Rubella virus (family Togaviridae, genus Rubivirus).
Person-to-person contact or droplets shed from the respiratory secretions of infected people. People may shed virus from 7 days before the onset of the rash to approximately 5–7 days after rash onset. Transmission from mother to fetus can also occur, with the highest risk of congenital rubella syndrome (CRS) if infection occurs in the first trimester. Infants with CRS can transmit virus for up to 1 year after birth.
Even though endemic rubella virus transmission has been interrupted in the Americas, rubella virus continues to circulate widely, especially in Africa, the Eastern Mediterranean, and Southeast Asia regions. In 2013, 2 large outbreaks were reported in Poland and Japan; cases were mostly among adolescent boys and adult men, but pregnant women were also affected, and their children subsequently developed CRS. In the United States, endemic rubella virus transmission has been eliminated since 2001, but cases continue to be imported. From 2004 to 2013, a median of 10 (range, 4–18) imported cases were reported annually in the United States, and 6 CRS cases were reported during the same period.
Average incubation period is 14 days (range, 12–23 days). Usually presents as a nonspecific, maculopapular, generalized rash that lasts ≤3 days with generalized lymphadenopathy. Rash may be preceded by low-grade fever, malaise, anorexia, mild conjunctivitis, runny nose, and sore throat. Adolescents and adults, especially women, can also present with transient arthritis. Asymptomatic rubella virus infections are common. Infection during early pregnancy can lead to miscarriage, fetal death, or CRS with severe birth defects.
Demonstration of specific rubella IgM or significant increase in rubella IgG in acute- and convalescent-phase specimens. RT-PCR can be used to detect virus infection; viral culture is also acceptable but is time-consuming and expensive.
All travelers aged ≥12 months should have evidence of immunity to rubella, as documented by ≥1 dose of rubella-containing vaccine on or after the first birthday, laboratory evidence of immunity, or birth before 1957. Unlike measles, there is no recommendation for rubella vaccination for infants aged <12 months before international travel. Health care providers should also ensure that all women of childbearing age and recent immigrants are up-to-date on their immunization status or have evidence of immunity to rubella, because these groups are at the highest risk for maternal-fetal transmission of rubella virus.
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