Rubella and Rubella Vaccine

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• Rubella and Rubella Vaccine

Epidemiology and Prevention of Vaccine-Preventable
Diseases National Center for Immunization and
Respiratory Diseases Centers for Disease Control
and Prevention
Revised May 2009
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Note to presenters Images of vaccine-preventable
diseases are available from the Immunization
Action Coalition website at http//www.vaccineinfo
rmation.org/photos/index.asp
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Rubella

• From Latin meaning "little red"
• Discovered in 18th century - thought to be
  variant of measles
• First described as distinct clinical entity in
  German literature
• Congenital rubella syndrome (CRS) described by
  Gregg in 1941

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Rubella Virus

• Togavirus
• RNA virus
• One antigenic type
• Rapidly inactivated by chemical agents,
  ultraviolet light, low pH, and heat

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Rubella Pathogenesis

• Respiratory transmission of virus
• Replication in nasopharynx and regional lymph
  nodes
• Viremia 5-7 days after exposure with spread to
  tissues
• Placenta and fetus infected during viremia

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Rubella Clinical Features

• Incubation period 14 days
• (range 12-23 days)
• Prodrome of low-grade fever
• Maculopapular rash 14-17 days after exposure
• Lymphadenopathy in second week

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Rubella Complications
Arthralgia or arthritis adult
female children Thrombocytopenic
purpura Encephalitis Neuritis Orchitis
up to 70 rare 1/3,000 cases 1/6,000
cases rare rare
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Epidemic Rubella United States, 1964-1965

• 12.5 million rubella cases
• 2,000 encephalitis cases
• 11,250 abortions (surgical/spontaneous)
• 2,100 neonatal deaths
• 20,000 CRS cases
• deaf - 11,600
• blind - 3,580
• mentally retarded - 1,800

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Congenital Rubella Syndrome

• Infection may affect all organs
• May lead to fetal death or premature delivery
• Severity of damage to fetus depends on
  gestational age
• Up to 85 of infants affected if infected during
  first trimester

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Congenital Rubella Syndrome

• Deafness
• Cataracts
• Heart defects
• Microcephaly
• Mental retardation
• Bone alterations
• Liver and spleen damage

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Rubella Laboratory Diagnosis

• Isolation of rubella virus from clinical specimen
  (e.g., nasopharynx, urine)
• Positive serologic test for rubella IgM antibody
• Significant rise in rubella IgG by any standard
  serologic assay (e.g., enzyme immunoassay)

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Rubella Epidemiology

• Reservoir Human
• Transmission Respiratory Subclinical
  cases may transmit
• Temporal pattern Peak in late winter and spring
• Communicability 7 days before to 5-7
  days after rash onset Infants with CRS
  may shed virus for a year or more

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• Rubella - United States, 1966-2007

Year
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• Rubella - United States, 1980-2007

Year
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Rubella - United States, 1980-2003Age
Distribution of Reported Cases
15-39 yrs
5-14 yrs
lt5 yrs
gt40 yrs
Year
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Rubella and CRS in the United States

• Most reported rubella in the U.S. since the
  mid-1990s has occurred among foreign-born
  Hispanic adult
• Majority of CRS since 1997 occurred in children
  of unvaccinated women born to Hispanic women,
  most born in Latin America

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Rubella Case Definition

• Acute onset of generalized maculopapular rash,
  and
• Temperature of gt99F (37.2 C), if measured, and
• Arthralgia or arthritis, lymphadenopathy, or
  conjunctivitis

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Rubella Outbreak Control Guidelines

• Laboratory diagnosis of rubella and CRS
• Step-by-step guidelines on evaluation and
  management of outbreak
• Rubella prevention and control among women of
  childbearing age
• Rubella and CRS surveillance

MMWR 200150(RR-12)
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Rubella Vaccine
Only vaccine currently licensed in U.S.
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Rubella Vaccine

• Composition Live virus (RA 27/3 strain)
• Efficacy 95 (1 dose)
• Duration ofImmunity Lifelong
• Schedule At least 1 dose
• Should be administered with measles and mumps as
  MMR or with measles, mumps and varicella as MMRV

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Rubella Vaccine (MMR) Indications

• All infants 12 months of age and older
• Susceptible adolescents and adults without
  documented evidence of rubella immunity
• Emphasis on nonpregnant women of childbearing
  age, particularly those born outside the U.S.

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Rubella Immunity

• Documentation of one dose of rubella-containing
  vaccine on or after the first birthday
• Serologic evidence of immunity
• Birth before 1957 (except women of childbearing
  age)

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Rubella Immunity

• Birth before 1957 is not acceptable evidence of
  rubella immunity for women who might become
  pregnant
• Only serology or documented vaccination should be
  accepted

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MMR Adverse Reactions

• Fever 5-15
• Rash 5
• Joint symptoms 25
• Thrombocytopenia lt1/30,000 doses
• Parotitis rare
• Deafness rare
• Encephalopathy lt1/1,000,000 doses

reactions that may be attributable to the
rubella component
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Rubella Vaccine Arthropathy

• Acute arthralgia in about 25 of vaccinated,
  susceptible adult women
• Acute arthritis-like signs and symptoms occurs in
  about 10 of recipients
• Rare reports of chronic or persistent symptoms
• Population-based studies have not confirmed an
  association with rubella vaccine

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MMR VaccineContraindications and Precautions

• Severe allergic reaction to vaccine component or
  following a prior dose
• Pregnancy
• Immunosuppression
• Moderate or severe acute illness
• Recent blood product

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Vaccination of Women of Childbearing Age

• Ask if pregnant or likely to become so in next 4
  weeks
• Exclude those who say "yes"
• For others
• explain theoretical risks
• vaccinate

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Vaccination in Pregnancy Study 1971-1989

• 321 women received rubella vaccine during
  pregnancy or near the estimated time of
  conception
• 324 live births
• No observed CRS
• 95 confidence limits 0-1.2

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Vaccine Storage and HandlingMMR Vaccine

• Store 35o - 46oF (2o - 8oC) (may be stored in the
  freezer)
• Store diluent at room temperature or refrigerate
• Protect vaccine from light
• Discard if not used within 8 hours reconstitution

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Vaccine Storage and HandlingMMRV Vaccine

• Must be stored at an average temperature of 5oF
  (-15oC ) or colder at all times
• May be stored at refrigerator temperature for up
  to 72 hours but must then be discarded if not
  used (do not refreeze)
• Must be administered within 30 minutes of
  reconstitution or must be discarded

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CDC Vaccines and ImmunizationContact Information

• Telephone 800.CDC.INFO
• Email nipinfo_at_cdc.gov
• Website www.cdc.gov/vaccines