Cases of congenital rubella syndrome have fallen by almost three quarters since 2012, according to figures published by the US Centers for Disease Control and Prevention (CDC).

The fall in birth defects tracks the growing coverage of the vaccine, now part of routine childhood immunisation in 179 of the world's 194 countries, up from 132 in 2012.

Congenital rubella syndrome can cause serious long-term birth defects. Children with the syndrome can suffer hearing impairments, eye and congenital heart defects, as well as developmental delay.

Wider reach

Rubella is a mild enough infection in children and adults to pass unnoticed.

However, it can be dangerous if women are infected when they are pregnant, causing miscarriage, stillbirth or the group of birth defects known as congenital rubella syndrome (CRS).

Congenital rubella syndrome can cause serious long-term birth defects. Children with the syndrome can suffer hearing impairments, eye and congenital heart defects, as well as developmental delay.

In 2012, when accelerated rubella control efforts began, 132 of the world’s 194 countries offered rubella vaccine as part of routine childhood immunisation.

By 2024, that had risen to 179 countries. Coverage increased with it: the share of infants aged 12 to 23 months receiving a first dose rose from 39% in 2012 to 73% in 2024.

Modelled estimates in the report suggest cases of congenital rubella syndrome fell by 73.5% over the same period, from around 101,000 a year to roughly 27,000.

The number of countries verified as having eliminated rubella has also climbed, from 84 in 2019 to 117 by the end of 2024. That is 60% of all countries.

Where the gap sits

However, by 2024, 15 countries had still not introduced the vaccine. Between them, they are home to about 21 million infants aged 12 to 23 months, or 16% of the world’s babies. Most are low-income or affected by conflict, among them Afghanistan, Chad, the Democratic Republic of the Congo (DRC), Ethiopia, Niger, Nigeria, Somalia and South Sudan.

The imbalance shows up sharply by region. Coverage in the African Region stood at 37% in 2024, against 96% in the South-East Asia Region. The African Region accounted for 89.1% of the world's estimated cases of congenital rubella syndrome that year.

Coverage across low-income countries as a group was 30% in 2024. That average includes the countries where the vaccine is not offered at all and coverage is therefore zero.

However, among low-income countries that have introduced it, coverage reached 82%, slightly above the 81% recorded across lower middle-income countries.

The obstacle is getting the vaccine into the schedule, not delivering it once it is there.

Cases rose again in 2024

Reported rubella cases dropped steeply for most of the period, from 94,277 in 2012 to 18,881 in 2022, before rising again to 31,593 in 2024.

The report attributes that rise to three countries. Chad and Nigeria had not introduced the vaccine and South Africa was in the middle of rolling it out. South Africa reported 15,100 cases in 2024 and Chad 6,177.

Reported cases of congenital rubella syndrome also went up, from 302 in 2012 to 611 in 2024.

The authors say this most likely reflects better detection rather than more disease, following the expansion of surveillance in several large countries including Afghanistan, Bangladesh, India, Indonesia and Pakistan.

What happens next

Nigeria and the Democratic Republic of the Congo (DRC) have been introducing the vaccine during 2025 and 2026, which the report expects to cut the number of unprotected infants substantially.

Nigeria began in October 2025 with an integrated measles, rubella and polio campaign run by its National Primary Health Care Development Agency with support from WHO, UNICEF, Gavi, Rotary and the Gates Foundation. It is designed to reach around 106 million children, and moved into its southern phase in January 2026.

Policy has shifted too. Until 2024, WHO advised countries to introduce rubella vaccine only once they had reached and could sustain high measles vaccination coverage.

Its Strategic Advisory Group of Experts dropped that condition in 2024 and now recommends that every country introduce it. In 2025 the Eastern Mediterranean Region adopted an elimination goal, meaning all six WHO regions now have formal targets.

Reassuringly, no country that has achieved rubella elimination has seen endemic transmission return.

The authors conclude that global elimination is feasible. Achieving it depends on the remaining countries introducing the vaccine and on all countries continuing to invest in immunisation and surveillance systems.