In 1993 the MMR vaccine was withdrawn in Japan due to high rates of aseptic meningitis from the mumps component. This was followed in 1994 by removal of the vaccine requirements to attend school. The result? A marked increase vaccine-preventable illness. 11,991 cases of rubella in the first six months of 2013 with 10 cases of congenital rubella. 76% of cases were in the unvaccinated. For comparison:
2004–2012, 79 cases of rubella and six cases of CRS were reported in the United States; all of the cases were import-associated or from unknown sources.
