Rubella and Congenital Rubella Syndrome Worldwide, 2012–2024: 117 Countries Rubella-Free

Rubella is usually a mild fever-and-rash illness in children and adults, but it is the leading cause of vaccine-preventable birth defects in the world. Infection in pregnancy — especially the first trimester — can cause miscarriage, fetal death, stillbirth, or a set of birth defects called congenital rubella syndrome (CRS). One dose of rubella-containing vaccine (RCV) gives lifelong protection.

Global targets

• 2011: the World Health Organization (WHO) recommended RCV for countries with high measles vaccination coverage (generally 80% or more with a first measles dose), alongside CRS surveillance.
• 2024: WHO's Strategic Advisory Group of Experts on Immunization (SAGE) dropped that condition and recommended RCV for every country, with a wide age-range campaign when it is introduced.
• Rubella elimination is a core goal of the Measles and Rubella Strategic Framework 2021–2030 under the Immunization Agenda 2030. Five of six WHO regions had adopted elimination goals by 2024; the Eastern Mediterranean Region made it all six in 2025.

Progress, 2012–2024

Figure 1. Countries with rubella vaccine in their routine schedules, and with verified elimination, 2012–2024. CDC.

Vaccination

• Every country in the Americas, European, South-East Asia and Western Pacific regions uses RCV; the African Region is at 35 of 47 countries and the Eastern Mediterranean at 18 of 21.
• Among low-income countries, use rose from 11% of 36 in 2012 to 16 of 26 (62%) in 2024; among lower-middle-income countries, from 50% of 46 to 46 of 49 (94%).
• 2024 coverage ranged from 37% (African Region) to 96% (South-East Asia). By income: 30% in low-income countries, 79% lower-middle, 87% upper-middle, 93% high. In countries using RCV, it was 82% (low-income), 81%, 88% and 94% (high-income).

Cases

• Reported rubella cases fell 80% from 2012 to 18,881 in 2022, then rose to 31,593 in 2024. The burden moved: most 2012 cases were in the Western Pacific and Europe; by 2024 the African Region reported the most. In 2023 and 2024, two countries accounted for 60% and 67% of global cases.
• Reported CRS cases rose — 302 in 2012, 424 in 2019, 611 in 2024 — largely because CRS surveillance began or expanded in populous countries including Afghanistan, Bangladesh, India, Indonesia and Pakistan.
• Modeled CRS cases, which correct for under-reporting, fell 73.5%. In 2024 the African Region had 89.1% of them; the Eastern Mediterranean dropped 65.6% after 2019; South-East Asia (under one case), the Americas (two) and the Western Pacific (three) had almost none.

Figure 2. Reported rubella cases by region, 2012–2024. CDC.

Genetic surveillance: of 6,792 rubella viruses sequenced from 49 countries, 56% were genotype 1E and 43% 2B — most from China (65%) and Japan (26%); many countries send no sequences at all.

Elimination

A country interrupts endemic transmission after 12 months without it, and is verified as having eliminated rubella after 36 months, with adequate surveillance, by an independent regional commission.

Kuwait and Qatar had passed 12 months without endemic spread but not yet 36. No country that eliminated rubella has seen it re-established.

What remains

• In 2024 about 21 million infants aged 12–23 months — 16% of the world's birth cohort — lived in the 15 countries without RCV, mostly low-income or conflict-affected.
• The 2023–2024 rise in cases came from Chad and Nigeria, which lacked RCV, and South Africa during its rollout. Nigeria and the Democratic Republic of the Congo are introducing RCV in 2025–2026.
• While rubella circulates anywhere, importations remain a risk everywhere.

Getting there will take RCV in every remaining country, catch-up campaigns across wide age ranges at introduction, stronger routine immunization and surveillance, efforts to reach unvaccinated communities — and perhaps adolescents and adults of childbearing age.

Limitations: surveillance and immunization data vary in quality; COVID-19 disrupted reporting, and some countries have not recovered; and the CRS model depends on incomplete serosurvey data and simplifying assumptions.

Sources

Based on Dahlke M, Dautel KA, Vynnycky E, Still C, Papadopoulos T, Kabore HJ, Singh T, Zimmerman LA, Morales M, "Progress Toward Rubella and Congenital Rubella Syndrome Elimination — Worldwide, 2012–2024," MMWR Morbidity and Mortality Weekly Report, volume 75, Centers for Disease Control and Prevention; a work of the United States government in the public domain.