Also known as: German Measles or Three-Day measles
Hospital: Report by IDSS, mail, facsimile or phone
Lab: Report by IDSS, mail, facsimile, or phone
Physician: Report by mail, facsimile, or phone
Local Public Health Agency (LPHA): Report by IDSS, mail, facsimile or phone. Follow-up required.
Iowa Department of Public Health
Disease Reporting Hotline: (800) 362-2736
Secure Fax: (515) 281-5698
A. Etiologic Agent
Rubella is caused by rubella virus (genus Rubivirus, family Togaviridae).
B. Clinical Description
When contracted after birth, rubella is usually a mild disease characterized by a generalized maculopapular rash, swollen lymph nodes, and slight fever. Transient inflammation of the joints rarely occurs in children, but is common in adolescents and adults, especially women (up to 70%). Encephalitis occurs (1 per 5,000 cases, more frequently in women) and hemorrhagic manifestations (1 per 3,000 cases, more often in children) are rare complications. Up to 50% of infections occur without recognized rash.
Rubella is of greatest danger to the fetus. Up to 90% of infants born to mothers infected in the first trimester will develop the physical anomalies referred to as congenital rubella syndrome (CRS). CRS is characterized by complications, which include blindness, heart defects, deafness, behavioral disorders, mental retardation, growth retardation, bone disease, enlarged liver and spleen, thrombocytopenia, and purple skin lesions. Some effects may not be apparent at birth.
Reinfection has been demonstrated on rare occasions, but only very rarely has resulted in CRS.
Clinical Case Definition
- Acute onset of generalized maculopapular rash
- Temperature >37.2°C (99°F), if measured
- Arthralgia/arthritis, or lymphadenopathy, or conjunctivitis
- Serologic confirmation (IgM or 4-fold increase in IgG)
Clinical diagnosis is UNRELIABLE. Serologic confirmation is critical.
Suspected. A case of any generalized rash illness of acute onset.
Probable. A case that meets the clinical case definition, has noncontributory or no serologic or virologic testing, and is not epidemiologically linked to a laboratory confirmed case.
Confirmed. A case that is laboratory confirmed or that meets the clinical case definition and is epidemiologically linked to a laboratory confirmed case.
Humans are the only known host.
D. Modes of Transmission
Rubella is transmitted person-to-person by droplet or direct contact with the nasopharyngeal secretions of an infected person or with the nasopharyngeal secretions or urine of an infant with CRS.
E. Incubation Period
The incubation period is usually 14 -17 days, with a range of 14–21 days.
F. Period of Communicability or Infectious Period
The infectious period is usually from 7 days before to at least 4 days after rash onset.
Infants with CRS shed virus in nasopharyngeal secretions and urine for a longer period; a small proportion of them continue to be infectious for 1 year or more.
Rubella occurs worldwide. In the temperate zones, peak incidence is in late winter and early spring. Before the widespread use of rubella vaccine, which was licensed in 1969, peaks of rubella incidence occurred in the United States every 6–9 years, and most cases occurred in children. Now that children are well immunized, most cases have occurred in young, unvaccinated adults in college and occupational settings. Recent serologic surveys indicate that about 10% of young adults are susceptible to rubella.
In recent years in the U.S. and Iowa, outbreaks have occurred among immigrant populations due to lack of rubella vaccination programs in their countries of origin. Outbreaks occur predominately in workplaces and communities at large. CRS disproportionately affects infants born to foreign-born women. The last case of Rubella reported in Iowa was in 2001.
H. Bioterrorism Potential
I. Additional Information
The Council of State and Territorial Epidemiologists (CSTE) surveillance case definitions for Rubella can be found at: www.cdc.gov/osels/ph_surveillance/nndss/phs/infdis.htm#top
CSTE case definitions should not affect the investigation or reporting of a case that fulfills the criteria in this chapter. (CSTE case definitions are used by the state health department and the CDC to maintain uniform standards for national reporting.)
Advisory Committee on Immunization Practices. Measles, Mumps, and Rubella Vaccine Use and Strategies for Elimination of Measles, Rubella, and Congenital Syndrome and Control of Mumps, May 22, 1998.
American Academy of Pediatrics. Red Book 2006: Report of the Committee on Infectious Diseases, 27th Edition. Illinois, American Academy of Pediatrics, 2006.
CDC. Immunization of Healthcare Workers. Recommendations of the Advisory Committee on Immunization Practices (ACIP) and the Hospital Infection Control Practices Advisory Committee (HICPAC). MMWR. 1997; 46:RR-18.
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CDC, Epidemiology and Prevention of Vaccine Preventable Diseases 9th Edition (Pink Book) January 2006 www.cdc.gov/vaccines/pubs/pinkbook/downloads/rubella.pdf
CDC Disease Surveillance Manual: www.cdc.gov/vaccines/pubs/surv-manual/chpt14-rubella.html