The following recommended changes are similar to, but not identical with, those recommended by the US Public Health Service Advisory Committee on Immunization Practices in November 1978.1 These changes focus on more effective delivery of the vaccine to older individuals, in particular to females in the childbearing age group. All comments related to the vaccine and its use pertain to all licensed vaccines available in the United States, including the recently licensed RA27/3 vaccine.
The major objective of the National Rubella Immunization Program is the prevention of rubella infection in early pregnancy, which in turn will prevent infection of the fetus and consequent congenital rubella. Prior to vaccine licensure in 1969, approximately 15% of women of childbearing age were susceptible to rubella. At the present time, more than 83 million doses of live, attenuated rubella virus vaccine have been distributed in the United States, which has clearly resulted in a widespread reduction of epidemic rubella in preschool-and elementary school-aged children. However, since the use of rubella vaccine has not been universal in the target population (only about two thirds of the children 1 to 12 years old have been immunized) and since vaccine usage has disrupted the epidemic nature of rubella, the population for whom antibody protection is desired (women of childbearing age) is still suspected of being as susceptible, or more so, than in the prevaccine era. Indeed, serologic surveys indicate that persons in this age group have a percentage of susceptibility similar to that noted prior to 1969.