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PubMed2004

Incidence, clinical features and estimated costs of congenital rubella syndrome after a large rubella outbreak in Recife, Brazil, 1999-2000.

BACKGROUND: During 1998-2000, a large rubella outbreak was reported from Recife, the capital municipality of Pernambuco State, in northeastern Brazil. In 2002, a study was conducted to assess the burden of congenital rubella syndrome (CRS) after this outbreak. METHODS: To describe the rubella outbreak, we analyzed data available from the National Notifiable Disease System. A retrospective record review for CRS was conducted at 6 maternity hospitals where 53% of Recife's resident live births occurred during 1999-2000 and 1 tertiary health care center. Suspected CRS cases were infants with any manifestation of CRS or maternal infection during pregnancy. Standard international definitions for compatible and confirmed CRS cases were used. Direct CRS costs were based on reimbursements by the National Health System. RESULTS: From October 1998 to July 2000, Recife reported 681 confirmed rubella cases. The highest incidence of rubella was among children 5-11 years of age (5.4 per 1000 population). Forty-five suspected CRS cases were identified; 29 were clinically compatible and 2 were laboratory-confirmed. The average annual incidence of CRS was 0.9 per 1000 live births during 1999-2000. Overall costs for the first year follow-up were estimated at 61,824 US dollars in this cohort. CONCLUSIONS: High rubella vaccination coverage is required to prevent the severe congenital disabilities and high economic costs of CRS. Increased clinician awareness is critical for early CRS detection. Complete reporting is essential to evaluate the impact of vaccination programs and to document progress toward the goal of CRS elimination in the Americas by the year 2010.

Adolescent↗
PubMed1993

[Avidity of rubella IgG antibody in rubella virus infection].

The avidity assay of rubella IgG antibody with urea was evaluated to distinguish the early convalescent phase of primary rubella from the late one and reinfection. We examined 116 sera from 23 patients with primary infection collected 7 to 1,477 days after the rash appeared and 25 sera from 8 patients with rubella reinfection and 16 sera from 15 pregnant women without fetal infection having high hemagglutination inhibition (HI) antibody or weak positive rubella IgM antibody. The avidity index (AI) was calculated as the ratio of the optical density from the urea-washed well to that of the non-treated well, expressed as a percentage. In primary infection AI were lower than 30% within 30 days after the rash appeared, then gradually increased and reached a plateau of 60 to 80% three months later, whereas the AIs of patients after reinfection, with high HI antibody and weak positive IgM antibody were as high as 79.2 +/- 7.5%, 93.5 +/- 4.1% and 90.6 +/- 5.0%, respectively. These results indicate that the measurement of avidity in rubella IgG antibody is valuable in diagnosing recent primary rubella in pregnant women having a high HI antibody or IgM antibody.

Antibodies, Viral↗
PubMed2000

Duration of rubella immunity induced by two-dose measles, mumps and rubella (MMR) vaccination. A 15-year follow-up in Finland.

A national two-dose vaccination program with a combined measles, mumps and rubella (MMR-II) vaccine was introduced in Finland, in 1982, immunizing children at the ages of 14-18 months and 6 years. Antibody levels were determined from serial samples from a group of originally 350 children during 15 years. The latest samples were taken 15.5 years after the first vaccination and 70% of the children could still be reached. The aim of this study was to determine the kinetics of rubella antibodies induced by the MMR-II vaccine in these individuals. Rubella antibodies were analyzed from three different cohorts: Group I seronegative children (n=166) vaccinated at 14-18 months and 6 years, Group II seronegative children (n=139) and Group III seropositive children (n=16) vaccinated at 6 and 11-13 years. Samples collected 0-9 years after vaccination were analyzed by hemolysis-in-gel (HIG) and later samples by enzyme immunoassay (EIA) techniques. The primary vaccination induced 100% seropositivity in vaccinees with a mean zone diameter of 10 (+/-1.3), 10.2 (+/-1.1) and 11.5 (+/-0.9) mm, in Groups I, II and III, respectively. The seropositivity rate was still high at 15 years, 99%, 100% and 100% with the geometric mean titer 23, 46 and 105 IU/ml, respectively. At 15 years, antibody levels <15 IU/ml which is the suggested protective level, were found in 31, 9 and 0% of children in Groups I, II and III, respectively. Because almost a third of the individuals in Group I now, at the age of 17 years, had low levels of rubella antibodies, it is possible that rubella infections may re-emerge during pregnancy. A careful surveillance including serological follow-up is therefore very important.

Adolescent↗
PubMedDate not supplied

Epidemiology of rubella and congenital rubella infection in Israel, a country with a selective immunization program.

A rubella immunization program directed at girls aged 12 years started in Israel in 1973, and its extension in 1980 to women of childbearing age had produced by 1983 several changes in the epidemiologic pattern of rubella infection in women of childbearing age and in the risk of congenital rubella: a 55%-77% decline in the incidence of the disease in the 15-44-year age group; a progressive reduction in the rate of seronegativity among women from greater than 20% to less than 10%; a risk of infection during pregnancy and a percentage of abortions associated with rubella infection in the 1983 outbreak that were one-twelfth and one-tenth, respectively, the values associated with the 1978 and 1979 epidemics; and an evident decrease in the frequency of cases of congenital rubella, as detected by either passive or active surveillance. It is predicted that of the women who will be pregnant in 1985, 98.2% and 94.3% of those in the 18-23 year and 24-44 year age groups, respectively, will be immune by the end of 1984.

Adolescent↗
PubMedDate not supplied

Epidemiology of rubella and congenital rubella infection in Japan.

During the last two decades, the Japanese mainland experienced three rubella epidemics; the first occurred in the latter half of 1960, the second in 1975-1977, and the third in 1981-1982. A retrospective study done after the first outbreak identified 49 newborns with congenital rubella syndrome (CRS). In contrast, the Ryukyu Islands were swept by a rubella epidemic in 1964-1965, and 408 babies with CRS were born, giving an incidence of 20 per 1,000 births. When the 1975-1977 epidemic hit the mainland, a notification system had been established, and two million cases of rubella were reported. In a retrospective survey, only 39 babies with CRS were found. The number of babies with CRS on the mainland was fewer than that observed on the Ryukyu Islands, and clinical illness appeared milder for these two populations than had previously been experienced. These observations seem to support a hypothesis that the teratogenicity of circulating rubella virus is lower in Japan than in the United States.

Abortion, Induced↗
PubMed1988

Low affinity antibody to rubella antigen in patients after rubella infection in utero.

As a measure of the affinity of antirubella antibody, the resistance of the antibody to elution was used by increasing concentration of ammonium thiocyanate. The term affinity index has been used to define the molarity of thiocyanate which leads to a reduction of 50% of the initial density. The serum from a group of patients with intrauterine rubella was compared with the serum from a group of deaf children, some of whom could have rubella, and a group of controls with antibody following natural infection. The results show that the affinity index of patients with rubella is significantly lower than that of controls. The other deaf patients span the range of indices of the rubella and control groups suggesting that a number of those children could have deafness caused by intrauterine rubella.

Adult↗
PubMed1977

Absence of cell-mediated immunity to rubella virus 5 years after rubella vaccination.

The long-term effectiveness of rubella vaccination in childhood is particularly important because the ultimate goal of immunization is the prevention of infection during pregnancy. Of 25 healthy children tested 4 to 5 years after rubella vaccination, 19 showed no evidence of cell-mediated immunity (CM) to rubella virus despite the presence of hemagglutination-inhibition or complement-fixation antibodies or both. Twenty-two of 25 seropositive, naturally infected young adults showed evidence of CMI. These results indicate that fetuses of women who have been vaccinated against rubella may not be protected against damage by wild rubella infection during the pregnancy, when CMI is physiologically depressed.

Adult↗
PubMed1976

Parity of women contracting rubella in pregnancy. Implications with respect to rubella vaccination.

Data from the National Congenital Rubella Surveillance Programme showed that 44% of children with congenital rubella reported to the programme were born to primiparae. This high proportion is thought to be due to the fact that there was a two-fold increase in the rate of abortion for rubella in pregnancy for women with two or more children. This higher incidence of congenital rubella in firstborns emphasises the need for rubella vaccination prior to a woman's first pregnancy.

Abortion, Therapeutic↗
PubMed1979

Single-radial-hemolysis test for the assay of rubella antibody in antenatal, vaccinated, and rubella virus-infected patients.

The single-radial-hemolysis test (SRHT) is a simple, convenient, and sensitive method that provides accurate measurement of IgG antibody to rubella virus. Lipoprotein inhibitors of rubella hemagglutination do not interfere with the SRHT; thus the assay of low levels of antibody is more reliable by SRHT than by the rubella hemagglutination-inhibition test (RHIT). The technique for the SRHT in a form suitable for large numbers of tests is detailed and compared with that of the RHIT, and the reproducibility of the SRHT in routine operation is assessed. Results obtained by testing various populations in Western Australia are used to show the application of the SRHT in the diagnosis of rubella and in the monitoring of rubella vaccination programs.

Adolescent↗
PubMed1986

Incidence of congenital rubella syndrome in Japan (1965-1985). A nationwide survey of the number of deaf children with history of maternal rubella attending special schools for the deaf in Japan.

Accurate congenital rubella syndrome surveillance in Japan is of great interest because of the hypothesis that the Japanese rubella virus was less virulent than the strains prevalent in Europe and the Americas 20 years ago. A nationwide survey of deaf children with a history of maternal rubella in special schools for the deaf in Japan yielded a total of 365 deaf school children with congenital rubella syndrome born between 1963 and 1982. The overall average prevalence was 0.31 case per 100,000 population, and the incidence was 0.1-6.1 cases per 100,000 annual live births in Japan. If one considers the decrease in the number of deaf children attending special schools for the deaf because of the recent adoption of the policy of integrating deaf children into ordinary schools, the number of cases of congenital rubella syndrome might actually be much greater than that revealed by this survey and much greater than the 88 cases previously reported in Japan. Among the 365 cases who had deafness, 8.2% were found to have cataract (with and without congenital heart disease), and 11.0% were found to be complicated by congenital heart disease (but without cataract).

Cataract↗
PubMed1994

Congenital rubella syndrome with rubella virus-associated generalized brownish macules, indurated erythemas, papules, and pigmentation.

BACKGROUND: We examined an infant with congenital rubella syndrome (CRS). The purpose of this report is to describe the skin manifestations in this patient and to prove that they were associated with rubella virus. OBSERVATIONS: A 7-month-old boy presented with generalized brownish macules, indurated erythemas, papules, and pigmentation. They first appeared at around 3 months of age. His mother had contracted rubella during the 14th gestational week. At the time of examination, rubella-specific IgM antibody was positive in both serum and cerebrospinal fluid of the baby. A physical exam had revealed deafness, mental and physical retardation, interstitial pneumonitis, and hepatosplenomegaly. A skin biopsy specimen showed a dense infiltration mainly of lymphocytes, with B cells predominant in the deep dermis. Electron microscopically abundant tubuloreticular structures were observed in capillary endothelial cells, lymphocytes, and dermal fibroblasts. Polymerase chain reaction (PCR) analysis suggested that rubella virus RNA was present in the patient's skin specimen, cerebrospinal fluid, and total blood. CONCLUSIONS: The cutaneous manifestations of our patient were extraordinary and informative. These prominent skin lesions should be recognized as cutaneous markers of CRS.

Humans↗
PubMed1991

[Immunization of healthy children with mumps-rubella bivalent live vaccine and simultaneous vaccination with mumps-rubella and varicella vaccines].

Bivalent virus vaccine, containing rubella TCRB-19 strain and mumps NK-M46 strain (MR vaccine), was administered to a total of 95 healthy children who had already received measles vaccine or had been infected with wild measles virus. The seroconversion rates for rubella and mumps viruses in subjects having no antibody to rubella or to mumps virus were 99% (75/76) and 97% (63/65), respectively, at 6-8 weeks after vaccination. The seroconversion rates for both rubella and mumps in vaccinees initially seronegative to both viruses were 95% (56/59). Immune responses after MR vaccine injection were comparable to those after administration of monovalent rubella or mumps vaccine. Clinical reactions observed in some subjects who received MR vaccine were mild fever (3.6%), exanthem (8%), lymphadenopathy (1.8%), and swelling of the parotis region (1.8%). MR vaccine could be simultaneously injected with varicella vaccine at the opposite site producing no adverse effect on immune response. Our results indicate that MR vaccine is a safe and effective vaccine, especially for children who have had wild measles or who have received measles vaccine.

Adolescent↗
PubMed1979

Rubella in Jerusalem. 2. Clinical and serologic findings in children with congenital rubella.

Forty-eight children born with clinical and serologic manifestations of congenital rubella were followed for a three-year period. Expanded rubella syndrome, multiple anomalies and single defects were found, mostly in the child's first year of life. Some new organic problems were found at a later age in children who had initially been healthy but who had been followed up because of their high antibody levels to rubella. Of the 48 children, 15 (31%) were born to mothers who had had clinically and serologically diagnosed rubella during pregnancy. In 33 children (69%) the mother had had asymptomatic rubella. These findings emphasize the need to identify and immunize seronegative women before pregnancy.

Abnormalities, Multiple↗
PubMed1982

Rubella immunization of teenage girls in Iceland and follow-up after a severe rubella epidemic.

Of 730 Icelandic schoolgirls, 12 years of age, screened for rubella antibodies by the haemagglutination-inhibition (HI) technique, 372 (50.9%) were found to be seronegative. Rubella vaccine was administered to 355 members of this group, and to 12 girls with an HI titre of 20. Blood samples were taken 6 weeks and 1 year after immunization from 336 previously seronegative girls and from the 12 low-positive vaccinees, and tested for HI antibodies. The seroconversion rate was 99.15%. One year after immunization, 94.8% of the girls tested had an HI antibody titre of 40 or more. The geometric mean titre (GMT) of the previously seronegative girls was 62.07 at 6 weeks and 61.69 at one year after vaccination. Of the girls with an initially low positive titre, only 3 (25%) showed a significant rise. The GMT was 40 at 6 weeks, but fell to 25.2 after 1 year. Re-immunization had no effect on antibody levels in either group.A severe rubella epidemic occurred 2 years after immunization, following which 345 vaccinees and 193 naturally immune controls were studied. All subjects had been exposed to wild rubella virus at school, and rubella cases had occurred in the homes of 116 vaccinees (33.6%) and 41 control subjects (21.2%). Only 5 (1.5%) primarily seronegative vaccinees and 2 unimmunized controls (1%) showed serological evidence of infection during the epidemic.

Adolescent↗
PubMed1980

[Virologic diagnosis of rubella. Findings in a rubella epidemic in a military training camp].

During a minor rubella epidemic in a Swiss army recruit training camp (Spring 1978), recent rubella infection was proved in 20 out of 22 investigated cases. In 18 cases virus replication could be shown by means of indirect immunofluorescence (IIF). Due to its higher sensitivity and easier performance in comparison with conventional echo interference, we believe IIF should be the method of choice for rubella virus isolation. In 2 out of 22 cases, the possibility of a secondary infection was discussed. A chceklist is given showing the necessary steps for virological investigations we think should be carried out to define immunity status, confirm or rule out a rubella infection, particular weight being attached to the embryopathy question. This article is therefore intended to provide the clinician interested in virological problems with a total to enable him to take the necessary measures for detection of rubella infection and interpretation of laboratory findings.

Adult↗
PubMed1996

[Simplified avidity assay of rubella IgG antibody in rubella virus infection].

Simplified avidity assay of rubella IgG antibody with urea was evaluated to distinguish primary rubella from reinfection. In this method urea washing was done once for 10 minutes. The avidity index (AI) was calculated as the optical density percentage for the urea-washed well when compared to that of the non-treated well. We examined 292 sera from 50 patients with primary infection collected 6 to 2,259 days after the rash appeared, 29 sera from 11 patients with rubella reinfection and 69 sera from 68 pregnant women without fetal infection and having a high hemagglutination inhibition (HI) antibody. In primary infection AI increased gradually from 0%, and reached a plateau of about 60% four months after the rash appeared, whereas the mean AIs of patients after reinfection and with high HI antibody were as high as 87.1% and 89.9%, respectively. These results indicate that the simplified avidity assay in rubella IgG antibody is also valuable in diagnosing recent primary rubella in pregnant women with a high HI antibody.

Antibodies, Viral↗
PubMed1983

Enzygnost-Rubella: an enzyme immunoassay for screening and quantitation of antibodies to rubella virus.

Calbiochem-Behring, Enzygnost-Rubella is an enzyme-linked immunosorbent assay (ELISA) for the determination of IgG antibodies to rubella virus. Two procedures, screening and quantitative, were used for the measurement of rubella antibodies in a characterized panel of sera and in random, premarital serum specimens. Using the screening procedure, no false-positive or false-negative results were observed in testing a panel of 40 sera previously characterized by human "O" cell and chick cell hemagglutination-inhibition (HI) tests. Additional testing of 323 random, premarital serum samples resulted in 99.4% agreement with HI tests in identifying positive and negative specimens. In the evaluation of the quantitative procedure, a coefficient of correlation (r) of 0.93 between ELISA titers and the geometric mean HI titers was obtained when testing the panel of 40 characterized sera. Furthermore, 100% agreement with HI test was obtained in the detection of titer rises in 20 pairs of acute and convalescent sera. The average within-run coefficients of variation for the screening and quantitative procedures were determined to be 11.2% and 15.6%, respectively. It is concluded that the Enzygnost-Rubella reagents are sensitive, specific, and provide objective means for assessing immunestatus and detecting rises in antibody titers to rubella virus.

Antibodies, Viral↗
PubMed1975

Seven-year follow-up study of rubella syndrome in Ryukyu with special reference to persistence of rubella hemagglutination inhibition antibodies.

Rubella hemagglutination inhibition (HI) antibodies in 266 children with rubella syndrome born in 1965 in the Ryukyu Islands and their mothers were followed for seven years. Titers of rubella HI antibody in the mothers declined slowly, while those in the children declined rapidly up to 40 months of age. Thereafter decline of titers became extremely slow and only seven cases (three per cent) became seronegative for rubella HI antibody. Rubella HI antibody titers seemed to have no particular correlation to the severity of clinical manifestations.

Adult↗