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PubMed1975

Progressive rubella panencephalitis. Late onset after congenital rubella.

In children with congenital rubella infection the deficits remain stable; neurologic deterioration after the first few years of life is not believed to occur. We have encountered three patients with a definite or presumptive diagnosis of congenital rubella, in whom a progressive neurologic illness developed that began in the second decade and was characterized by spasticity, ataxia, intellectual deterioration, and seizures. High antibody titers to rubella virus in serum and spinal fluid were present in two, and all had increased cerebrospinal-fluid protein and gamma globulin. Extensive attempts to recover a virus from brain and body fluids were unsuccessful. The brains of two patients showed a widespread, progressive, subacute panencephalitis mainly affecting white matter. These data suggest that rubella virus may be a cause of progressive panencephalitis.

Adolescent↗

PubMed1998

Etiology of measles- and rubella-like illnesses in measles, mumps, and rubella-vaccinated children.

The viral etiology of measles- or rubella-like illnesses after MMR (measles, mumps, and rubella) vaccination was studied prospectively in 993 acutely ill Finnish children with fever and rash in 1983-1995. Their sera were tested for adeno-, entero-, and parvovirus B19 antibodies. Sera of 300 children <4 years old were also tested for human herpesvirus 6 (HHV-6) antibodies. Measles and rubella had been excluded by previous antibody testing. Serologic diagnosis of adeno-, entero-, or parvovirus infection was based on EIA (IgM or IgG antibodies) and that of HHV-6 on indirect immunofluorescence. A viral etiology was verified in 368 cases, most commonly parvovirus (20%), followed by enterovirus (9%) and adenovirus (4%). Among young children, HHV-6 infection was found in 37 (12%). Thirty-eight children (4%) had double infections. This study confirms that measles- or rubella-like illnesses in MMR-vaccinated children are often caused by other viruses. Each suspected vaccine failure requires laboratory confirmation to maintain reliable surveillance and control and to establish the specific etiology of the disease.

Adenoviruses, Human↗

PubMed2006

Genetic analysis of rubella viruses found in the United States between 1966 and 2004: evidence that indigenous rubella viruses have been eliminated.

Wild-type rubella viruses are genetically classified into 2 clades and 10 intraclade genotypes, of which 3 are provisional. The genotypes of 118 viruses from the United States were determined by sequencing part of the E1 coding region of these viruses and comparing the resulting sequences with reference sequences for each genotype, using the Bayesian inference program MRBAYES. Three genotypes of rubella viruses were found in the United States too infrequently to be considered for indigenous transmission. A fourth genotype was found frequently until 1981, and a fifth genotype was found frequently until 1988, but neither was obtained from nonimported cases after 1988. A sixth genotype was found frequently during 1996-2000, likely because of multiple importations from neighboring countries. The results of the present genetic analysis of rubella viruses found in the United States are consistent with elimination of indigenous viruses by 2001, the year when rubella was considered to be eliminated on the basis of epidemiological evidence.

Bayes Theorem↗

PubMed1998

Incidence of congenital rubella syndrome and influence of the rubella vaccination program for schoolgirls in Japan, 1981-1989.

In 1984, the authors first conducted a nationwide survey of deaf children with a history of maternal rubella (HMR) in special schools for the deaf in Japan. The survey showed that the incidence of congenital rubella syndrome in the Japanese mainlands was similar to those in the United States and Europe. In 1993, a second nationwide survey by the authors evaluated the efficacy of the vaccination program for schoolgirls begun in 1977. This second survey yielded 272 deaf children with HMR born between 1981 and 1989. Per 100,000 annual livebirths, the incidence rates were 1.56-9.95 in the epidemic years 1981-1982 and 1987-1988 and 0.20-0.72 in the interepidemic years. During the 1987-1988 epidemic, the incidence rates per 100,000 livebirths were 1.52 among mothers eligible for the vaccination program and 5.52-7.44 among mothers not eligible, and the difference was significant. However, only 21.7% of the women who delivered children during the 1987-1988 rubella epidemic were eligible for the vaccination program, and because the majority of deaf children with HMR were born to mothers not eligible, a decrease in the birth rate of deaf children with HMR was not observed. These data suggested the need to introduce a new vaccine program to suppress rubella epidemics.

Adolescent↗

PubMed1995

Evaluation of Cobas Core Rubella IgG EIA recomb, a new enzyme immunoassay based on recombinant rubella-like particles.

Cobas Core Rubella IgG EIA recomb (Roche), a new, commercially available rubella enzyme immunoassay using recombinant rubella-like particles, was compared with a hemagglutination inhibition assay (Rubenosticon; Organon Teknika) and two whole-virus enzyme immunoassays (IMx [Abbott] and Platelia [Sanofi Diagnostics Pasteur]). Compared with those of these reference assays, the relative sensitivities of Cobas Core Rubella IgG recomb were 100, 94, and 95.9%, with specificities amounting to 80.8, 98, and 98.2%, respectively.

Antibodies, Viral↗

PubMed1977

Modified staphylococcal absorption method used for detecting rubella-specific immunoglobin M antibodies during a rubella epidemic.

A recently described method for detecting rubella-specific immunoglobulin M (IgM) antibody based on absorption of IgG by Staphylococcus aureus strain Cowan I has been applied to 198 sera collected during a recent rubella epidemic in Israel. Modification of the original method introduced for the present study includes treatment with 2-mercaptoethanol of antibody remaining after absorption by staphylococci. This treatment confirms that the residual antibody is IgM (sensitive to 2-mercaptoethanol) rather than IgG (2-mercaptoethanol resistant). None of the 67 control patients (seropositive for rubella but without history of recent illness or contact) had specific IgM when tested by this method, though 15 showed some residual antibody after staphylococcal absorption. A total of 125 of 131 rubella convalescents (95%) were positive 4 to 49 days after onset of the clinical symptoms. Six patients had no IgM antibodies when tested by the method described, and all were convalescents tested late in relation to onset of clinical symptoms (beyond 3 weeks). When density gradient centrifugation was applied to clarify some results, 2 of 3 convalescents classified as IgM negative by the staphylococcal absorption method did in fact possess IgM antibody. None of 10 controls tested by density gradient centrifugation was IgM positive. This combination of staphylococcal absorption and 2-mercaptoethanol treatment is recommended as a screening test for selection of IgM positives, in addition to the use of a more sensitive method (such as density gradient centrifugation) on at least some samples classified as IgM negative.

Absorption↗

PubMed1976

Rubella 1974 and its aftermath, congenital rubella syndrome.

An epidemic of rubella reached its peak in the Atlantic provinces in 1974, subsiding in early 1975. With the exception of Quebec the remainder of Canada showed a reverse trend, with a large increase in the numbers of cases reported in the first 41/2 months of 1975. The Halifax virus laboratory reported 106 serologically proven cases of rubella in 1974, 44 of them in pregnant women. In the aftermath of the epidemic many infants were born with the congenital rubella syndrome (CRS). A study carried out from Sept. 1, 1974 through Apr. 30, 1975 showed an 80% correlation between clinical diagnosis and the presence of rubella-specific IgM antibodies in 35 of these infants. Of the 23 infants in whom the diagnosis of CRS was made by laboratory or clinical findings or both, laboratory criteria were met in 20 (87.0%), clinical criteria in 19 (82.6%) and both laboratory and clinical criteria in 16 (69.6%).

Antibodies, Viral↗

PubMed1983

Surveillance of congenital rubella and the immunity status to rubella in the Jerusalem area.

A retrospective study on the incidence of congenital rubella (CR) in the past 10 years in the Jerusalem area was conducted. After the 1972 epidemic, which resulted in 48 cases of congenital rubella, few sporadic cases of CR appeared each year, and in the 1978-79 period the number of CR cases was relatively small. Immunity to rubella in different categories of population (children 3 months to 18 years, college students, nurses in pediatric, newborn and intensive care units, student nurses, and women of childbearing age) was determined by hemolysis in gel (HIG) and hemagglutination inhibition (HI) methods. Susceptibility was defined as an absence of antibody at a dilution of 1:16 in HI, and hemolysis of less than 7 mm in the HIG test. Compared with previous studies on the incidence of antibodies to rubella in women of childbearing age, a mild decrease in the percentage of sero-negative women was found.

Adolescent↗

PubMed1978

Rubella antibody titer. The significance of low-titered rubella antibodies.

The hemagglutination inhibition (HAI) test is not mathematically precise and reproducible. Thus, it is critical to know whether or not the threshold titer (1 : 10) of detectable rubella antibody is indicative of true immunity. Three patients with a 1 : 10 HAI titer presented with subsequent rubella during gestation. Ninety postpartum patients with a HAI titer of 1 : 10 were vaccinated and the rubella antibody titers were reassessed. Seventeen percent of these patients responded to the vaccine challenge with an eightfold or greater rise in titer. Thus, we recommend that the patient with a low HAI titer (1 : 10) should be considered to have marginal immunity to rubella and should be vaccinated.

Adult↗

PubMed1997

Rubella seroprevalence in the Singapore Armed Forces (SAF) and the changing need of the SAF rubella immunisation programme.

A seroepidemiological study on the prevalence of rubella antibodies in a cohort of Singapore Armed Forces (SAF) recruits was conducted in 1994, twelve years after rubella immunisation was routinely given to primary 6 school boys in 1982. The results showed a high level of immunity (97.1% seropositive) in the study cohort. The implication of this finding is that it may no longer be necessary to routinely immunise recruits on entry into the SAF against rubella; the latter can be limited to those with no evidence of prior rubella immunisation.

Adult↗

PubMed1980

Circulating immune complexes containing rubella antigens in late-onset rubella syndrome.

Eight infants with late-onset rubella syndrome were investigated. All patients had been infected by rubella virus during gestation but had minimal clinical symptoms at birth and during a latent period of several months. They presented secondarily an acute phase characterized by a severe multisystem disease. Antirubella antibody titers were present at low levels before and during the first weeks of the acute phase, contrasting with high serum levels of IgM. The percentage of T lymphocytes was very low and an increase of B lymphocytes was observed. The presence of circulating immune complexes which appeared to contain rubella antigens was demonstrated. These findings suggest that the lesions observed in late-onset rubella syndrome are partly due to CIC, and that suscepibility to infection can be related to a peripheral T and B lymphocyte disequilibrium.

Antigen-Antibody Complex↗

PubMed1988

Sister chromatid exchanges in peripheral lymphocytes of children vaccinated against rubella and measles-mumps-rubella.

This study was undertaken in order to evaluate the cytogenetic and immunological responses to the effective, harmless and world-wide used vaccines of I. rubella and II. measles-mumps-rubella (M-M-RII). In one group (A) of five girls vaccinated against rubella and in another group (B) of four boys and two girls vaccinated against measles-mumps-rubella, the following parameters were studied before and repeatedly after vaccination: (a) SCE frequency, in peripheral lymphocytes, (b) DNA-synthesis, in peripheral mononuclear cells, and (c) antibody titres. The mononuclear cell proliferation rate was elevated between the 3rd and 7th day, preceeding the humoral immunological reactions, which began after the 25th day (group A) and the 28th day (group B). The latter findings coincided with a significant increase of SCE frequency in group A (one child) and in group B (all six children); in no case did the highest SCE/cell ratio exceed the normal value.

Adolescent↗

PubMed1985

Study of discrepancies in rubella haemagglutinin titrations and a reappraisal of diluents used in the rubella haemagglutination inhibition technique.

To elucidate inconsistencies in rubella haemagglutinin assays the components of the assay technique were examined. The results of carefully controlled assays of rubella haemagglutinin antigens from different sources in various plates and diluents with four species of indicator cells are reported. The quality and quantity of gelatin in the dextrose-gelatin-veronal buffered diluent commonly used in rubella haemagglutinin assays had a profound effect on the haemagglutination pattern and antigen titre. The veronal buffered saline used in the complement fixation test offered a valid alternative to the more complex diluents incorporating gelatin currently used in rubella haemagglutinin assays and haemagglutination inhibition tests.

Albumins↗

PubMed1981

Low-birth-weight and congenital rubella syndrome: effect of gestational age at time of maternal rubella infection.

Birth weights of 42 full-term patients with congenital rubella syndrome were analyzed. All of these infants were products of pregnancies in which the exact dates of the maternal first day of last menstrual period and of the time of onset of the mothers' rubella rash were known. The range of time of maternal rubella associated with low-birth-weight was in the gestational age interval from 16 to 100 days. Low-birth-weight may have a relationship with time of maternal rubella rather than with the type of defects, i.e., cataract, heart disease, and deafness.

Female↗

PubMed1988

[Detection of seropositivity against rubella virus in women in the reproductive age and comparison of the rubella hemagglutination inhibition test and the ELISA-IgG test].

In this study Hemagglutination Inhibition (HI) and ELISA-IgG tests used for Rubella serology were compared in terms of specificity and sensitivity In addition, 100 sera samples taken from women in pregnancy age were tested for Rubella antibodies. The results indicated that the sensitivity of Rubella ELISA IgG test is 100% and the specificity is 97.4%. The seropositivity of women in pregnancy age was found to be 93% by Rubella ELISA-IgG test.

Adolescent↗

PubMed1974

Studies on live rubella vaccine. V. Quantitative aspects of interference between rubella, measles and mumps viruses in their trivalent vaccine.

Rubella vaccine combined with measles and mumps vaccines was administered in a single injection to children of 1 to 5 years of age. All three vaccines were serologically effective, and the clinical reactions caused by measles vaccine were considerably alleviated, when 6 x 10(3) PFU of rubella and 10(4) TCD50 per dose of mumps vaccines were combined with 5 x 10(4) TCD50 of measles vaccine. When a larger amount of mumps vaccine (3 x 10(5) TCD50/dose) was used, it caused interference with the rubella and measles viruses, i.e., the antibody response to rubella virus became poor and the incidence of clinical reactions to measles virus decreased. On the other hand, when 5 x 10(5) TCD50/dose of measles vaccine was combined with 10(4) TCD50/dose of mumps vaccine, the clinical reactions to measles virus were decreased but were almost the same as those induced by this vaccine alone.

Child, Preschool↗

PubMed1993

Rubella surveillance to December 1992: second joint report from the PHLS and National Congenital Rubella Surveillance Programme.

The high uptake of measles/mumps/rubella vaccine since October 1988 has had a major impact on rubella susceptibility in children under five years of age, with interruption of the epidemic cycle and reduction in incidence to a low endemic level. The number of infections in pregnancy reported in England and Wales to the PHLS Communicable Disease Surveillance Centre fell to 23 in 1990, and to 12 and two, respectively, in 1991 and 1992. The reduction was greatest in parous women, a group who were previously at risk through exposure to their own children. During 1991, however, susceptibility in parous antenatal women rose from 0.7% to 1%, suggesting that post-partum immunisation rates may have declined recently. If continued, this could give rise to outbreaks of congenital rubella in the future during the brief periods of rubella resurgence expected before disease elimination is achieved. Susceptibility among Asian women was four times higher than among non-Asians. Of the total of 94 births of congenitally infected infants since January 1987, only 19 occurred during 1990-92 (but this may increase due to late diagnoses). Factors contributing to the continuing occurrence of congenital rubella include missed opportunities for immunisation at school or post-partum, maternal reinfection, and recent immigration into the United Kingdom. Twenty-two (24%) of the women giving birth to congenitally infected infants since 1987 were Asian or Oriental women, of whom at least three acquired their infections abroad. Imported cases will be distinguished in future surveillance reports.

Abortion, Eugenic↗

PubMed2004

Development of a rubella vaccination strategy: contribution of a rubella susceptibility study of women of childbearing age in Kyrgyzstan, 2001.

To contribute to the development of a rubella vaccination strategy, we conducted a study to determine age-specific susceptibility among women aged 15-39 years by testing for rubella-specific IgG antibodies. Of 964 women, 13% were found to be susceptible to rubella. Significantly higher susceptibility among women >25 years old was observed. Susceptibility data are important but are not sufficient to develop a vaccination strategy. After considering all available information, we suggested vaccination of women aged <35 years and selective vaccination of older women who were planning pregnancy.

Adolescent↗