In the UK in the pre-vaccine era, rubella was uncommon under the age of 5 years, with the peak incidence being at 5 to 10 years of age. Before the licensure of rubella vaccine in the US in 1969, rubella caused late-winter and early-spring epidemics at 3- to 9-year intervals. The incidence of endemic rubella in un-immunised populations was highest in pre-school and young school-age children. In 2004, the US Centers for Disease Control and Prevention (CDC) announced the elimination of endemic rubella in the US. Between 2000 and 2018 there was a 97% decline in reported rubella cases, from 670,894 cases in 102 countries, to 14,621 cases in 151 countries. At present, fewer than 10 people per year in the US are reported as having rubella infection, and since 2012, all those with rubella infections had evidence of becoming infected while living or traveling outside the US. Most cases now affect adolescents and young adults. Hispanic ethnicity was, in the past, an important epidemiological factor, but a region-wide control programme for the Americas was adopted in 1997 and, in 2015, the Pan American Health Organization determined that endemic transmission of rubella in the region had been eliminated. Endemic rubella and congenital rubella syndrome remain a global health problem, primarily of South East Asia and Africa. Outbreaks have been reported in countries where vaccination rates are sub-optimal. The risk to un-immunised travellers to areas where rubella remains endemic may be high.
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