<unk>  occurs worldwide. The virus tends to peak during the spring in countries with temperate climates. Before the vaccine against<unk>  was introduced in 1969, widespread outbreaks usually occurred every 6–9 years in the United States and 3–5 years in Europe, mostly affecting children in the 5–9 year old age group. Since the introduction of vaccine, occurrences have become rare in those countries with high uptake rates. Vaccination has interrupted the transmission of<unk>  in the Americas: no endemic case has been observed since February 2009. Vaccination is still strongly recommended as the virus could be reintroduced from other continents should vaccination rates in the Americas drop. During the epidemic in the U.S. between 1962 and 1965,<unk>  virus infections during pregnancy were estimated to have caused 30,000 stillbirths and 20,000 children to be born impaired or disabled as a result of CRS. Universal immunisation producing a high level of herd immunity is important in the control of epidemics of<unk> . In the UK, there remains a large population of men susceptible to<unk>  who have not been vaccinated. Outbreaks of<unk>  occurred amongst many young men in the UK in 1993 and in 1996 the infection was transmitted to pregnant women, many of whom were immigrants and were susceptible. Outbreaks still arise, usually in developing countries where the vaccine is not as accessible. The complications encountered in pregnancy from<unk>  infection (miscarriage, fetal death, congenital<unk>  syndrome) are more common in Africa and Southeast Asia at a rate of 121 per 100,000 live births compared to 2 per 100,000 live births in the Americas and Europe. In Japan, 15,000 cases of<unk>  and 43 cases of congenital<unk>  syndrome were reported to the National Epidemiological Surveillance of Infectious Diseases between October 15, 2012, and March 2, 2014, during the 2012–13<unk>  outbreak in Japan. They mainly occurred in men aged 31–51 and young adults aged 24–34.
Rubella
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Ebola
Spanish flu
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Hong Kong flu
Smallpox
Mumps