# Presentation: 498860

## Rubella and Rubella Vaccine

**Epidemiology and Prevention of Vaccine-Preventable Diseases**
**National Immunization Program**
**Centers for Disease Control and Prevention**

**Revised January 2007**

## NOTICEContent and order of the slides in this file may differ from those presented on the broadcast and webcast

## Rubella Virus

**Togavirus**
**RNA virus**
**One antigenic type**
**Rapidly inactivated by chemical agents, ultraviolet light, low pH, and heat**

## Rubella Clinical Features

**Incubation period 14 days **
**  ****(range 12-23 days)**
**Prodrome of low-grade fever**
**Lymphadenopathy in second week**
**Maculopapular rash 14-17 days after exposure **

## Rubella Complications

**Arthralgia or arthritis****	****	****adult female****	****	****children****	****	**
**Thrombocytopenic purpura**
**Encephalitis**
**Neuritis**
**Orchitis**

**up to 70% **
**rare**
**1/3,000 cases**
**1/6,000 cases**
**rare**
**rare**

## Congenital Rubella Syndrome

**Deafness**
**Cataracts**
**Heart defects**
**Microcephaly**
**Mental retardation**
**Bone alterations**
**Liver and spleen damage**

## Rubella Epidemiology

**Reservoir****	****	****Human**** **
**Transmission****	****	****Respiratory****	****	****	****	****	****	****	****	****Subclinical cases may                   ****	****	****	****	****	****transmit**** **
**Temporal pattern****	****Peak in late winter and spring**
**Communicability****	****7 days before to 5-7 days**
**	****	****	****	****	****after rash onset****	****	****	****	****	****Infants with CRS may shed ****	****	****	****	****	****	****virus for a year or more**

## Rubella - United States, 1966-2005*

**Rubella - United States, 1966-2005***

**Year**

***2005 provisional total**

## Rubella - United States, 1980-2005*

**Rubella - United States, 1980-2005***

**Year**

***2005 provisional total**

## Rubella - United States, 1980-2003Age Distribution of Reported Cases

**Rubella - United States, 1980-2003****Age Distribution of Reported Cases**

**<5 yrs**

**15-39 yrs**

_**>**_**40 yrs**

**5-14 yrs**

**Year**

## Rubella Vaccine

***Only vaccine currently licensed in U.S.**

**Rubella Vaccine**

**Notes:**
Only RA 27/3 vaccine available now.  Less reactive than earlier vaccines.  Terminal abbreviations refer to cell line used – RK=rhesus kidney, DK=duck kidney, DE=duck embryo.  RA 27/3 grown on human diploid cells.

## Rubella Vaccine

**Composition****	****Live virus (RA 27/3 strain)**** **
**Efficacy****	****	****95% (Range, 90%-97%)**** **
**Duration of****Immunity****	****	****Lifelong**** **
**Schedule****	****	****At least 1 dose**

## Rubella Vaccine 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.**

## 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)**

## Birth before 1957 is not acceptable evidence of rubella immunity for women who might become pregnant 
Only serology or documented vaccination should be accepted

**Only serology or documented vaccination should be accepted**

**Rubella Immunity**

## 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**

**Notes:**
Joint symptoms usually associated with the rubella component of MMR.

## Severe allergic reaction to vaccine component or following a prior dose
Pregnancy
Immunosuppression
Moderate or severe acute illness
Recent blood product

**Pregnancy**
**Immunosuppression**
**Moderate or severe acute illness**
**Recent blood product**

**MMR Vaccine****Contraindications and Precautions**

## 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**

**Notes:**
Pregnancy testing not routinely recommended by ACIP.

## Vaccination in Pregnancy Study 1971-1989

**321 women vaccinated**** **
**324 live births**** **
**No observed CRS**** **
**95% confidence limits 0%-1.2%**** **

## National Immunization ProgramContact Information

**Telephone****	****	****800.CDC.INFO**** **
**Email****	****	****	****nipinfo@cdc.gov**** **
**Website****	****	****www.cdc.gov/nip**