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PubMed1975

[The role of rubella specific IgM within the serological diagnosis of rubella (German measles) (authors transl)].

The sera of 327 patients were investigated for rubella specific IgA after separation of the IgM fraction by sucrose density gradient centrifugation. 1. In 96 out of 137 cases suspicious of clinical rubella, where the time for demonstration of a significant rise of the antibody titer had been missed, the demonstration of rubella specific IgM confirmed the diagnosis of German measles. This demonstration was still possible in 9 out of 10 cases 5 to 7 weeks after the onset of the disease, but in only 2 out 7 cases 8 to 15 weeks after the onset of the disease. 2. In 48 patients who had contact with patients with German measles but did not develop any symptoms, a primary infection could not be excluded by the examination of the whole serum. In 5 out of them rubella specific IgM indicted a recent rubella infection. 3. Rubella specific IgM could not be demonstrated in 47 patients who had high antibody titers but no other hints for a recent rubella infection. 4. In 89 newborns, the investigation was prompted, when elevated IgM levels were found in umbilical cord blood, or when the newborn was sick, or when a rubella infection of the mother was suspected or proven. Rubella infection of the newborn was confirmed by rubella specific IgM only if the mother had contracted German measles during the first trimester of the pregnancy (6 out of 7 cases). The diagnosis of primary rubella infection during pregnancy is proven only if 2 out the fose in antibody titer, demonstration of rubella specific IgM.

Antibodies, Viral↗
PubMed2003

Susceptibility to rubella among pregnant women and the serological evidence of congenital rubella in newborn babies at Colombo South Teaching Hospital.

OBJECTIVE: To determine the susceptibility to rubella infection in early pregnancy and the incidence of seropositivity of cord blood for rubella specific IgM among the newborn babies at Colombo South Teaching Hospital. METHODS: 1000 cord blood samples and 500 maternal blood samples from pregnant women before the 16th week of gestation were taken from the labour room and the antenatal clinic of the University Unit, Colombo South Teaching Hospital during the period of February 1999 to February 2001. These samples were tested for rubella specific IgM and IgG antibodies by ELISA. A detailed questionnaire was filled during the time of sampling. RESULTS: Of the 500 antenatal blood samples 82% were positive for rubella specific IgG. 373(75%) women gave a history of vaccination against rubella before their present pregnancy. Among the vaccinated 2(0.5%) were negative for IgG antibodies by ELISA. Out of 127 unvaccinated women 12(9%) gave a history of past infection with rubella and of this 3(25%) were seronegative for rubella specific IgG. 18% of pregnant women at 16 weeks of gestation were at risk of giving birth to a baby with congenital rubella syndrome. Among the tested 1000 cord blood samples three were seropositive (0.3%) for rubella specific IgM. CONCLUSIONS: A significant proportion of pregnant women were susceptible to rubella infection in the studied population. The present strategy of selective rubella vaccination should be reconsidered if we are to get closer to eliminating rubella syndrome in Sri Lanka.

Adult↗
PubMed1988

Maternal rubella and the congenital rubella syndrome.

The major goal of rubella immunization is the prevention of the congenital rubella syndrome. As many as 20 per cent of women in the reproductive age group in the United States continue to be susceptible to rubella despite the immunization programs currently in place. Intensified efforts are therefore needed to identify persons at risk for infection and to vaccinate them. Women who develop a rubella-like illness during pregnancy should have the diagnosis confirmed serologically because a diagnosis based on clinical criteria alone is unreliable and because of the serious implications of gestational rubella infection. The rubella virus can infect the fetus at any stage of pregnancy, but defects are rarely noted when this occurs after the 16th week of gestation. The most common abnormalities in the congenital rubella syndrome are hearing loss, mental retardation, cardiac malformations, and eye defects. Diabetes mellitus, thyroid disease, glaucoma, and other delayed manifestations of congenital rubella syndrome are common, thereby necessitating long-term followup of these patients. The detection of rubella-specific IgM antibodies in fetal blood is helpful in establishing the diagnosis prenatally and can aid in the management of pregnancies complicated by this infection. Susceptible women identified through screening during pregnancy should be immunized in the immediate postpartum or postabortion period. Although the live, attenuated rubella vaccine is contraindicated during pregnancy, pregnant women who are inadvertently immunized are not candidates for pregnancy termination because no defects consistent with congenital rubella have been reported to date in the offspring of other similarly vaccinated women.

Female↗
PubMed2006

Efforts at rubella elimination in the United States: the impact of hemispheric rubella control.

We examined rubella vaccination trends, rubella surveillance, and disease patterns for the Americas, Mexico, and the United States, to evaluate the impact of hemispheric rubella control on rubella elimination in the United States during 1997-2004. In 1997, 130,375 rubella cases were reported in the Americas, with 38,042 reported in Mexico. Over the next 7 years, a rubella control initiative resulted in the administration of approximately 110 million rubella-containing vaccine doses in Latin America, with 77.7 million doses administered within Mexico. By 2004, the number of reported rubella cases had declined to 3103 in the Americas and 698 in Mexico. Concurrently, the number of rubella cases in the United States fell from 817 during 1997-1999 to <25 cases/year from 2001 onward, with loss of seasonality and geographic clustering, despite no change in vaccination rates. Implementation of rubella control strategies in the Americas, particularly in Mexico, appears to have facilitated rubella elimination in the United States.

Adolescent↗
PubMed1993

Cellular hyperimmunoreactivity to rubella virus synthetic peptides in chronic rubella associated arthritis.

OBJECTIVES: Immune recognition of the major structural proteins of rubella virus by peripheral blood mononuclear cells and synovial inflammatory infiltrates of a patient with documented chronic rubella associated arthritis was compared with responses of normal healthy rubella virus immunoreactive subjects to establish if there were unusual response patterns associated with rubella associated arthritis in this subject. METHODS: Synthetic peptides (16-33 amino acids in length) representing selected amino acid sequences of the rubella virus envelope (E1 and E2) and capsid (C) proteins were used in lymphocyte stimulation assays with peripheral blood mononuclear cells or synovial inflammatory infiltrates to determine T lymphocyte recognition of antigenic sites within the synthetic peptides. A rubella virus specific polymerase chain reaction was used to determine the persistence of rubella virus in the patient's cells. RESULTS: The patient's peripheral blood mononuclear cells showed abnormally increased lymphoproliferative responses to three E1 synthetic peptides encompassing residues 219-234, 389-411, and 462-481, and one E2 synthetic peptide containing the sequence 50-72, of which the last three were predicted to contain T cell antigenic sites. Although the patient's peripheral blood mononuclear cells showed positive proliferative responses to C synthetic peptides, these were not unusual. The number of synthetic peptides within the E1, E2, and C panels recognised by the patient's peripheral blood mononuclear cells was greater than was previously observed in normal healthy subjects. The recognition of synthetic peptides by synovial inflammatory infiltrates was similar to peripheral blood mononuclear cells but the responses measured were lower. The polymerase chain reaction was negative for rubella virus detection in peripheral blood mononuclear cells and synovial inflammatory infiltrates. CONCLUSIONS: Abnormally increased T cell recognition of antigenic sites within rubella virus E1 and E2 proteins observed in this patient with rubella associated arthritis suggests chronic antigenaemia due to persistent rubella virus in tissue sites other than peripheral blood mononuclear cells or synovial inflammatory infiltrates.

Aged↗
PubMed2005

Rubella and congenital rubella (German measles).

Rubella, also known as German measles, is usually a very mild infection that can have devastating effects in certain instances. It is a pleomorphic RNA virus in the Togaviridae family of the genus Rubivirus. It typically causes a scarletiniform rash, cervical lymphadenopathy, and mild constitutional symptoms, but in older children and adults, especially women, it may be more severe, with joint involvement and purpuric rash. Infection during the first 12 weeks of pregnancy results in congenital infection and/or miscarriage in 80-90% of cases. The congenital rubella syndrome (CRS) involves multiple organ systems and has a long period of active infection and virus shedding in the postnatal period. For these reasons, the rubella vaccine program was instituted in 1969, and the incidence of rubella infection in the United States has since declined by 99%. Rubella has been recognized as a disease for approximately 200 years, and it has since been found that humans are the only natural reservoir for the rubella virus. Virus is present in nasopharyngeal secretions, blood, feces, and urine during the clinical illness, although patients with subclinical disease are also infectious. The virus is spread via oral droplets and is shed in the nasopharynx for approximately 7 days before and after the rash is visible. CRS includes a configuration of anomalies, including nerve deafness, cataracts, cardiac anomalies (usually pulmonary artery and valvular stenosis, and patent ductus arteriosis), and mental retardation, with late complications including diabetes, thyroid disease, growth hormone deficiency, and progressive panencephalitis. In 1969, the first rubella vaccine was licensed for use, and the Centers for Disease Control and Prevention (CDC) began its National Congenital Rubella Syndrome Registry. As required under the National Childhood Injury Act, all healthcare providers in the United States who administer any vaccine shall, prior to administration of the vaccine, provide a copy of the Vaccine Information Statements (VIS) produced by the CDC to the parent or legal representative of any child to whom the provider intends to administer such vaccine, or to any adult to whom the provider intends to administer such vaccine. Despite efforts to vaccinate children, CRS continues to occur in the United States. Hispanic infants have an increased risk of CRS. HIV-1infected children with a preserved immune system and MMR immunization had a good response to rubella vaccine. In contrast, those in more advanced categories for HIV infection responded poorly. Issues of risk, choice, and chance are central to the controversy over the MMR vaccine that erupted in the UK in 1998, and has continued into the new millennium. An important contribution to the MMR controversy has come from the parents of autistic children, some of whom reject the notion that this disorder is a random genetic misfortune and insist that it is, at least in part, the result of some environmental insult, such as MMR vaccinations.

Child↗
PubMed2006

The epidemiological profile of rubella and congenital rubella syndrome in the United States, 1998-2004: the evidence for absence of endemic transmission.

In 1969, the United States established its national rubella vaccination program. With the success of the program, 32 years later, reports of rubella reached record low numbers. To assess the achievement of elimination of rubella and congenital rubella syndrome (CRS) in the United States, 7 epidemiological criteria were used. Rubella cases reported to the National Notifiable Diseases Surveillance System from 1998 through 2004 and CRS cases reported to the National Congenital Rubella Syndrome Registry from 1998 through 2004 were analyzed. During 1998-2000, the median number of reported rubella cases was 272, whereas, during 2001-2004, the median number reported was 13. The incidence of rubella decreased significantly, from 0.1/100,000 population in 1998 to 0.005/100,000 population in 2004. Since 2001, 5 infants with CRS have been reported--3 were born in 2001, 1 was born in 2003, and 1 was born in 2004. The epidemiological evidence strongly supports the claim that rubella is no longer endemic in the United States. To prevent future rubella outbreaks and CRS cases, current strategies must be maintained.

Adolescent↗
PubMed1975

Cytotoxic activity against rubella-infected cells in the supernatants of human lymphocyte cultures stimulated by rubella virus.

Supernatant fluids of lymphocyte cultures from rubella-seropositive donors, stimulated with inactivated rubella virus, showed cytotoxic activity against rubella-infected target cells (NYU 32 line of human embryonic fibroblasts) but not against uninfected fibroblasts. The time of appearance of cytotoxic activity in rubella-stimulated lymphocyte cultures correlated with increased rate of DNA synthesis as measured by thymidine uptake. No such cytotoxic activity became detectable in the supernatants of lymphocyte cultures from rubella-seronegative donors cultured in the presence of rubella virus, or in unstimulated lymphocyte cultures from seropositive or seronegative donors. The cytotoxic activity was lost at 60degreesC in 30 min. In contrast to this rubella virus-induced cytotoxic activity, cytotoxin produced in mitogen-stimulated lymphocyte cultures from rubella seropositive and seronegative donors was equally cytocidal against rubella-infected and uninfected human fibroblasts. Although the nature of cytotoxic activity remains to be characterized, it is suggested that it is associated with a lymphokine released immune-specifically from rubella virus-stimulated lymphocytes.

Antibodies, Viral↗
PubMedDate not supplied

[Use of a combined epidemiological, virological and morphological analysis of rubella infection for an epidemiological survey of congenital rubella].

The results of composite epidemiological, virological and morphological studies of intrauterine rubella infection performed in 1979, in the period of maximum increase of rubella incidence in Moscow for 11 years (1969-1979) are presented. Investigations of 125 foci of rubella established a relatively high frequency of contacts of pregnant women with the source of infection in families of rubella patients. Twenty-nine cases of clinically manifest and inapparent rubella among pregnant women were detected and confirmed in the laboratory; intrauterine infection at 3-17 weeks was established in 16 out of 18 virologically examined women. The ratio of the disease forms was 3.5 : 1. Using laboratory methods of investigations, rubella of pregnant women was confirmed in 100% cases. From the aborted and fetal materials collected in the disease or inapparent infections of pregnant women rubella virus was isolated in 88.9%, marked pathomorphological lesions were found in organs of 61% of the fetuses examined. The organotropism of rubella virus was confirmed by a high rate (87%) of virus isolation from placenta and umbilical cords as well as by localization of morphological lesions in these organs and in the eye lens tissues. These characteristics of marked teratogenic potentials of the circulating virus strains indicate the necessity of organization of regular epidemiological surveys of rubella in pregnant women for prevention of congenital rubella in the USSR.

Animals↗
PubMed1999

Rubella seroprevalence in an unvaccinated population in Izmir: recommendations for rubella vaccination in Turkey.

BACKGROUND: The European Advisory Group on the Expanded Program on Immunization of WHO has recommended that by 2010 or earlier congenital rubella should be well-controlled or eliminated in all countries in Europe. Debate on the introduction of rubella vaccine into national immunization schedules continues to occur, and data on rubella and congenital rubella syndrome in Turkey are insufficient. OBJECTIVE: To determine age-specific rubella seroprevalence in the 1- to 29-year-old unvaccinated population in Izmir, Turkey. METHODS: A total of 600 unvaccinated persons 1 to 29 years old were selected for the study with cluster sampling in Izmir, Turkey. The information on sociodemographic characteristics and disease history was gathered for each participant, and in 580 of them rubella-specific IgG antibodies were assayed quantitatively by the micro-enzyme immunoassay. RESULTS: Of the 580 participants tested for rubella antibodies, 135 (23.3%) were seronegative. The proportions of susceptible individuals were 61.7, 29.5, 12.4, 10.3 and 8.4% in the age groups of 1 to 4, 5 to 9, 10 to 14, 15 to 19 and 20 to 29 years, respectively. Of the young women 15 to 19 years of age, 13.5% were susceptible to rubella infection. CONCLUSIONS: Because a substantial proportion of women in their childbearing years are susceptible to rubella, immunization efforts should be directed at infants or prepubertal children.

Adolescent↗
PubMed1999

The epidemiology of rubella and congenital rubella in Australia, 1992 to 1997.

Selective rubella vaccination of schoolgirls commenced in 1971 and was followed by a significant reduction in congenital rubella. Infant vaccination with MMR was introduced in 1989 to interrupt circulation of the virus in young children, and in 1994/95 the adolescent school based rubella vaccination program was changed to MMR for both boys and girls. This report reviews the epidemiology of rubella and congenital rubella between 1992 and 1997 using reports to the National Notifiable Diseases Surveillance System (NNDSS) and the Australian Paediatric Surveillance Unit (APSU). Notification rates for rubella exceeded 20 per 100,000 in 1992, 1993 and 1995 and declined to 7.2 per 100,000 in 1997. Sixty-one per cent of notifications occurred between September and December and 68% occurred in males. The incidence rate in males aged 15-22 years peaked at 152.6 per 100,000 in 1995 reflecting the lack of immunisation in this cohort. From 1993 to 1997, 19 children were reported with congenital rubella syndrome, representing 1 in 67,000 live births. Of these, 17 had multiple defects (4 died) and 2 had deafness only. There were also 5 infants with congenital rubella infection but no defects. Australia's rate of congenital rubella syndrome exceeded that of the United Kingdom and the United States of America but this may be partly attributable to differences in reporting practices. The impact of changing the second dose of MMR vaccine to 4 years of age in 1998 will require careful monitoring.

Adolescent↗
PubMed1976

[Diagnosis of rubella by demonstrating rubella-specific 19 S and 7 S antibodies (author's transl)].

Identification and measurement of rubella antibody of 19 S (IgM) and 7 S (IgG) immunoglobulins by sucrose density gradient centrifugation and a modified hemagglutination-inhibition (HAI)-test is described. Human group 0 of red blood cells were employed after trypsination. The method proved to be highly reliable and sensitive for the rapid detection of rubella IgM antibody in routine research to make an accurate diagnosis of recent rubella infection. Sera from 185 pregnant women, 200 children suspect of congenital infection, 15 mothers of intrauterin infected children, and 32 cases of rubella vaccine-induced immunity control were studied. In postnatal rubella infections, specific IgM-antibody could be detected in all sera after the onset of the rash up to eight or ten weeks after infection. From March 1973 until September 1974 laboratory diagnosis confirmed 30 of 185 pregnant women to have been recently infected with rubella. In less than 3% (4 cases) the results could not confirm or exclude a recent history of rubella. Among 200 children with congenital defects or some irregular development, specific IgM antibody was detected in 36 cases. The diagnosis of congenital rubella was confirmed or detected in the first months of life. One of the infected children was well at birth but later developed mental retardation and hearing loss, and some others showed only minor defects. In some children rubell IgM antibody persisted 5-14 months. IgM rubella antibody was not found in the sera of 15 mothers from children with intrauterine infection confirmed by IgM antibody demonstration. Post-vaccination-tests showed serum IgM and IgG immunoglobulin-responses to be similar to the natural rubella-virus-infection. Maximal titers of both immunoglobulin-fractions were but four-fold lower after vaccination (28 of 32 tested cases). The described method is able to verify the time of infection by testing a single serum. The HAI-test of the 12 fractions collected from each serum after density-gradient centrifugation shows a typical titer-profil for every time of immunization status: beginning with traces of IgM-antibody - when the HAI-test of the uncentrifugated serum may be less than 1:10 - until 10 weeks after infection when only IgG-antibody will be detectable. The greatest amount of IgM-antibody is found in the 2. to 4. week after the rash.

Adult↗
PubMed2005

Elimination of rubella and congenital rubella syndrome--United States, 1969-2004.

In October 2004, CDC convened an independent panel of internationally recognized authorities on public health, infectious disease, and immunization to assess progress toward elimination of rubella and congenital rubella syndrome (CRS) in the United States, a national health objective for 2010. Since rubella vaccine licensure in 1969, substantial declines in rubella and CRS have occurred, and the absence of endemic transmission in the United States is supported by recent data: 1) fewer than 25 reported rubella cases each year since 2001, 2) at least 95% vaccination coverage among school-aged children, 3) estimated 91% population immunity, 4) adequate surveillance to detect rubella outbreaks, and 5) a pattern of virus genotypes consistent with virus originating in other parts of the world. Given the available data, panel members concluded unanimously that rubella is no longer endemic in the United States. This report summarizes the history and accomplishments of the rubella vaccination program in the United States and the Western Hemisphere and the challenges posed by rubella for the future.

Global Health↗
PubMed1972

Responses of previously reinfected rubella vaccinees to challenge with Brown strain rubella virus.

The responses of seven hpv-77 rubella vaccinees to initial challenge with "wild" rubella virus have been compared with their responses to rechallenge with Brown strain rubella virus and to the responses of five "natural" immunes to initial Brown strain challenge. Previous exposure to "wild" rubella virus 220 days post vaccine-induced immunity had resulted in six of the seven vaccinees experiencing asymptomatic reinfection. On "rechallenge" none of the previously "reinfected vaccine immunes" demonstrated clinical, virologic or serologic evidence of reinfection. These data are consistent with the conclusion that persons with vaccine-induced immunity may be assured of more prolonged and solid immunity to rubella without having to suffer the clinical disease if they are reinfected with nonattenuated rubella virus. Rigidly controlled experiments, designed to study the practicality and safety of immunization with live rubella vaccine(s), followed by deliberate challenge of vaccinees with "wild" or low tissue culture passage rubella virus, seem warranted. In addition, these data indicate that it is imperative that a distinction should be made between "vaccine immunes" and previously "reinfected vaccine immunes" in any evaluation of long term rubella vaccine(s) efficacy and vaccine-induced antibody decay.

Adolescent↗
PubMed2005

Reducing the global burden of congenital rubella syndrome: report of the World Health Organization Steering Committee On Research Related To Measles and Rubella Vaccines and Vaccination, June 2004.

Rubella and congenital rubella syndrome (CRS) continue to be important health problems in many countries. In June 2004, the World Health Organization Steering Committee on Research Related to Measles and Rubella Vaccines and Vaccination met to evaluate data from research and operational activities and to identify critical scientific issues and gaps in knowledge that need to be addressed to improve the global control of rubella and CRS. Information about surveillance for rubella, natural and vaccine-induced immunity to rubella, laboratory diagnosis, the molecular epidemiological profile of rubella virus, and mathematical modeling to assess the burden of CRS and the impact of rubella vaccination was reviewed. This report summarizes the presentations and recommendations for future research.

Antibodies, Viral↗
PubMed1987

Maternal rubella at St Thomas' Hospital in 1978 and 1986: support for augmenting the rubella vaccination programme.

The effects of the rubella epidemics in 1978 and 1986 among patients attending antenatal clinics at St Thomas' Hospital were compared. Although many pregnant women who had been exposed to rubella-like illnesses were investigated in both 1978 (269) and 1986 (160), the number of cases of maternal rubella was substantially lower in 1986 (1) than in 1978 (17). Rubella vaccination of 11-14-year-old girls was introduced in the United Kingdom in 1970, but 10% of our patients were susceptible and only 36% gave a definite history of vaccination. Despite the smaller number of maternal rubella cases, substantial resources were expended on assessing patients who had been exposed to or who presented with rubella-like illnesses. In 1978 an intensification of the selective rubella vaccination campaign was recommended, but experience in the 1986 epidemic supports the view that the programme should be augmented by vaccination of preschool children with a combined measles, mumps, and rubella vaccine, with a view to rubella eradication.

Adolescent↗
PubMed1978

Rubella, measles and mumps antibodies following vaccination of children. A potential rubella problem.

One hundred sixty-eight children immunized by one suburban Minneapolis clinic during routine pediatric visits had serum antibodies measured to determine the efficacy of rubella (HPV77 DE5 strain), measles (Edmonston B and Moraten strains), and mumps (Jeryl Lynn strain) vaccines. Serologic failure rates at the mean postvaccination times tested were as follows: rubella, 36% (4.7 years); measles, 18% (6.5 years); and mumps, 9% (4.5 years). Antibody titers shortly after vaccination were not done, so seronegative subjects may never have responded or their titers may have declined with time; our rubella data suggest the former. Children vaccinated with rubella and measles at less than 14 months of age had higher failure rates than those vaccinated at a later age. This supports postponement of rubella and measles vaccinations until at least 15 months of age. In addition to current measles reimmunization policies, consideration also should be given to reimmunizing girls who were given rubella vaccine at less than 14 months of age. Twenty-four percent (19/79) of children vaccinated with HPV77 DE5 strain rubella at 14 months or older had rubella hemagglutination-inhibiting titers less than 8. This is disturbing and, if confirmed by others, would prompt the use of a different strain of rubella vaccine for routine immunization.

Adolescent↗
PubMed2005

[Analysis on the changing of age patterns among rubella patients after rubella vaccine immunization for children in Shandong Province, China].

OBJECTIVE: To analyze the changing of age patterns among rubella patients after implementing rubella vaccine immunization to children in Shandong province since 1995. METHODS: Epidemiologic data on rubella through surveillance system for suspected measles from 1999 to 2004 and data on rubella vaccination were used and analyzed. RESULTS: The annual average incidence rate of rubella from 1999 to 2004 had been 0.59 per 100 thousands population while 81.17% of cases were concentrated during the outbreaks. 77.77% of the cases were school children between 7-15 years old and 7.93% of the cases were under 7 years old. The age-median of cases were 10.37, 11.66, 11.41, 12.81, 14.28 and 13.96 years old from 1999 to 2004, respectively. The estimated coverage of rubella vaccine for pre-school children was about 60% but only 20% were for school children. CONCLUSION: The peak age of cases moved from youth towards adolescence which indicated that women with child-bearing age might have been under risk of developing the congenital rubella syndrome (CRS). It is necessary to carry out screening test of rubella antibody and vaccination to women with child-bearing age and the immunization strategy should be established to guide the control of rubella and CRS.

Adolescent↗