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Rubella and Rubella Vaccine

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 March 2008. Note to presenters:

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Rubella and Rubella Vaccine

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  1. 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 March 2008

  2. Note to presenters: Images of vaccine-preventable diseases are available from the Immunization Action Coalition website at http://www.vaccineinformation.org/photos/index.asp

  3. 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

  4. Rubella Virus • Togavirus • RNA virus • One antigenic type • Rapidly inactivated by chemical agents, ultraviolet light, low pH, and heat

  5. 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

  6. 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

  7. 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

  8. 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

  9. 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

  10. Congenital Rubella Syndrome • Deafness • Cataracts • Heart defects • Microcephaly • Mental retardation • Bone alterations • Liver and spleen damage

  11. 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)

  12. 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

  13. Rubella - United States, 1966-2006 Year

  14. Rubella - United States, 1980-2006 Year

  15. Rubella - United States, 1980-2003Age Distribution of Reported Cases 15-39 yrs 5-14 yrs <5 yrs >40 yrs Year

  16. 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

  17. 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

  18. 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)

  19. Trade Name Meruvax Rubelogen Cendevax Meruvax II Licensure 1969 1969 1969 1979 Vaccine HPV-77:DE5 HPV-77:DK12 GMK-3:RK53 RA 27/3* Rubella Vaccine *Only vaccine currently licensed in U.S.

  20. 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

  21. 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.

  22. 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)

  23. 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

  24. 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

  25. 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

  26. 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

  27. 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

  28. 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%

  29. 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

  30. 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

  31. CDC Vaccines and ImmunizationContact Information • Telephone 800.CDC.INFO • Email nipinfo@cdc.gov • Website www.cdc.gov/vaccines

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