Making vaccination policy: the experience with rubella

The massive rubella epidemic of 1962-1965 stimulated the development of rubella vaccine. Once vaccines were developed, the U.S. vaccination program, initially focused on infants and children, reduced both rubella and congenital rubella. However, later extension of vaccination to certain older age groups achieved significantly better control. While rubella clearly is not the perfect model for pertussis, a review of its history is illuminating. Current rubella vaccination policies resulted from an evolution in scientific understanding. Controversies, including those related to communicability, reactivity, and teratogenicity of the rubella vaccine virus, duration of immunity following vaccination, and protection following reinfection, led countries to use different approaches for national immunization programs. These differences were eventually resolved by clinical and epidemiological research coupled with rigorous scientific debate. Increased scientific understanding of pertussis, its epidemiology, and the effects of the new pertussis vaccines will similarly enable informed decision making on whether to extend pertussis immunization to adolescents and adults.