Susan E. Reef

Infectious Agent

Rubella virus is a member of Togaviridae family and the only member of the genus Rubivirus.

Mode of Transmission

• Rubella virus is transmitted through person-to-person contact or droplets shed from the respiratory secretions of infected persons.
• If a woman with rubella is infected during pregnancy, the virus can cross the placenta and infect the fetus.

Occurrence

• Rubella occurs worldwide.
• In the United States, endemic rubella has been eliminated. However, since 2005, an average of 10 cases is reported each year. Of these cases, approximately 33% are imported or linked to importations.

Risk for Travelers

• All susceptible persons are at risk for infection from exposure to rubella during travel outside the United States.
• Because asymptomatic rubella infections are common, travelers may be unaware that they have been in contact with an infected person.

Clinical Presentation

• The average incubation period is 14 days, with a range of 12–23 days.
• Rubella usually presents as a nonspecific, maculopapular, generalized rash lasting 3 days or fewer (hence the term “3-day measles”) with generalized lymphadenopathy, particularly of the posterior auricular, suboccipital and posterior cervical lymph nodes.
• Asymptomatic rubella virus infections are common, and up to 50% of infections occur without rash.
• In adults and adolescents, the rash may be preceded by a 1- to 5-day prodrome of low-grade fever, malaise, anorexia, mild conjunctivitis, coryza, sore throat, and lymphadenopathy.
• The most important and serious consequence of rubella is infection during early pregnancy. These consequences may include miscarriages, fetal deaths/stillbirths, and an infant born with constellation of severe birth defects known as congenital rubella syndrome (CRS). The most common congenital defects are cataracts, heart defects, and hearing impairment.

Diagnosis

• Many illnesses can mimic rubella, and up to 50% of rubella infections are asymptomatic. Therefore, the only reliable evidence of acute rubella virus infection is laboratory diagnosis.
• Serologic testing for rubella-specific IgM antibody is the most commonly used for diagnosis of rubella.
• Diagnosis can also be made by demonstration of seroconversion of rubella-specific IgG antibody titers and by detection of virus either through virus culture or PCR.

Treatment

There is no specific antiviral therapy for rubella; basic treatment consists of supportive care.

Preventive Measures for Travelers

Vaccine

• Before international travel, persons should be immune to rubella.
• Acceptable presumptive evidence of immunity to rubella for international travelers includes—
  • Documentation of receipt of one or more doses of rubella-containing vaccine on or after the first birthday
  • Laboratory evidence of rubella immunity (a positive serologic test for rubella-specific IgG antibody)

Adverse Reactions, Precautions, and Contraindications to Rubella Vaccine

• Refer to theMeasles (Rubeola) section earlier in this chapter for information on reactions following MMR vaccine and additional precautions and contraindications.

References

1. CDC. Rubella. In: Atkinson W, Hamborsky J, McIntyre L, Wolfe S, editors. Epidemiology and prevention of vaccine-preventable diseases. 10th ed. Washington (DC): Public Health Foundation, 2008. p. 159–74.
2. Reef SE, Redd SB, Abernathy E, et al. The epidemiological profile of rubella and congenital rubella syndrome in the United States, 1998–2004: the evidence for absence of endemic transmission. Clin Infect Dis. 2006;43(Suppl 3):S126–32.
3. Plotkin SA, Reef SE. Rubella vaccine. In: Plotkin SA, Orenstein WA, Offit PA, editors. Vaccines. 5th ed. Philadelphia: Saunders Elsevier; 2008. p. 735–71.
4. Reef SE, Cochi SL. The evidence for the elimination of rubella and congenital rubella syndrome in the United States: a public health achievement. Clin Infect Dis. 2006;43(Suppl 3):S123–5.
5. Meissner HC, Reef SE, Cochi S. Elimination of rubella from the United States: a milestone on the road to global elimination. Pediatrics. 2006;117(3):933–5.
6. Robertson SE, Featherstone DA, Gacic-Dobo M, et al. Rubella and congenital rubella syndrome: global update. Rev Panam Salud Publica. 2003;14(5):306–15.
7. Plotinsky RN, Talbot EA, Kellenberg JE, et al. Congenital rubella syndrome in a child born to Liberian refugees: clinical and public health perspectives. Clin Pediatr (Phila). 2007;46(4):349–55.
8. Watson JC, Hadler SC, Dykewicz CA, et al. Measles, mumps, and rubella-vaccine use and strategies for elimination of measles, rubella, congenital rubella syndrome and control of mumps: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 1998;47(RR-8):1–57.
9. Kroger AT, Atkinson WL, Marcuse EK, et al.; CDC. General recommendations on immunization: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2006;55(RR-15):1–48.