Congenital rubella syndrome and autism spectrum disorder prevented by rubella vaccination - United States, 2001-2010

Prevention estimates were calculated through simple mathematical modeling, with values of model parameters determined from published literature. Model parameters included pre-vaccine era CRS incidence, vaccine era CRS incidence, the number of live births per year, and the percentage of CRS cases presenting with an ASD.Based on our estimates, 16,600 CRS cases (range: 8300-62,250) were prevented by rubella vaccination from 2001 through 2010 in the United States. An estimated 1228 ASD cases were prevented by rubella vaccination in the United States during this time period. Simulating a slight expansion in ASD diagnostic criteria in recent decades, we estimate that a minimum of 830 ASD cases and a maximum of 6225 ASD cases were prevented.We estimate that rubella vaccination prevented substantial numbers of CRS and ASD cases in the United States from 2001 through 2010. These findings provide additional incentive to maintain high measles-mumps-rubella (MMR) vaccination coverage.Rubella is a significant public health concern, as maternal rubella infection during pregnancy can lead to congenital rubella syndrome (CRS) in the fetus [1]. CRS comprises various defects, including deafness, cataracts, encephalitis, heart abnormalities, and mental retardation, among others [1,2]. The severity of CRS depends on the time of infection during gestation, with the most serious complications resulting from maternal infection in the first trimester [2]. The largest rubella epidemic occurred in the United States in the mid-1960s, when more than 20,000 children were born with CRS after an outbreak of over 12.5 million cases of rubella during 1963-1965 [3-5]. Prenatal rubella infection also led to thousands of fetal and infant deaths [6].After the epidemic, several large-scale studies were conducted on the so-called "rubella children," establishing a firm link between prenatal rubella infection and congenital disorders [1,3,4]. Moreover, Chess found that autism is one of the many outcomes a