Rubella virus pathogenesis

Congenital infection with rubella virus can affect many organ systems. Congenital rubella syndrome includes a constellation of birth defects, such as deafness, eye abnormalities cataracts, glaucoma, retinopathy, microphthalmia , and congenital heart disease. Many rash illnesses can mimic rubella infection, so clinical diagnosis is unreliable. Acute or recent rubella infection can be confirmed by detection of rubella virus by polymerase chain reaction PCR , a significant rise in rubella specific immune globulin Ig G antibody from paired acute- and convalescent-phase sera, or the presence of rubella-specific IgM antibody.

The optimal time for serum collection for IgM detection is 5 days after onset of symptoms fever and rash. If serum is collected less than 5 days after onset and is IgM negative, a second sample is necessary to confirm or rule out rubella using IgM detection.

In persons with rubella infection, the virus may be detected in nasal, throat, urine, blood, and cerebrospinal fluid specimens up to 10 days after rash onset most successful within 3 days. If CRS is confirmed, infants should be screened for viral shedding monthly after the age of 3 months until two consecutive negative tests are obtained. Viral shedding may be detected for up to one year. Rubella used to be a worldwide infection. Rubella is a human disease.

There is no known animal reservoir and no evidence of insect transmission. Infants with CRS may shed rubella virus for an extended period. Rubella is spread from person-to-person via direct contact or droplets shed from the respiratory secretions of infected persons.

Since rubella elimination in the United States, sporadic cases of rubella have been imported or linked to an imported case, with no temporal pattern. Rubella is most contagious when the rash first appears, but virus may be shed from 7 days before to 7 days after rash onset.

Infants with CRS shed large quantities of virus from body secretions for up to 1 year and can therefore transmit rubella to persons caring for them who are susceptible to the disease. Rubella and congenital rubella syndrome became nationally notifiable diseases in Following vaccine introduction in , rubella incidence declined dramatically. Rubella outbreaks continued to occur among adolescents and young adults and in settings where unvaccinated adults gathered. National recommendations to vaccinate susceptible postpubertal females, adolescents, persons in military service, college students, and persons in certain work settings, as well as increased rubella vaccination efforts in the Region of the Americas, led to further declines in rubella and CRS cases.

In , endemic rubella was declared eliminated in the United States, with fewer than 10 cases reported annually and less than one CRS case per year. Since , all rubella cases reported in the United States had evidence the patients were infected outside the United States. Among nine CRS cases reported in the United States between and , all were import-associated or from unknown sources.

Among children born during —, Single-antigen rubella vaccine is not available in the United States. MMR and MMRV vaccines are supplied as a lyophilized freeze-dried powder and are reconstituted with sterile, preservative-free water and vaccine contains gelatin.

It contains no adjuvant or preservative. MMR vaccine or MMRV vaccine can be used to implement the vaccination recommendations for prevention of measles, mumps, and rubella. MMR vaccine is licensed for use in persons age 12 months or older. MMRV vaccine is licensed for use in persons age 12 months through 12 years; MMRV vaccine should not be administered to persons age 13 years or older. Two doses of MMR vaccine, separated by at least 4 weeks, are routinely recommended for children age 12 months or older.

Dose 1 of MMR vaccine should be given at age 12 through 15 months. A second dose of MMR vaccine is recommended based on previous observations of the failure of some to generate an immune response to measles following dose 1. Dose 2 is routinely given at age 4 through 6 years, before a child enters kindergarten or first grade. All students entering school should receive 2 doses of MMR vaccine with the first dose administered at age 12 months or older before enrollment.

Dose 2 of MMR vaccine may be administered as soon as 4 weeks after dose 1. The minimum interval between doses of MMRV vaccine is 3 months, although when dose 2 is administered 4 weeks following dose 1, it can be considered valid. Providers who are considering administering MMRV should discuss the benefits and risks of both vaccination options with the parents.

For the second dose of measles, mumps, rubella, and varicella vaccines at any age and for the first dose at age 48 months or older, the use of MMRV generally is preferred over separate injections of its equivalent component vaccines i. Adults born in or later should receive at least 1 dose of MMR vaccine unless they have documentation of vaccination with at least 1 dose of measles, mumps, and rubella-containing vaccine or other acceptable presumptive evidence of immunity to these three diseases.

Except for health care personnel, who should have documented immunity, birth before generally can be considered acceptable evidence of immunity to measles, mumps, and rubella. Colleges and other post-high-school educational institutions are potential high-risk areas for measles, mumps, and rubella transmission because of large concentrations of persons. Prematriculation vaccination requirements for measles immunity have been shown to significantly decrease the risk of measles outbreaks on college campuses where such requirements are implemented and enforced.

All students entering colleges, universities, technical and vocational schools, and other institutions for post-high-school education should receive 2 doses of MMR vaccine or have other acceptable evidence of measles, mumps, and rubella immunity before entry.

For unvaccinated health care personnel born before who lack laboratory evidence of measles, mumps, or rubella immunity or laboratory confirmation of disease, health care facilities should have policies that offer 2 doses of MMR vaccine at the appropriate interval for measles and mumps and 1 dose of MMR vaccine for rubella, respectively. Health care facilities should also have policies for such personnel that recommend 2 doses of MMR vaccine during an outbreak of measles or mumps and 1 dose during an outbreak of rubella.

Adequate vaccination for health care personnel born during or after consists of at least 1 dose of MMR for rubella, and 2 appropriately spaced MMR doses for measles and mumps. Elimination of indigenous rubella and CRS can be maintained by continuing efforts to vaccinate susceptible adolescents and women of childbearing age, particularly those born outside the United States.

These efforts should include vaccinating in family planning clinics and sexually transmitted disease STD clinics, and as part of routine gynecologic care.

Efforts should also be made to maximize use of premarital serology results when such tests assess rubella immunity; emphasize vaccination for college students; vaccinate women postpartum and postabortion; immunize female prison staff and, when possible, female prison inmates; offer vaccination to at-risk women through the special supplemental program for Women, Infants, and Children WIC ; and implement vaccination programs in certain workplaces, particularly those employing persons born outside the United States.

Measles-, mumps-, or rubella- virus-containing vaccine administered prior to age 12 months e. Rubella is caused by a different virus than measles, and rubella isn't as infectious or as severe as measles. In many countries, rubella infection is rare or even nonexistent.

However, because the vaccine isn't used everywhere, the virus still causes serious problems for babies whose mothers are infected during pregnancy. The signs and symptoms of rubella are often difficult to notice, especially in children.

Signs and symptoms generally appear between two and three weeks after exposure to the virus. They usually last about one to five days and may include:. Contact your doctor if you think you or your child may have been exposed to rubella or if you have the signs or symptoms listed above.

If you're considering getting pregnant, check your vaccination record to make sure you've received your MMR vaccine. If you're pregnant and you develop rubella, especially during your first trimester, the virus can cause death or serious birth defects in the developing fetus. Rubella during pregnancy is the most common cause of congenital deafness. It's best to be protected against rubella before pregnancy. If you're pregnant, you'll likely undergo a routine screening for immunity to rubella.

But if you've never received the vaccine and you think you might have been exposed to rubella, contact your doctor immediately.

A blood test might confirm that you're already immune. Rubella is caused by a virus that's passed from person to person. It can spread when an infected person coughs or sneezes. It can also spread by direct contact with an infected person's respiratory secretions, such as mucus. It can also be passed on from pregnant women to their unborn children via the bloodstream. A person who has been infected with the virus that causes rubella is contagious for one to two weeks before the onset of the rash until about one or two weeks after the rash disappears.

An infected person can spread the illness before the person realizes he or she has it. To the best of our knowledge, this study is the first report demonstrating that the rubella virus infection occurred via systemic organs of the human body. Importantly, virus infection of the ciliary body could play an important role in cataractogenesis. The cause of the growth disturbance appears to be an activity of the proliferating virus which inhibits cell multiplication.

Necrotic or inflammatory changes in the tissues are rare. The subnormal number of cells in many body organs provides a partial explanation for the long-term physical and mental retardation encountered in some persons who have had congenital rubella. Naeye RL, Blanc W. Pathogenesis of Congenital Rubella.

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