<unk>  infections are prevented by active immunisation programs using live attenuated virus vaccines. Two live attenuated virus vaccines, RA 27/3 and Cendehill strains, were effective in the prevention of adult disease. However their use in prepubertal females did not produce a significant fall in the overall incidence rate of CRS in the UK. Reductions were only achieved by immunisation of all children. The vaccine is now usually given as part of the MMR vaccine. The WHO recommends the first dose be given at 12 to 18 months of age with a second dose at 36 months. Pregnant women are usually tested for immunity to<unk>  early on. Women found to be susceptible are not vaccinated until after the baby is born because the vaccine contains live virus. The immunisation program has been quite successful. Cuba declared the disease eliminated in the 1990s, and in 2004 the Centers for Disease Control and Prevention announced that both the congenital and acquired forms of<unk>  had been eliminated from the United States. The World Health Organisation declared Australia<unk>  free in October 2018. Screening for<unk>  susceptibility by history of vaccination or by serology is recommended in the United States for all women of childbearing age at their first preconception counseling visit to reduce incidence of congenital<unk>  syndrome (CRS). It is recommended that all susceptible non-pregnant women of childbearing age should be offered<unk>  vaccination. Due to concerns about possible teratogenicity, use of MMR vaccine is not recommended during pregnancy. Instead, susceptible pregnant women should be vaccinated as soon as possible in the postpartum period. In susceptible people passive immunization, in the form of polyclonal immunoglobulins appears effective up to the fifth day post-exposure.
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