Rubella

The rubella virus is a Togavirus and also an RNA virus. It causes the infectious disease known by the common names German measles or three-day measles. The virus passes from person to person through droplet transmission. Rubella has an incubation period of 14 to 21 days with an average of 16 days between exposure and illness.

Rubella is a mild disease with signs and symptoms of low-grade fever, swollen lymph nodes in the neck and a pink rash of many tiny raised bumps on the face, trunk and extremities. The rash usually lasts no longer than three days; hence the common name three-day measles. The symptoms of rubella are similar to other virus infections like infectious mononucleosis and the pink rash might be mistaken for scarlet fever. The diagnosis of rubella can be confirmed with laboratory tests for rubella virus including fluorescent antibody test a reaction where fluorescing dyes attached to rubella antibodies glow when attached to the rubella antigen from the infected person's blood and hemagglutination reaction where antigens and antibodies combine to form a clump.

The greatest health concern with rubella is to women in the first trimester of pregnancy and may [Page 1502]result in spontaneous abortion of the fetus or Congenital Rubella Syndrome in infants. Infants born to mothers having the infection before the fetus's organs have developed may result in birth defects including blindness, deafness, congenital heart defects and learning disorders. From 1962–1965 a worldwide epidemic of rubella resulted in 20,000 infants being born with birth defects.

Even though the greatest health risk from rubella is in pregnant women, the first attenuated live virus vaccines for rubella were recommended for administration to children. From the first availability of a rubella vaccine in 1969 to 1977, the United States recorded a decrease in rubella cases and in the number of children born with Congenital Rubella Syndrome.

By 1978, the changing epidemiology of rubella brought about new recommendations for vaccination to include females of childbearing age, college students, military personnel and healthcare workers and people in other institutional settings.

Acquired immunity to rubella is achieved in one of two ways, having the disease or being immunized. Rubella vaccination provides active immunity by stimulating the formation of antibodies. If the virus invades again, the body's defenses will include an artificially induced memory of having the disease and being able to combat it, rubella antibodies remain in the immune system and will fight off future disease if the person is exposed to rubella.

The rubella vaccine is a live/attenuated virus vaccine grown in cell cultures with human diploid cells. The rubella virus is altered enough allow the immunized person's immune system remain ahead of the infection. Because the rubella vaccine is a live virus, it should not be administered to pregnant women or persons who are immunocompromised. Current U.S. guidelines recommend the administration of rubella virus vaccine, in a combination with measles and mumps, to children aged 12 to 15 months with a second dose at 4–6 years of age or at 11–12 years of age. Proof of immunization for rubella may be required for college matriculation, to work in a healthcare facility and other settings. To prevent birth defects from rubella, physicians remain vigilant in making sure women of childbearing age are immunized, including women coming to the United States from other countries. If record of immunization is unavailable, blood tests can confirm high enough levels of the antibody to ensure immunity. As a global health issue, to decrease the incidence of rubella worldwide will require the support and participation of countries to include vaccination for rubella. According to a 2003 World Health Organization survey, 57 percent of member countries included rubella vaccination in their vaccination programs. Travel to countries not requiring rubella vaccination persons who have not been immunized risk contracting the disease.

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