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Issue Number 517            March 28, 2005


  1. CDC announces the elimination of rubella and congenital rubella syndrome in the United States
  2. CDC posts new NIIW resources to the NIP website, offers a technical assistance teleconference on March 29 and 31
  3. Note: On March 29, IAC will publish an Unprotected People report about recent varicella deaths in the United States
  4. CDC reports on varicella surveillance in Oregon public elementary schools
  5. New: The March issue of CDC's Immunization Works electronic newsletter is now available on the NIP website
  6. CDC reports on progress toward polio eradication in Afghanistan and Pakistan in 2004-05


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ABBREVIATIONS: AAFP, American Academy of Family Physicians; AAP, American Academy of Pediatrics; ACIP, Advisory Committee on Immunization Practices; CDC, Centers for Disease Control and Prevention; FDA, Food and Drug Administration; IAC, Immunization Action Coalition; MMWR, Morbidity and Mortality Weekly Report; NIP, National Immunization Program; VIS, Vaccine Information Statement; VPD, vaccine-preventable disease; WHO, World Health Organization.

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March 28, 2005

On March 21, CDC issued a press release announcing a significant public health achievement: the elimination of rubella and congenital rubella syndrome in the United States. Also on March 21, MMWR published an electronic Early Release on the same topic. The press release is reprinted below in its entirety. The URL for the Early Release is given at the end of this article.


For immediate release
March 21, 2005


A major public health milestone has been achieved in the United States--the rubella virus, a major cause of serious birth defects such as deafness and blindness, also known as congenital rubella syndrome (CRS), is no longer considered to be a major public health threat in the United States, Dr. Julie Gerberding, director, Centers for Disease Control and Prevention, announced at the National Immunization Conference today in Washington, DC.

"The elimination of rubella in the United States is a tremendous step in protecting the health and well being of pregnant women and infants," said Dr. Gerberding. "A disease that once seriously harmed tens of thousands of infants is no longer a major health threat, thanks to a safe and effective vaccine and successful immunization programs across the country. We should take pride in this accomplishment, and also recognize that we must maintain our vigilance or we can see a resurgence of disease."

Currently about 93 percent of the nation's children under age two are vaccinated against measles, mumps, and rubella, according to the CDC's National Immunization Survey. More than 95 percent of the nation's children are vaccinated against rubella by the time they enter school. "The importance of continuing vaccination cannot be emphasized enough," said Dr. Steve Cochi, acting director, CDC's National Immunization Program. "Cases of rubella continue to be brought into the country by worldwide travelers and because of bordering countries where the disease is active."

During 1964 and 1965 a rubella epidemic in the United States caused an estimated 12.5 million cases of rubella and 20,000 cases of congenital rubella syndrome (CRS), which led to more than 11,600 babies born deaf, 11,250 fetal deaths, 2,100 neonatal deaths, 3,580 babies born blind, and 1,800 babies born mentally retarded.

Since reporting of rubella began in 1966, the largest number of rubella cases reported was in 1969 with 57,686 cases. Following vaccine licensure in 1969 and development of a rubella vaccination program to prevent rubella infection during pregnancy, rubella incidence fell rapidly. By 1983, fewer than 1,000 cases were reported per year.

In 1989, CDC established a rubella elimination goal. [D]espite a resurgence in rubella and measles cases during the measles epidemic from 1989-1991, reported rubella cases in the 1990s declined to all-time low numbers. From 1990 through 1999, only 117 cases of CRS were reported; 66 of these babies were born in 1990 and 1991. In 2001, for the first time in history, [fewer] than 100 cases were reported in the United States. In 2003, there were only eight rubella cases and one CRS case reported in the United States. In 2004, there were only nine rubella cases reported in the United States.

Since the mid-1990s, the United States has worked closely with the Pan American Health Organization (PAHO) and Mexico to improve rubella control in the Americas. Those efforts have resulted in dramatic reductions of rubella in many nations of the Americas. In September 2003, ministers of health of all countries in the Americas resolved to eliminate rubella and CRS by 2010.

Last fall, an independent panel including internationally recognized immunization experts from academia, the Council for State and Territorial Epidemiologists (CSTE), the Advisory Committee on Immunization Practices (ACIP), the American Academy of Pediatrics (AAP), the American Academy of Family Physicians (AAFP), the Pan American Health Organization, Mexico, and the CDC concluded that rubella virus in no longer endemic in the United States.

Rubella is prevented through vaccination. Rubella vaccine is recommended for all children and for adolescents and adults without documented evidence of immunity. It is especially important to verify that all women of childbearing age are immune to rubella before they get pregnant.

Although it is available as a single preparation, it is recommended that rubella vaccine be given as MMR vaccine (protecting against measles, mumps, and rubella). The first dose of MMR should be given on or after the first birthday; the recommended range is from 12-15 months. The second dose is usually given when the child is 4-6 years old, or before he or she enters kindergarten or first grade. Maintaining high coverage and rubella population immunity in the United States among children and adults will be important to maintain the benefits of achieving rubella elimination.


To access a web-text (HTML) version of the press release, go to:

CDC published "Achievements in Public Health: Elimination of Rubella and Congenital Rubella Syndrome--United States, 1969-2004" in the March 21 issue of MMWR Early Release.

To access a web-text (HTML) version of it, go to:

To access a ready-to-print (PDF) version of it, go to:

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March 28, 2005

The March issue of CDC's Immunization Works electronic newsletter features information about resources for National Infant Immunization Week (NIIW). The information is reprinted below in its entirety.


NATIONAL INFANT IMMUNIZATION WEEK: National Infant Immunization Week (NIIW) will be held April 24-30, 2005. This week is set aside annually to promote, through community events, the benefits of immunizations and highlight the importance of vaccinating children by the age of 2. This year, NIIW will again be held in conjunction with the Pan American Health Organization's Vaccination Week in the Americas (VWA), April 23-30, 2005. The U.S. and 35 countries in the Western Hemisphere will promote the need for routine vaccinations for infants and children.

To assist communities in promoting infant immunization during NIIW-VWA, CDC has English- and Spanish-language resources to support local NIIW activities. Materials and planning tools are available online at and include

  • Posters
  • Web Buttons and Banners
  • Television Public Service Announcements (PSAs); available online the week of March 28
  • Radio Public Service Announcements (PSAs); available online the week of March 28
  • Sample Key Messages
  • Sample Media Advisory
  • Sample Proclamations
  • Stickers
  • And more!

New this year--NIP will provide two teleconferences so that program coordinators, health departments, coalitions, and others can learn about the 2005 Spanish- and English-language childhood campaign materials, television PSA satellite downlink information, and tips for local placement of the campaign, especially through minority media outlets. Teleconferences will be held on March 29 at noon-1 p.m. (EST) and March 31 at 3 p.m.–4 p.m. (EST), and will be led by NIP's childhood campaign contractor, HMA Associates, Inc., a nationally recognized full-service multicultural marketing firm comprising social marketing and public relations veterans with a variety of communications backgrounds. To register for the teleconference and receive connection information and materials, please email Cindy Alvarez at

Numerous events are planned in the United States to celebrate NIIW-VWA. Other activities are also scheduled throughout the Western Hemisphere as part of VWA. Find out how others will celebrate NIIW-VWA, and let us know what you are doing to promote childhood immunization during the week, by adding your events to the national NIIW-VWA event listing located at


To access this information from the March issue of Immunization Works, go to:

For additional material from the March issue of Immunization Works, see article #5 below.

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March 28, 2005

On March 29, IAC will publish an IAC Express Unprotected People report about three recent varicella deaths in the United States. The report is based on information reported to CDC by public health professionals in Arizona, Arkansas, and New York.

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March 28, 2005

CDC published "Varicella Surveillance in Public Elementary Schools--Multnomah County, Oregon, 2002-2004" in the March 25 issue of MMWR. A portion of a summary made available to the press is reprinted below.


Varicella vaccination may be reducing the occurrence of chickenpox in Multnomah County public elementary schools: cases reported for the 2003-04 school year were 30 percent lower than [for] the previous school year, and the actual numbers were small (86 and 114, respectively). Surveillance for chickenpox is being conducted in Multnomah County public elementary schools by the Oregon Department of Health Services and the Multnomah Education Services District. Reports of chickenpox cases are collected from school nurses.


To access a web-text (HTML) version of the complete article, go to:

To access a ready-to-print (PDF) version of this issue of MMWR, go to:

To receive a FREE electronic subscription to MMWR (which includes new ACIP statements), go to:

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March 28, 2005

The March issue of Immunization Works, a monthly email newsletter published by CDC, is available on NIP's website. The newsletter offers members of the immunization community non-proprietary information about current topics. CDC encourages its wide dissemination.

Some of the information in the March issue has already appeared in previous issues of IAC Express. Following is the text of four articles we have not covered. One article, "National Infant Immunization Week," appears in this issue of IAC Express as article #2 (above).


50TH ANNIVERSARY OF THE SALK POLIO VACCINE: April 12, 1955, heralds a unique moment in our contemporary culture. That was the date that culminated more than 17 years of unparalleled research that led to the development and distribution of the first inactivated poliovirus vaccine by Dr. Jonas Salk and other colleagues. The development of the vaccine was an accomplishment that ended an era of global fear of a dreaded contagious disease, and in the process, reshaped the conduct of science, the funding of science, and the public's role in the support of science. These efforts impacted the way that public health was administered and advanced the general understanding of ways basic scientific research benefited humanity though collaboration between academic, philanthropic, and government institutions. April 12, 2005, marks the 50th anniversary of the announcement that a safe, potent, and effective vaccine against polio had been found.

The fight against polio brought together communities in a national collaboration that at that time was the largest human cooperative effort in history. In the days leading up to the vaccine's approval, children in communities across the United States participated in the field trials as America's "Polio Pioneers." Thousands of healthcare workers and lay people volunteered their time to assist with the vaccine field trials, the largest ever in United States history. Millions of Americans participated by raising funds in their communities to support the larger research effort and a single goal: victory over polio.

Although polio was eliminated from the Americas in 1994, the disease still circulates in Asia and Africa, paralyzing the world's most vulnerable children. In a continually shrinking world, polio and other vaccine-preventable diseases remain only a plane ride away. The Global Polio Eradication Initiative, spearheaded by the World Health Organization, Rotary International, CDC, and UNICEF, was begun in 1988. That year, an estimated 350,000 children were paralyzed with polio worldwide; in 2004, polio cases had fallen to just over 1,200 cases globally. The Initiative's success will be a triumph of international cooperation, attesting to our ability to unite across borders and differences to conquer global public health issues.

Since the introduction of the vaccine, great strides have been made in significantly reducing the health impact of vaccine-preventable diseases on children and adults worldwide. We can now protect children from more than 12 vaccine-preventable diseases, and disease rates have been reduced by 99% in the U.S. Yet, without diligent efforts to maintain immunization programs in the U.S. and strengthen them worldwide, the diseases seen 50 years ago remain a threat to our children.

Commemorative Events
Public events, which will be occurring on April 12, include the opening of a year-long exhibit at the Smithsonian's National Museum of American History on "Whatever Happened to Polio," as well as symposiums at the University of Michigan (where the trials were conducted) and the University of Pittsburgh (where the vaccine was discovered).

In an effort to promote the anniversary, CDC has information related to the anniversary available on our website. The information includes timelines, background information, links to key organizations, and general promotional materials. The information may be found at

This day is a powerful marker that can be used to create sustainable, proactive awareness and action in vaccine-preventable diseases and public health nationally and globally. As we approach the 50th anniversary of the discovery of polio vaccine, we have a unique opportunity to leverage history to create a better future for our children.



DISCONTINUATION OF NATIONAL REPORTING OF INVASIVE PNEUMOCOCCAL DISEASE IN CHILDREN VACCINATED WITH PNEUMOCOCCAL CONJUGATE VACCINE (PCV7): CDC is no longer requesting reports of cases of invasive pneumococcal disease occurring in children who have received the pneumococcal conjugate vaccine. For the last several years, CDC has requested these reports and has been analyzing the strains to evaluate possible vaccine failures. Because the number of reported cases in vaccinated children is now adequate to permit analysis, and surveillance data indicate that the disease rates have dropped dramatically, these reports are no longer needed. In special situations requiring the typing of pneumococci, CDC should be contacted at (404) 639-2215. We are grateful for the efforts of those who have participated in this reporting system during the last few years.


CDC VACCINE SAFETY ACTIVITIES: CDC is taking an initial series of four steps to build a more robust vaccine safety activity to keep pace with the increasing number and combinations of recommended immunizations, especially for children under 2. CDC's initial steps to strengthen efforts to protect children's health and safety include the following:

  • Increasing the resources for immunization safety research and immunization safety activities,
  • Working with sister agencies in the Department of Health and Human Services to define vaccine safety research and safety monitoring priorities and agenda for addressing gaps,
  • Separating the vaccine safety activity from CDC's immunization education and recommendation programs and moving the vaccine safety activity to CDC's Office of the Chief of Science, and
  • Emphasizing the transparency of CDC's science and research work regarding immunization safety issues with continued communication between it and concerned parents, public officials, and healthcare professionals.

When making immunization recommendations, CDC is committed to a scientifically thorough and transparent decision process. We intend to make our safety program even stronger and respect ongoing input from those who share our concerns. Although no single step can satisfy everyone, we believe these new actions will help reassure the public that we are absolutely committed to protecting our children's health and safety.



CDC-WIDE RESEARCH AGENDA: CDC is developing a CDC-Wide Research Agenda and invites the public to provide input during four Public Participation Meetings held during March 2005. Meetings have already been held in Washington, DC, and Atlanta, GA. A meeting is scheduled in Seattle, WA, March 24 and in Columbus, OH, March 31. To attend these meetings, please register at Additional information on development of the CDC-Wide Research Agenda is available by visiting The Infectious Diseases Workgroup has developed agenda themes specific to immunization. Other topics of interests are integrated generally across many of the other five workgroups--Health Promotion; Environmental and Occupational Health and Injury Prevention; Health Information and Services; Global Health; and Community Preparedness and Response. Future opportunities for comment on the CDC-Wide Research agenda will be announced in the Federal Register in June 2005.


To access the complete March issue from the NIP website, go to:

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March 28, 2005

CDC published "Progress Toward Poliomyelitis Eradication--Afghanistan and Pakistan, January 2004-February 2005" in the March 25 issue of MMWR. A portion of a summary made available to the press is reprinted below.


Although poliomyelitis remained endemic in six countries at the end of 2003, progress toward interrupting poliovirus transmission continued during 2004 in Afghanistan and Pakistan, which with India are the only countries in Asia where poliomyelitis is endemic. From 2003 to 2004, the number of reported polio cases decreased approximately 50 percent in both countries. Although the quality of national and sub-national immunization campaigns is improving, children are still being missed. The achievements to date toward eradicating polio in Afghanistan and Pakistan would not have been possible without continued support from the international polio partnership, especially from political and health leaders at national, provincial, and district levels in both countries. With continued support, elimination of poliomyelitis in both countries can be accomplished by the end of 2005.


To access a web-text (HTML) version of the complete article, go to:

To access a ready-to-print (PDF) version of this issue of MMWR, go to:

About IZ Express

IZ Express is supported in part by Grant No. 1NH23IP922654 from CDC’s National Center for Immunization and Respiratory Diseases. Its contents are solely the responsibility of and do not necessarily represent the official views of CDC.

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ISSN 2771-8085

Editorial Information

  • Editor-in-Chief
    Kelly L. Moore, MD, MPH
  • Managing Editor
    John D. Grabenstein, RPh, PhD
  • Associate Editor
    Sharon G. Humiston, MD, MPH
  • Writer/Publication Coordinator
    Taryn Chapman, MS
    Courtnay Londo, MA
  • Style and Copy Editor
    Marian Deegan, JD
  • Web Edition Managers
    Arkady Shakhnovich
    Jermaine Royes
  • Contributing Writer
    Laurel H. Wood, MPA
  • Technical Reviewer
    Kayla Ohlde

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