Abstract
The last large epidemic of rubella in the United States was in 1964 when almost half a million cases were reported. The National Communicable Disease Center, now the Centers for Disease Control and Prevention, estimated the true size of the 1964 epidemic as 12.5 million cases, and at least 20 000 clinically evident cases of the congenital rubella syndrome (CRS) were subsequently reported.<sup>1</sup>The first rubella vaccine was licensed in the United States in 1969, and from that year on rubella and CRS incidence began to decline. In 1994, there were 227 reported cases of rubella and 7 cases of CRS<sup>2</sup>; in 1995, there were 128 cases of rubella—the lowest number in history—and 6 cases of CRS<sup>3</sup>; and in 1996, there were 210 cases of rubella (CRS data are not yet available).<sup>4</sup>Through June 1997, only 64 cases of rubella had been reported in the United
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