Rubella

Description

Rubella is an acute viral disease that can affect susceptible people of any age. Although generally mild in infants and children, rubella can be associated with significant morbidity in adults and is associated with a high rate of fetal wastage or anomalies if contracted in the early months of pregnancy.

Occurrence

The largest annual total number of cases of rubella in the United States occurred in 1969, when 57,686 cases were reported. Following vaccine licensure in 1969, rubella incidence fell rapidly. Since 1992, fewer that 500 cases have been reported each year. However, the proportion of reported rubella cases among adults 20 years of age or older has risen steadily from 29% in 1991 to 74% in 1999. Since 1992, an average of six cases of congenital rubella syndrome (CRS) have been reported annually. Most people 20 through 30 years of age with rubella, as well as the mothers of all infants with CRS, were born outside the United States in areas where rubella vaccine is not routinely given.

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Risk for Travelers

Rubella occurs worldwide, and the risk of exposure to rubella outside the United States can be high. Few countries routinely use rubella vaccine, so rubella remains a common disease in many countries in the world.

Preventive Measures

Vaccine

Rubella vaccine contains live, attenuated rubella virus. It is available as a single antigen preparation or combined with live, attenuated measles or mumps vaccines, or both. Combined measles, mumps, and rubella (MMR) vaccine is recommended whenever one or more of the individual components is indicated.

Although vaccination against measles, mumps, or rubella is not a requirement for entry into any country (including the United States), people traveling or living abroad should ensure that they are immune to all three diseases. Immunity to rubella is particularly important for women of childbearing age. People can be considered immune to rubella if they have documentation of receipt of one or more doses of a rubella-containing vaccine on or after their first birthday, or laboratory evidence of rubella immunity. Birth before 1957 provides only presumptive evidence of rubella immunity and does not guarantee that a person is immune. Rubella can occur in susceptible people born before 1957, and CRS can occur in the offspring of women infected with rubella during pregnancy. The Advisory Committee on Immunization Practices (ACIP) recommends that birth before 1957 not be accepted as evidence of rubella immunity for women who might become pregnant. A clinical diagnosis of rubella is unreliable and should not be considered in assessing immune status. Because many rash illnesses can mimic rubella infection and many rubelior vaccination.

The first dose of MMR should be routinely administered when an infant is 12 to 15 months of age. A single dose of MMR vaccine induces antibody formation to all three viruses in at least 95% of susceptibles vaccinated at 12 months of age or older. The second dose should be separated from the first dose by a minimum of 28 days. (See Vaccine Recommendations for Infants and Children for a discussion of the rubella immunization schedule modifications for infants who will be traveling.)

Credits: National Center of Infectious Disease