Background

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 associated with CRS.[7]

Using simple mathematical modeling, we calculated the number of CRS and ASD cases that were prevented by rubella vaccination in the United States from 2001 through 2010. We also performed sensitivity analyses to examine how changes in certain model parameters affect these prevention estimates.