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To assess previous missed opportunities for rubella screening and vaccination of women delivering infants with congenital rubella syndrome and to discuss prevention strategies.Descriptive analysis of data collected through interviews and review of medical records.Twenty-one women who delivered infants with congenital rubella syndrome in four Southern California counties from January 1, 1990, through January 8, 1991.Twelve (57%) of the women had a total of 22 known missed opportunities for rubella screening or vaccination. Of the 22 missed opportunities, three (14%) were missed screenings at the time of marriage, two (9%) were missed screenings during previous pregnancies, five (23%) were missed screenings during induced abortions, and 12 (55%) were missed opportunities for vaccination postpartum or after induced abortions. Nine (43%) of the women had no known missed opportunities for rubella screening or vaccination. Of 12 women educated in California, only four (33%) were subject to the 1982 California school rubella immunization requirement.Congenital rubella syndrome could have been prevented in more than half of the infants born to these women if missed opportunities for rubella testing and/or vaccination had not occurred. Because premarital rubella testing and school immunization requirements do not ensure that all women of childbearing age are immune to rubella, physicians and hospitals should establish procedures for postpartum rubella vaccination of susceptible women. Family planning and abortion clinics should implement routine rubella testing and follow-up vaccination of susceptible women.