Chapter 3Infectious Diseases Related To Travel
Huong Q. McLean, Susan E. Reef
Rubella virus is a member of the Togaviridae family and the only member of the genus Rubivirus. Humans are the only known natural host for the rubella virus.
MODE OF TRANSMISSION
Rubella virus is transmitted through person-to-person contact or droplets shed from the respiratory secretions of infected people. If a woman is infected with rubella virus during pregnancy, the virus can cross the placenta and infect the fetus.
Rubella used to occur worldwide. However, in September 2010, the Pan American Health Organization announced that the region of the Americas had achieved the rubella elimination goals, based on surveillance data; documentation of elimination is in progress. In the United States, endemic rubella virus transmission has been eliminated. However, from 2005 through 2009, an average of 11 cases (range, 4–16) were reported each year, of which approximately 30% were imported or linked to an imported case. Of the imported cases, 32% occurred in US residents returning from foreign countries. All susceptible people are at risk for infection during travel outside the United States. Because asymptomatic rubella virus infections are common, travelers may be unaware that they have been in contact with an infected person.
The average incubation period is 14 days, with a range of 12–23 days. Rubella usually presents as a nonspecific, maculopapular, generalized rash that lasts ≤3 days (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; 20%–50% of infections occur without rash or are asymptomatic. In adults and adolescents, the rash may be preceded by a 1- to 5-day prodrome of low-grade fever, malaise, anorexia, mild conjunctivitis, runny nose, sore throat, and lymphadenopathy. When rubella virus infection occurs during early pregnancy, consequences may include miscarriage, fetal death, or an infant born with the constellation of severe birth defects known as congenital rubella syndrome. The most common congenital defects are cataracts, heart defects, and hearing impairment.
A clinical case of rubella is characterized by the following characteristics:
- Acute onset of generalized maculopapular rash
- Temperature >99°F (37.2°C)
- Arthralgia or arthritis, lymphadenopathy, or conjunctivitis
Many illnesses can mimic rubella, and rubella virus infections can occur without a rash or be asymptomatic. Therefore, the only reliable evidence of acute rubella virus infection is laboratory diagnosis. Serologic testing for rubella-specific IgM is most commonly used to diagnose rubella. Diagnosis can also be made by demonstrating seroconversion of rubella-specific IgG titers and by detecting virus either through virus culture or PCR. A confirmed case of rubella is either laboratory confirmed or meets the clinical case definition and is epidemiologically linked to a laboratory-confirmed case.
There is no specific antiviral therapy for rubella; basic treatment consists of supportive care.
PREVENTIVE MEASURES FOR TRAVELERS
Before international travel, travelers should be immune to rubella. This is the most important prevention message, because many imported cases result from US residents returning from countries where rubella vaccination is not widespread. Acceptable presumptive evidence of immunity to rubella for international travelers includes the following:
- Documentation of receipt of ≥1 dose of rubella-containing vaccine on or after the first birthday
- Laboratory evidence of rubella immunity (a positive serologic test for rubella-specific IgG)
- Born before 1957 (except women of childbearing age who could become pregnant)
Travelers who do not meet the above criteria for rubella immunity should be vaccinated before departure.
Vaccine Safety, Adverse Reactions, Precautions, and Contraindications to Rubella Vaccine
Refer to the Measles (Rubeola) section earlier in this chapter for information on reactions after MMR vaccine and additional precautions and contraindications.
- CDC. Measles, mumps, and rubella—vaccine use and strategies for elimination of measles, rubella, and 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.
- CDC. Progress toward control of rubella and prevention of congenital rubella syndrome—worldwide, 2009. MMWR Morb Mortal Wkly Rep. 2010 Oct 15;59(40):1307–10.
- CDC. Rubella. In: Atkinson W, Hamborsky J, McIntyre L, Wolfe S, editors. Epidemiology and Prevention of Vaccine-Preventable Diseases. 11th ed. Washington, DC: Public Health Foundation; 2009. p. 257–71.
- Kroger AT, Atkinson WL, Marcuse EK, Pickering LK. General recommendations on immunization: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2006 Dec 1;55(RR-15):1–48.
- Meissner HC, Reef SE, Cochi S. Elimination of rubella from the United States: a milestone on the road to global elimination. Pediatrics. 2006 Mar;117(3):933–5.
- Plotinsky RN, Talbot EA, Kellenberg JE, Reef SE, Buseman SK, Wright KD, et al. Congenital rubella syndrome in a child born to Liberian refugees: clinical and public health perspectives. Clin Pediatr (Phila). 2007 May;46(4):349–55.
- Plotkin SA, Reef SE. Rubella vaccine. In: Plotkin SA, Orenstein WA, Offit PA, editors. Vaccines. 5th ed. Philadelphia: Saunders Elsevier; 2008. p. 735–71.
- Reef S, Redd SB, Abernathy E, Kutty PK, Icenogle J. Evidence used to support the achievement and maintenance of elimination of rubella and congenital rubella syndrome in the United States. J Infect Dis. 2011. In Press.
- 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 Nov 1;43 Suppl 3:S123–5.
- Reef SE, Redd SB, Abernathy E, Zimmerman L, Icenogle JP. 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 Nov 1;43 Suppl 3:S126–32.
- Strebel P, Gacic-Dobo M, Reef S, Cochi S. Global use of rubella vaccines, 1980–2009. J Infect Dis. 2011. In Press.
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