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PubMed1995

High incidence of congenital rubella syndrome after a rubella outbreak.

Previous studies of the incidence of congenital rubella syndrome (CRS) after rubella outbreaks have been limited because most women with infection during the first trimester elected to have their pregnancies terminated. After a rubella outbreak in 1991 we measured prospectively the impact of maternal infection on CRS among the Amish in one county in Pennsylvania. We compared rubella serology of Amish women delivering before and after the outbreak and cord blood rubella IgM from Amish and non-Amish infants. Before the outbreak 20% of Amish women were susceptible to rubella; after the outbreak 4% were (P = 0.001). Of Amish infants 15% tested positive for rubella IgM; no non-Amish infants did (P < 0.001). This rubella outbreak in a largely unimmunized community led to a high rate of CRS. The annual CRS rate among the Amish was 2130/100,000 live births. Health care providers should promote immunization in all clients and intensify efforts among the Amish.

Antibodies, Viral↗
PubMed2006

[The first newborn with congenital rubella syndrome during the rubella epidemic in The Netherlands in 2004/'05].

A newborn male was diagnosed with congenital rubella syndrome. His 31-year-old mother had had erythematous exanthema during a period of amenorrhea lasting 7 weeks; she was not vaccinated and had never had a rubella infection. The infection was confirmed serologically. The mother gave birth to an icteric, microcephalic, dysmature neonate with hepatosplenomegaly and exanthema with multiple, small purple-red spots. Ultrasound cardiography revealed a persistently open arterial duct and a small defect of the ventricular septum. Radiological evaluation of the long bones showed the characteristic longitudinal lucent strands ('celery stalk appearance'). Ultrasound of the cerebrum showed diffuse widespread calcifications in the white matter and basal ganglia, striatal vasculopathy and diffuse parenchymal disorders. Psychomotor development was impaired. The patient was completely deaf in the left ear and had severely poor hearing in the right ear. After the introduction of the rubella vaccine in the Netherlands in 1974 a substantial decrease was seen in the incidence of rubella infections as well as congenital rubella syndrome. An epidemic of rubella infections has been present within the non-vaccinated population since September 2004. Recognition of the clinical symptoms and confirmation of the clinical suspicion with proper viral diagnostic methods are needed to control the current epidemic and to prevent secundary spread. Infants born with congenital rubella syndrome remain infectious to non-vaccinated individuals for a prolonged period of time; the virus is excreted in the urine and faeces. Long-term medical follow-up is necessary because the congenital rubella infection can cause abnormalities after the neonatal period.

Adult↗
PubMed1991

Kinetics of rubella-specific IgM antibody response in postnatal rubella infection.

The serological diagnosis of primary postnatal rubella infection is based on detection of rubella-virus-specific IgM antibody or a four-fold rise in rubella-specific IgG antibody. Although there are several different methods of enzyme immunoassays that are commercially available, the cost benefit evaluation makes them impractical for use in developing countries. For this reason, we have standardized the measurement of rubella IgM antibody by HAI following serum fractionation by ion-exchange chromatography. The sera samples obtained from pregnant women infected with rubella virus at different times during gestation were fractionated and tested by HAI. Seven out of nine sera collected within the first two days after onset of rash showed detectable levels of rubella IgM antibody. All 57 sera collected between 3 and 30 days after the onset of rash contained rubella IgM antibody. After 30 days, only 1 of 5, or 20%, of sera contained IgM antibody. The HAI testing method was rapid and specific and the cost was not prohibitive. HAI-IgM testing could be used to diagnose primary rubella infections in developing countries where expensive EIAs are unaffordable.

Antibodies, Viral↗
PubMed2004

Increase of immunity to rubella and interruption of rubella transmission in Gipuzkoa (Basque Country, Spain) after an enhanced vaccination programme.

In Spain, vaccination against rubella was initiated in schoolgirls in the mid-1970s. In Gipuzkoa, subsequent extensions to the vaccination schedule culminated in 1992 with the introduction of the two-dose measles, mumps and rubella vaccine in children and adolescents of both sexes. Moreover, in 1985 a programme for the identification and vaccination of non-immune parturient women was implemented in the region's main hospital. The prevalence of rubella-susceptible parturient women decreased from 3.7 % at the beginning of the study to < 1.5 % by 1992. Despite this overall decrease, 4.8 % of adolescent parturients were susceptible to rubella during 2001--2002. From 1984, the number of reported cases of rubella (children and adults) progressively decreased until 1997, after which there have been no cases of indigenous rubella. There have been no cases of reported congenital rubella since 1984. These results indicate that the vaccine policy carried out in this geographical area has been effective in achieving considerable progress towards rubella elimination.

Adolescent↗
PubMed2003

Investigation of a rubella outbreak in Kyrgyzstan in 2001: implications for an integrated approach to measles elimination and prevention of congenital rubella syndrome.

In 1999, the Ministry of Health of Kyrgyzstan adopted the goal of measles elimination. This opportunity was used to launch a rubella and congenital rubella syndrome prevention program. Between January and August 2001, a rubella outbreak occurred in Bishkek City and Chui Oblast. Rubella surveillance data were reviewed for Kyrgyzstan (1981-2000) and rubella case-patient and laboratory information from Bishkek City and Chui Oblast during the outbreak. The data suggest that rubella is endemic in Kyrgyzstan with periodic epidemics every 3-5 years. From January to August 2001, 1936 rubella case-patients were reported from Bishkek City and Chui Oblast; 242 were tested and 176 (73%) were laboratory confirmed. Most case-patients were 3-14 years old. However, the incidence rate per 100,000 among persons aged 15-35 years increased >/=40-fold from 1 in 2000 to 41 in 2001. These findings highlight the importance of introducing rubella-containing vaccine in conjunction with measles elimination activities.

Adolescent↗
PubMed1985

Subclinical rubella reinfection in vaccinated women with rubella-specific IgM response during pregnancy and transmission of virus to the fetus.

This report concerns 2 cases of documented rubella reinfection during pregnancy in previously vaccinated women. The antibody response at reinfection comprised not only anti-rubella IgG but also IgM. In the first case the reinfection occurred between the 13th and 19th week of pregnancy and was followed by transmission of virus to the fetus (anti-rubella IgM in cord blood and persisting antibody activity). The child had no clinical signs of congenital rubella and is normally developed without hearing impairment at 41/2 years of age. In the second case the reinfection resulted from exposure in the 15th week of pregnancy; there were neither serological nor clinical signs of congenital rubella in the child. The reported case of fetal infection in spite of previous rubella vaccination of the mother does not discourage the use of rubella vaccine. Rubella vaccine induces long lasting immunity and protection from viremia in the vast majority of individuals.

Adult↗
PubMed2002

Economic analyses of rubella and rubella vaccines: a global review.

OBJECTIVE: To investigate whether the incorporation of rubella vaccine into immunization programmes in developing countries is economically justified. METHODS: A MEDLINE search was conducted for articles published between 1970 and 2000 that dealt with economic analyses of rubella and rubella-containing vaccines. The Eastern Mediterranean, South-East Asia, and Africa regional Index Medicus databases and the LILACS database for Latin America and the Caribbean were also searched. FINDINGS: For developed countries, five cost- benefit analyses of rubella vaccine and five of measles-mumps-rubella vaccine as well as two cost-effectiveness analyses were found. For developing countries, five cost analyses and five cost-benefit analyses were found. All the cost-benefit analyses had a benefit:cost ratio greater than 1 and the cost-effectiveness studies indicated that rubella immunization was a cost-effective means of reducing the impact of congenital rubella syndrome. However, the methodologies were not standardized. CONCLUSION: The data support the inclusion of rubella vaccine in the immunization programmes of both developing and developed countries and indicate economic benefits comparable to those associated with hepatitis B vaccine and Haemophilus influenzae type b vaccine. More studies should be carried out on costs for care and immunization using standardized methodologies and locally obtained information.

Cost-Benefit Analysis↗
PubMedDate not supplied

Rubella seroprevalence among young women taipei county after routine measles, mumps and rubella immunization program.

To better target rubella immunization efforts by determining the age-specific rubella seroprevalence and the related factors for children in Taiwan after the 1986 national vaccine policy. A cross-sectional study was conducted for these girls aged 10 years (1994 cohorts), 13 years (1991 cohorts), 16 years (1988 cohorts), and 19 to approximately 22 years (1982-1985 cohorts), respectively, in 2004 in Taipei county. Participants were given a questionnaire detailing family income, education level, ethnicity of mother, number of siblings, and history of rubella infection. Possible predictors of rubella seropositivity and differences in seroprevalence were calculated by multivariate logistic regression analysis. A total of 826 cases were recruited. The geometric mean titer of rubella IgG antibody was 60.7 +/- 2.1 IU/ml. Rubella seropositive rates were 282/287 (98.3%) in children aged 10 years, 234/235 (99.6%) in aged 13 years, 179/185 (96.8%) in aged 16 years, and 110/119 (92. 4%) in aged 19-22 years. Older age, low maternal education level, and foreign mothers were correlated with seronegativity (p < 0.05). The MMR vaccine program has induced effectively the immunity against rubella. However, to eliminate congenital rubella syndrome, more effort should be taken for the vaccination of susceptible adolescents and young women.

Adolescent↗
PubMed1994

Prenatal diagnosis of congenital rubella infection from maternal rubella in Taiwan.

OBJECTIVE: To determine the frequency of intrauterine rubella infection in Taiwan. METHODS: One hundred three pregnant women with evidence of rubella infection were enrolled. Congenital rubella infection was diagnosed by testing specific immunoglobulin (Ig) M in fetal cord serum obtained from funipuncture or amniotic fluid culture. The fetal outcomes were evaluated by ultrasonic examination, specific antibody detection in cord blood at birth, and complete physical examination during early childhood. RESULTS: Prenatal diagnosis was possible in 95 of 103 fetuses, 93 by funipuncture and two by amniocentesis. Five intrauterine rubella infections were detected prenatally, and another one was diagnosed after birth. The intrauterine infection rates were 10.0, 11.8, 2.9, and 6.5% after maternal infection at 1-10, 11-14, 15-19, and 20-29 gestational weeks, respectively. Among the six fetuses with serologic evidence of congenital infection, one had congenital rubella syndrome with sensorineural deafness, two were terminated during the second trimester, two others were normal, and one was lost to follow-up. With the exception of the infant with clinical congenital rubella syndrome, no evidence of rubella defects was found in the other 81 children who received follow-up to 2-4 years old. CONCLUSION: The risk of congenital rubella infection in seropositive pregnant women is relatively low in Taiwan.

Adult↗
PubMed1994

Rubella and congenital rubella syndrome--United States, January 1, 1991-May 7, 1994.

Following a resurgence of rubella and congenital rubella syndrome (CRS) during 1989-1991, the reported number of rubella cases during 1992 and 1993 was the lowest ever recorded. However, outbreaks of rubella have continued to occur, indicating the need for intensified and sustained efforts to reach the goal of eliminating indigenous rubella and CRS in the United States by 1996. This report summarizes surveillance for rubella and CRS from January 1, 1991, through May 7, 1994. Information is based on cases reported to the National Notifiable Disease Surveillance System (NNDSS) and a telephone survey of 28 areas reporting rubella to obtain verification and information on age, laboratory confirmation, and vaccination status of persons with rubella reported in 1993.

Adolescent↗
PubMed1997

Rubella and congenital rubella syndrome--United States, 1994-1997.

Indigenous rubella and congenital rubella syndrome (CRS) have been targeted for elimination in the United States by the year 2000. Progress toward reaching this goal is monitored through the National Notifiable Diseases Surveillance System and the National Congenital Rubella Syndrome Registry. From 1969 through 1989, the numbers of annual reported cases decreased 99.6% for rubella and 97.4% for CRS. Following a slight resurgence during 1990-1991, the number of reported rubella cases reached record lows during 1992-1996 (annual average: 183 reported cases). This report summarizes the characteristics of rubella and CRS cases and outbreaks reported in the United States from 1994 through 1996 and provisional data as of April 18, 1997. The findings indicate sustained low incidence of rubella and CRS since 1992 and possible interruption of transmission of rubella virus in late 1996.

Adolescent↗
PubMedDate not supplied

Hybrids between rubella virus and a latent virus of baby hamster kidney cell line BHK21: characterization of rubella virus and type 2 hybrid virus genomes and determination of their physical homology.

The biochemical nature of rubella virus and type 2 hybrid virus, which is a recombinant between rubella virus and a latent retrovirus of BHK21 cells, has been characterized. Type 2 hybrid virus carries DNA polymerase able to copy exogenous DNA. However, disrupted type 2 hybrid virions do not synthesize detectable amounts of DNA using the endogenous viral RNA or synthetic poly(rA)/oligo(dT) primed as a template. Thus, the type 2 hybrid virus DNA polymerase has no detectable reverse transcriptase activity. Rubella virus and type 2 hybrid virus RNA can serve as templates for avian myeloblastosis virus (AMV) reverse transcriptase, although they are inefficient. The addition of oligo(dT) to these viral RNA showed no significant stimulation of their template activity for AMV reverse transcriptase. The oligo(dT)-cellulose affinity column bound neither rubella virus nor type 2 hybrid virus RNA. This suggests that both RNA genomes have a very short poly(A) tail at their 3' end. Thus, complementary DNA (cDNA) synthesis by AMV reverse transcriptase using oligo(dT) primers showed no preferential reverse transcription from the genomic 3' terminus and produced only short cDNA fragments (about 200 nucleotides). We cross-hybridized these short cDNA fragments with their viral RNA, assuming that they are copies of random sites of the genome. These cDNA-RNA hybridization analyses of physical homology between type 2 hybrid virus and rubella virus genomes revealed that about 70% of the type 2 hybrid virus genome is derived from about an 85% portion of the rubella virus genome. These values indicate that the size of the type 2 hybrid virus genome is about 21% larger than that of the rubella virus genome. Co-sedimentation studies of these viral RNA by sucrose density gradient centrifugation confirmed that the molecular weight of type 2 hybrid virus RNA is 20% higher than that of rubella virus RNA. We propose a genomic structure of the type 2 hybrid virus taking into account both physical and biochemical data.

Animals↗
PubMed1984

Therapeutic abortions following rubella infection in pregnancy: the potential impact on the incidence of congenital rubella syndrome.

In 1977, a large rubella outbreak occurred in Hawaii. Because attack rates were high among women of childbearing age, we conducted extensive surveillance efforts to detect both pregnancies complicated by rubella and cases of congenital rubella syndrome (CRS). Initial surveillance included a survey of physicians and hospitals, review of fetal death and birth certificates, and cord blood screening for rubella-specific IgM of infants born following the epidemic. Two years after the outbreak, the medical community was again surveyed to identify affected children who were missed initially. No case of CRS was identified either shortly after the outbreak or in the ensuing two years. In addition, none of the 5,605 cord serum samples obtained was found to contain rubella-specific IgM antibody. Through active surveillance, we received 12 reports of rubella in pregnant women, of whom 11 elected to terminate their pregnancies. The extensive use of therapeutic abortion by exposed women may have prevented the birth of infants with CRS. Surveillance for rubella-related abortions is an important component in assessing the health impact of rubella in a community.

Abortion, Therapeutic↗
PubMed1982

Persistent rubella infection and rubella-associated arthritis.

Rubella virus has been isolated from peripheral blood lymphocytes in six out of seven women with rubella-associated arthritis. The arthritis occurred after natural infection (one case) or immunisation with HPV 77 DES vaccine (six cases) and had been present for up to 6 years. The identification of rubella virus was confirmed by plaque/microfocus reduction in the presence of anti-rubella antiserum, and by immunoprecipitation of rubella virus antigens and their analysis on polyacrylamide gels. These women with rubella virus in their lymphocytes did not have abnormal serum antibody levels, but a standard lymphoproliferative assay showed that they had strong cell-mediated immune responses to rubella virus antigens.

Adult↗
PubMed2000

Rubella in the Russian Federation: epidemiological features and control measures to prevent the congenital rubella syndrome.

A review of the epidemiology of clinical rubella in the Perm region of the Russian Federation from 1979-97 showed that the incidence was about 220 cases per 100,000 population. Congenital rubella syndrome (CRS) accounted for 15% of birth defects and for about 3.5 cases of CRS per 1000 live births per year. Surveys of the seroepidemiology of rubella infection revealed that the susceptibility rate among pregnant women (i.e. rubella virus antibody haemagglutination-inhibition (HAI) assay titres < 10) was 16.5%. As serum rubella antibody HAI titres > or = 10 both prevented infection in pregnant women and protected their foetuses, serological testing has been introduced into the routine antenatal services. Pre-existing rubella antibodies were found not to interfere with the immune response to vaccination, so selective immunization was provided to girls approaching puberty and to women of childbearing age. A programme of epidemiological surveillance is being developed to define tactics for the widescale introduction of rubella vaccination.

Adolescent↗