| website= PAHO.org| publisher= Pan American Health Organization, World Health Organization |url-status=live |archive-url= https://web.archive.org/web/20110612181019/http://new.paho.org/hq/index.php?option=com_docman&task=cat_view&gid=2010&Itemid=673 |archive-date=2011-06-12 |accessdate= 2010-04-10}}</ref> Vaccination is still strongly recommended as the virus could be reintroduced from other continents should vaccination rates in the Americas drop.<ref>{{Cite web|url=https://www.cdc.gov/rubella/about/in-the-us.html|title=Rubella {{!}} Rubella in the United States|publisher=Centers for Disease Control and Prevention|date=2017-09-12|website=www.cdc.gov|language=en-us|access-date=2018-10-21|archive-date=2018-12-07|archive-url=https://web.archive.org/web/20181207180248/https://www.cdc.gov/rubella/about/in-the-us.html|url-status=live}}</ref> During the [[1962–1965 rubella epidemic|epidemic in the US between 1962 and 1965]], rubella virus infections during pregnancy were estimated to have caused 30,000 stillbirths and 20,000 children to be born impaired or disabled as a result of CRS.<ref name="pmid11348695">{{cite journal|author=Plotkin SA|title=Rubella eradication|journal = [[Vaccine (journal)|Vaccine]]|volume=19|issue=25–26|pages=3311–9|year=2001|pmid=11348695|doi=10.1016/S0264-410X(01)00073-1}}</ref><ref>{{cite book |first=L.Z. |last=Cooper |chapter=Congenital Rubella in the United States |editor=Krugman S Gershon A |title=Symposium on Infections Of the Fetus and Newborn Infant |publisher=Alan R. Liss  |location=New York |year=1975 |isbn=978-0-8451-0003-5 |pages=1– }}</ref> Universal immunisation producing a high level of [[herd immunity]] is important in the control of epidemics of rubella.<ref name="pmid11105178">{{cite journal |vauthors=Danovaro-Holliday MC, LeBaron CW, Allensworth C, etal |title=A large rubella outbreak with spread from the workplace to the community|journal=JAMA|volume=284|issue=21|pages=2733–9|year=2000|pmid=11105178|doi=10.1001/jama.284.21.2733|doi-access=free}}</ref>

In the [[United Kingdom|UK]], there remains a large population of men susceptible to rubella who have not been vaccinated. Outbreaks of rubella occurred amongst many young men in the UK in 1993 and in 1996 the infection was transmitted to pregnant women, many of whom were immigrants and were susceptible. Outbreaks still arise, usually in [[developing country|developing countries]] where the vaccine is not as accessible.<ref name="pmid16989272">{{cite journal|author=Reef S|title=Rubella Mass Campaigns|journal=Curr. Top. Microbiol. Immunol.|volume=304|pages=221–9|year=2006|pmid=16989272|doi=10.1007/3-540-36583-4_12}}</ref> The complications encountered in pregnancy from rubella infection (miscarriage, fetal death, congenital rubella syndrome) are more common in Africa and Southeast Asia at a rate of 121 per 100,000 live births compared to 2 per 100,000 live births in the Americas and Europe.<ref>{{Cite journal |last1=Di Pietrantonj |first1=Carlo |last2=Rivetti |first2=Alessandro |last3=Marchione |first3=Pasquale |last4=Debalini |first4=Maria Grazia |last5=Demicheli |first5=Vittorio |date=2021-11-22 |title=Vaccines for measles, mumps, rubella, and varicella in children |journal=The Cochrane Database of Systematic Reviews |volume=2021 |issue=11 |pages=CD004407 |doi=10.1002/14651858.CD004407.pub5 |issn=1469-493X |pmc=8607336 |pmid=34806766}}</ref>

In [[Japan]], 15,000 cases of rubella and 43 cases of congenital rubella syndrome were reported to the National Epidemiological Surveillance of Infectious Diseases between October 15, 2012, and March 2, 2014, during the 2012–13 rubella outbreak in Japan. They mainly occurred in men aged 31–51 and young adults aged 24–34.<ref>{{Cite journal|last1=Ujiie|first1=Mugen|last2=Nabae|first2=Koji|last3=Shobayashi|first3=Tokuaki|s2cid=2939503|date=2014-04-26|title=Rubella outbreak in Japan|journal=The Lancet|language=en|volume=383|issue=9927|doi=10.1016/S0140-6736(14)60712-1|pmid=24766958|issn=0140-6736|pages=1460–1461|doi-access=free}}</ref>