rubella 11
TRANSCRIPT
![Page 1: Rubella 11](https://reader034.vdocuments.site/reader034/viewer/2022050807/544a87b0af7959ac438b491a/html5/thumbnails/1.jpg)
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
![Page 2: Rubella 11](https://reader034.vdocuments.site/reader034/viewer/2022050807/544a87b0af7959ac438b491a/html5/thumbnails/2.jpg)
Note to presenters:
Images of vaccine-preventable diseases are available from the Immunization Action Coalition website at http://www.vaccineinformation.org/photos/index.asp
![Page 3: Rubella 11](https://reader034.vdocuments.site/reader034/viewer/2022050807/544a87b0af7959ac438b491a/html5/thumbnails/3.jpg)
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
![Page 4: Rubella 11](https://reader034.vdocuments.site/reader034/viewer/2022050807/544a87b0af7959ac438b491a/html5/thumbnails/4.jpg)
Rubella Virus
• Togavirus
• RNA virus
• One antigenic type
• Rapidly inactivated by chemical agents, ultraviolet light, low pH, and heat
![Page 5: Rubella 11](https://reader034.vdocuments.site/reader034/viewer/2022050807/544a87b0af7959ac438b491a/html5/thumbnails/5.jpg)
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
![Page 6: Rubella 11](https://reader034.vdocuments.site/reader034/viewer/2022050807/544a87b0af7959ac438b491a/html5/thumbnails/6.jpg)
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
![Page 7: Rubella 11](https://reader034.vdocuments.site/reader034/viewer/2022050807/544a87b0af7959ac438b491a/html5/thumbnails/7.jpg)
Rubella Complications
Arthralgia or arthritisadult femalechildren
Thrombocytopenic purpuraEncephalitisNeuritisOrchitis
up to 70% rare
1/3,000 cases1/6,000 casesrarerare
![Page 8: Rubella 11](https://reader034.vdocuments.site/reader034/viewer/2022050807/544a87b0af7959ac438b491a/html5/thumbnails/8.jpg)
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
![Page 9: Rubella 11](https://reader034.vdocuments.site/reader034/viewer/2022050807/544a87b0af7959ac438b491a/html5/thumbnails/9.jpg)
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
![Page 10: Rubella 11](https://reader034.vdocuments.site/reader034/viewer/2022050807/544a87b0af7959ac438b491a/html5/thumbnails/10.jpg)
Congenital Rubella Syndrome
• Deafness
• Cataracts
• Heart defects
• Microcephaly
• Mental retardation
• Bone alterations
• Liver and spleen damage
![Page 11: Rubella 11](https://reader034.vdocuments.site/reader034/viewer/2022050807/544a87b0af7959ac438b491a/html5/thumbnails/11.jpg)
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)
![Page 12: Rubella 11](https://reader034.vdocuments.site/reader034/viewer/2022050807/544a87b0af7959ac438b491a/html5/thumbnails/12.jpg)
Rubella Epidemiology
• Reservoir Human
• Transmission RespiratorySubclinical cases may
transmit
• Temporal pattern Peak in late winter and spring
• Communicability 7 days before to 5-7 daysafter rash onset
Infants with CRS may shed virus for a year or more
![Page 13: Rubella 11](https://reader034.vdocuments.site/reader034/viewer/2022050807/544a87b0af7959ac438b491a/html5/thumbnails/13.jpg)
0
10000
20000
30000
40000
50000
60000
70000
19661970 1975 1980 1985 1990 1995 2000 2005
Ru
bel
la C
ases
0
10
20
30
40
50
60
70
80
CR
S C
ases
Rubella CRS
Rubella - United States, 1966-2007
Year
![Page 14: Rubella 11](https://reader034.vdocuments.site/reader034/viewer/2022050807/544a87b0af7959ac438b491a/html5/thumbnails/14.jpg)
0
500
1000
1500
2000
2500
3000
3500
4000
4500
1980 1985 1990 1995 2000 2005
Ru
bel
la C
ases
0
5
10
15
20
25
30
35
40
CR
S C
ases
Rubella CRS
Rubella - United States, 1980-2007
Year
![Page 15: Rubella 11](https://reader034.vdocuments.site/reader034/viewer/2022050807/544a87b0af7959ac438b491a/html5/thumbnails/15.jpg)
0
10
20
30
40
50
60
70
80
90
100
1980 1985 1990 1995 2000
Per
cen
t
Rubella - United States, 1980-2003Age Distribution of Reported Cases
<5 yrs
15-39 yrs
>40 yrs
5-14 yrs
Year
![Page 16: Rubella 11](https://reader034.vdocuments.site/reader034/viewer/2022050807/544a87b0af7959ac438b491a/html5/thumbnails/16.jpg)
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
![Page 17: Rubella 11](https://reader034.vdocuments.site/reader034/viewer/2022050807/544a87b0af7959ac438b491a/html5/thumbnails/17.jpg)
Rubella Case Definition
• Acute onset of generalized maculopapular rash, and
• Temperature of >99°F (37.2 °C), if measured, and
• Arthralgia or arthritis, lymphadenopathy, or conjunctivitis
![Page 18: Rubella 11](https://reader034.vdocuments.site/reader034/viewer/2022050807/544a87b0af7959ac438b491a/html5/thumbnails/18.jpg)
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 2001;50(RR-12)
![Page 19: Rubella 11](https://reader034.vdocuments.site/reader034/viewer/2022050807/544a87b0af7959ac438b491a/html5/thumbnails/19.jpg)
VaccineHPV-77:DE5
HPV-77:DK12
GMK-3:RK53
RA 27/3*
Trade Name Meruvax
Rubelogen
Cendevax
Meruvax II
Licensure1969
1969
1969
1979
*Only vaccine currently licensed in U.S.
Rubella Vaccine
![Page 20: Rubella 11](https://reader034.vdocuments.site/reader034/viewer/2022050807/544a87b0af7959ac438b491a/html5/thumbnails/20.jpg)
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
![Page 21: Rubella 11](https://reader034.vdocuments.site/reader034/viewer/2022050807/544a87b0af7959ac438b491a/html5/thumbnails/21.jpg)
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.
![Page 22: Rubella 11](https://reader034.vdocuments.site/reader034/viewer/2022050807/544a87b0af7959ac438b491a/html5/thumbnails/22.jpg)
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)
![Page 23: Rubella 11](https://reader034.vdocuments.site/reader034/viewer/2022050807/544a87b0af7959ac438b491a/html5/thumbnails/23.jpg)
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
![Page 24: Rubella 11](https://reader034.vdocuments.site/reader034/viewer/2022050807/544a87b0af7959ac438b491a/html5/thumbnails/24.jpg)
MMR Adverse Reactions
• Fever* 5%-15%
• Rash* 5%
• Joint symptoms* 25%
• Thrombocytopenia <1/30,000 doses
• Parotitis rare
• Deafness rare
• Encephalopathy <1/1,000,000 doses
*reactions that may be attributable to the rubella component
![Page 25: Rubella 11](https://reader034.vdocuments.site/reader034/viewer/2022050807/544a87b0af7959ac438b491a/html5/thumbnails/25.jpg)
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
![Page 26: Rubella 11](https://reader034.vdocuments.site/reader034/viewer/2022050807/544a87b0af7959ac438b491a/html5/thumbnails/26.jpg)
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
![Page 27: Rubella 11](https://reader034.vdocuments.site/reader034/viewer/2022050807/544a87b0af7959ac438b491a/html5/thumbnails/27.jpg)
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
![Page 28: Rubella 11](https://reader034.vdocuments.site/reader034/viewer/2022050807/544a87b0af7959ac438b491a/html5/thumbnails/28.jpg)
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%
![Page 29: Rubella 11](https://reader034.vdocuments.site/reader034/viewer/2022050807/544a87b0af7959ac438b491a/html5/thumbnails/29.jpg)
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
![Page 30: Rubella 11](https://reader034.vdocuments.site/reader034/viewer/2022050807/544a87b0af7959ac438b491a/html5/thumbnails/30.jpg)
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
![Page 31: Rubella 11](https://reader034.vdocuments.site/reader034/viewer/2022050807/544a87b0af7959ac438b491a/html5/thumbnails/31.jpg)
CDC Vaccines and ImmunizationContact Information
• Telephone 800.CDC.INFO
• Email [email protected]
• Website www.cdc.gov/vaccines