Introduction.Rubella is a viral disease caused by the rubella virus. Together with measles and varicella, it belongs to the group of febrile rashes. Although the clinical course is mild in both children and adults, infection during pregnancy can lead to serious congenital malformations in the fetus. The consequences of such an infection can be blindness, deafness, heart defects in newborns, but also stillbirths. Vaccination against rubella is crucial in medicine and is important for controlling and eradicating the disease. The vaccine mandatorily administered to children in the Republic of Serbia according to the vaccination calendar is the MMR vaccine. The MMR vaccine is a live virus vaccine that is administered to infants after the age of one, i.e., in the second year of life. The booster vaccination is given in the seventh year of life before entering elementary school. Regular vaccinations against this disease are carried out worldwide. This research aimed to analyze the impact of the COVID-19 pandemic on the rubella vaccination rate by following trends in immunization before, during, and after the pandemic. Research Methodology. The research is conducted by analyzing data from official health sources and the immunization database from health institutions and institutions in the period 2014 - 2024 for the territory of the Šumadija District. Descriptive statistics were applied to analyze annual vaccination rates and comparative analysis before, during, and after the Coronavirus pandemic. Results and Discussion. The COVID-19 pandemic led to a different organization in the functioning of the health system, especially primary health care. All of this affected the coverage of vaccinations against infectious diseases, which are legally mandatory according to the vaccination calendar in our country. The analysis of statistically processed data showed a significant drop in the MMR vaccination rate during the COVID-19 pandemic. Before the pandemic, vaccination coverage in the territory of Šumadija District was more than 95%, so immunization with the MMR vaccine was successfully carried out. During and immediately after the Coronavirus pandemic, vaccination coverage was drastically reduced, and it was observed that the COVID-19 pandemic harmed the mandatory vaccination that is applied in our country. Conclusion. It is important to implement a strategy for compensating for missed vaccines through population education and strengthening immunization systems and programs to increase collective immunity and reduce the possibility of rubella epidemics.

1. A. L. Lopez et al., “Rubella and Congenital Rubella Syndrome in the Philippines: A Systematic Review,” Int. J. Pediatr., 8158712, 2016.
   DOI: 10.1155/2016/8158712
   PMid: 28115948
   PMCid: PMC5225339
2. G. Adamo et al., “The end of measles and congenital rubella: an achievable dream?” Ann. Ig., vol. 29, no. 1, pp. 1 – 26, Jan.-Feb. 2017.
   DOI: 10.7416/ai.2017.2128
   PMid: 28067934
3. Elimination of measles and rubella in the WHO European Region: progress report 2022, WHO Regional Office for Europe, Copenhagen, Denmark, 2023.
   Retrieved from: https://www.who.int/europe/publications
   Retrieved on: Nov. 7, 2025.
4. N. V. Motaze et al., “The Impact of Rubella Vaccine Introduction on Rubella Infection and Congenital Rubella Syndrome: A Systematic Review of Mathematical Modelling Studies,” Vaccines, vol. 9, no. 2, 84, Jan. 2021.
   DOI: 10.3390/vaccines9020084
   PMid: 33503898
   PMCid: PMC7912610
5. Rubella (German measles): Key facts, WHO Fact Sheet, Geneva, Switzerland, 2024.
   Retrieved from: https://www.who.int/news-room/fact-sheets/detail/rubella
   Retrieved on: Nov. 9, 2025.
6. L. C. De Melo et al., “Congenital Rubella Syndrome in the Post-Elimination Era: Why Vigilance Remains Essential,” J. Clin. Med., vol. 14, no. 11, 3986, Jun. 2025.
   DOI: 10.3390/jcm14113986
   PMid: 40507747
   PMCid: PMC12156454
7. Y. C. Xue, P. Ren, “Diagnostic Approaches for Measles Virus: Methods, Advances, and Ongoing Challenges,” Pathogens, vol. 14, no. 12, 1295, Dec. 2025.
   DOI: 10.3390/pathogens14121295
   PMid: 41471250
   PMCid: PMC12736324
8. M. V. Zartarian, G. Friedly, E. M. Peterson, L. M. de la Maza, “Detection of rubella antibodies by hemagglutination inhibition, indirect fluorescent-antibody test, and enzyme-linked immunosorbent assay,” J. Clin. Microbiol., vol. 14, no. 6, pp. 640 – 645, Dec. 1981.
   DOI: 10.1128/jcm.14.6.640-645.1981
   PMid: 7037834
   PMCid: PMC274013
9. M. Dittmar et al., “Nucleoside analogs NM107 and AT-527 are antiviral against rubella virus,” PNAS nexus, vol. 2, no. 9, pgad256, Aug. 2023.
   DOI: 10.1093/pnasnexus/pgad256
   PMid: 37674858
   PMCid: PMC10479830
10. Z. Cherri et al., “The immune status of migrant populations in Europe and implications for vaccine-preventable disease control: a systematic review and meta-analysis,” J. Travel Med., vol. 31, no. 6, taae033, Aug. 2024.
    DOI: 10.1093/jtm/taae033
    PMid: 38423523
    PMCid: PMC11790012
11. F. Kauffmann et al., “Measles, mumps, rubella prevention: how can we do better?” Expert Rev. Vaccines, vol. 20, no. 7, pp. 811 – 826, Jul. 2021.
    DOI: 10.1080/14760584.2021.1927722
    PMid: 34096442
12. A. C. Zimakoff et al., ”Measles, mumps, and rubella vaccine at age 6 months and hospitalisation for infection before age 12 months: randomised controlled trial,” BMJ, vol. 381, e072724, Jun. 2023.
    DOI: 10.1136/bmj-2022-072724
    PMid: 37286215
    PMCid: PMC10245144
13. M. Böttiger, B. Christenson, A. Strandell, V. Romanus, “Vaccination with a combined vaccine against measles, mumps and rubella aiming at elimination of the three diseases,” Dev. Biol. Stand., vol. 65, pp. 37 – 43, 1986.
    PMid: 3556776
14. C. Gidengil et al., “Safety of vaccines used for routine immunization in the United States: An updated systematic review and meta-analysis,” Vaccine, vol. 39, no. 28, pp. 3696 – 3716, Jun. 2021.
    DOI: 10.1016/j.vaccine.2021.03.079
    PMid: 34049735
15. A. Banko et al., “Seroprevalence of Measles-, Mumps-, and Rubella-Specific Antibodies in Future Healthcare Workers in Serbia: A Cross-Sectional Study,” Vaccines, vol. 13, no. 7, 700, Jun. 2025.
    DOI: 10.3390/vaccines13070700
    PMid: 40733677
    PMCid: PMC12298484
16. M. K. Patel et al., “Progress Toward Regional Measles Elimination - Worldwide, 2000-2018,” MMWR, vol. 68, no. 48, pp. 1105 – 1111, Dec. 2019.
    DOI: 10.15585/mmwr.mm6848a1
    PMid: 31805033
    PMCid: PMC6897527
17. T. Panagiotopoulos, I. Antoniadou, E. Valassi-Adam, “Increase in congenital rubella occurrence after immunisation in Greece: retrospective survey and systematic review,” BMJ, vol. 319, no. 7223, pp. 1462 – 1467, Dec. 1999.
    DOI: 10.1136/bmj.319.7223.1462
    PMid: 10582926
    PMCid: PMC28289
18. E. Vynnycky et al., “Using Seroprevalence and Immunisation Coverage Data to Estimate the Global Burden of Congenital Rubella Syndrome, 1996-2010: A Systematic Review,” PloS one, vol. 11, no. 3, e0149160, Mar. 2016.
    DOI: 10.1371/journal.pone.0149160
    PMid: 26962867
    PMCid: PMC4786291
19. P. Dewan, P. Gupta, “Burden of Congenital Rubella Syndrome (CRS) in India: a systematic review,” Indian Pediatr., vol. 49, no. 5, pp. 377 – 399, May 2012.
    DOI: 10.1007/s13312-012-0087-4
    PMid: 22700664
20. M. O. C. Ota, S. Badur, L. Romano-Mazzotti, L. R. Friedland, “Impact of COVID-19 pandemic on routine immunization,” Ann. Med., vol. 53, no. 1, pp. 2286 – 2297, Dec. 2021.
    DOI: 10.1080/07853890.2021.2009128
    PMid: 34854789
    PMCid: PMC8648038
21. Zarazne bolesti — godišnji izveštaj 2015, Institut za javno zdravlje Srbije “Dr Milan Jovanović Batut,” Beograd, Srbija, 2016.
    (Infectious diseases — annual report 2015, Institute for Public Health of Serbia “Dr Milan Jovanović Batut”, Belgrade, Serbia, 2016.)
22. Z. S. Lassi, R. Naseem, R. A. Salam, F. Siddiqui, J. K. Das, “The Impact of the COVID-19 Pandemic on Immunization Campaigns and Programs: A Systematic Review,” Int. J. Environ. Res. Public Health, vol. 18, no. 3, 988, Jan. 2021.
    DOI: 10.3390/ijerph18030988
    PMid: 33499422
    PMCid: PMC7908591
23. S. Basu et al., “Impact of the COVID-19 pandemic on routine vaccine landscape: A global perspective,” Hum. Vaccin. Immunother., vol. 19, no. 1, 2199656, Dec. 2023.
    DOI: 10.1080/21645515.2023.2199656
    PMid: 37078597
    PMCid: PMC10294763
24. J. Toor et al., “COVID-19 impact on routine immunisations for vaccine-preventable diseases: Projecting the effect of different routes to recovery,” Vaccine, vol. 40, no. 31, pp. 4142 – 4149, Jul. 2022.
    DOI: 10.1016/j.vaccine.2022.05.074
    PMid: 35672179
    PMCid: PMC9148934
25. M. Taheri Soodejani, M. Basti, S. M. Tabatabaei, K. Rajabkhah, “Measles, mumps, and rubella (MMR) vaccine and COVID-19: a systematic review,” Int. J. Mol. Epidemiol. Genet., vol. 12, no. 3, pp. 35 – 39, Jun. 2021.
    PMid: 34336136
    PMCid: PMC8310886
26. T. M. R. da Silva et al., “Number of doses of Measles-Mumps-Rubella vaccine applied in Brazil before and during the COVID-19 pandemic,” BMC Infect. Dis., vol. 21, no. 1, 1237, Dec. 2021.
    DOI: 10.1186/s12879-021-06927-6
    PMid: 34886804
    PMCid: PMC8655492
27. A. Salamony et al., “Are Measles-Mumps-Rubella (MMR) Antibodies Friends or Foes for Covid-19 Disease?” Arch. Immunol. Ther. Exp., vol. 71, no. 1, 15, Jun. 2023.
    DOI: 10.1007/s00005-023-00680-1
    PMid: 37341786
    PMCid: PMC10284972