Rubella in Australia: can we explain two recent cases of congenital rubella syndrome?

Vaccination has lead to a considerable reduction in rubella and congenital rubella syndrome (CRS) in Australia. In 2002, national notifi cation rates for rubella were the lowest on record and there were no notifi ed cases of CRS between 1997 and 2002—in stark contrast to the pre-vaccination era when there were an average of 120 cases of CRS reported annually. It is a concern therefore that two cases of CRS have been reported from Queensland in 2003.1 To investigate possible reasons why these two cases occurred, we reviewed recent surveillance data about rubella incidence, immunity and vaccination coverage.