Presentation on theme: "Rubella and Rubella Vaccine"— Presentation transcript:
1 Rubella and Rubella Vaccine Epidemiology and Prevention of Vaccine-Preventable DiseasesNational Immunization ProgramCenters for Disease Control and PreventionDr Esteghamati EPI Manager
2 Rubella From Latin meaning "little red" Discovered in 18th century - thought to be variant of measlesFirst described as distinct clinical entity in German literatureCongenital rubella syndrome described by Gregg in 1941
3 Rubella Virus Togavirus RNA virus One antigenic type Rapidly inactivated by chemical agents, low pH, heat and ultraviolet light
4 Rubella Pathogenesis Respiratory transmission of virus Replication in nasopharynx and regional lymph nodesViremia 5-7 days after exposure with spread to tissuesPlacenta and fetus infected during viremia
5 Rubella Clinical Features Incubation period 14 days (range days)Prodrome of low grade feverLymphadenopathy in second weekMaculopapular rash days after exposure
6 Rubella Complications Arthralgia or arthritis children adult femaleThrombocytopenic purpuraEncephalitisNeuritisOrchitisrareup to 70%1/3000 cases1/6,000 cases
7 Congenital Rubella Syndrome Infection may affect all organsMay lead to fetal death or premature deliverySeverity of damage to fetus depends on gestational ageUp to 85% of infants affected if infected during first trimester
10 CRS case definitions (1) Suspected CRS: A child <1 year withmaternal history of rubella in pregnancyand/orheart disease, or deafness, or eye signs:white pupil (cataract); diminished vision; pendular eye movement (nystagmus); squint; smaller eye ball (micropthalmos);larger eye ball (congenital glaucoma)
11 CRS case definitions (2) Clinically confirmed CRS: A child <1 year with two complications in group (a) orone from (a) and one from (b)(a) cataract(s), congenital glaucoma, congenital heart disease, loss of hearing, pigmentary retinopathy(b) purpura, splenomegaly, microcephaly, mental retardation, meningoencephalitis, radiolucent bone disease, jaundice with onset within 24 hours after birth.
12 CRS case definitions (3) Laboratory-confirmed CRS:An infant with a positive blood test for rubella-specific IgM and clinically-confirmed CRS.Congenital rubella infection (CRI):An infant with a positive blood test for rubella-specific IgM who does not have clinically-confirmed CRS.
13 TOP PRIORITY: Use rubella vaccine to prevent CRS To prevent CRS introduce rubella vaccine for women of childbearing ageDefine age of target groupconsider local fertility ratesWhere to offer vaccinepostpartum and family planningmass campaigns (Cuba, Malaysia)
15 Rubella Laboratory Diagnosis Isolation of rubella virus from clinical specimen (e.g., nasopharynx, urine)Significant rise in rubella IgG by any standard serologic assay (e.g., enzyme immunoassay)Positive serologic test for rubella IgM antibody
16 Rubella Epidemiology Reservoir Human Transmission Respiratory Subclinical cases maytransmitTemporal pattern Peak in late winter and springCommunicability 7 days before to 5-7 daysafter rash onset Infants with CRS may shedvirus for a year or more
19 Rubella - United States, 1980-2002 Age Distribution of Reported Cases 15-39 yrs<5 yrs5-14 yrs>40 yrs
20 Rubella and CRS in the United States Most reported rubella in the U.S. since the mid-1990s has occurred among foreign-born Hispanic adultsRubella outbreaks have occurred in workplaces where most employees are foreign-bornMajority of CRS since 1997 occurred in children of unvaccinated women born to Hispanic women, most born in Latin America
21 Rubella Case Definition Acute onset of generalized maculopapular rash, andTemperature of >37.2 C (>99 F), if measured, andArthralgia or arthritis, or lymph-adenopathy, or conjunctivitis
22 Rubella Outbreak Control Guidelines Laboratory diagnosis of rubella and CRSStep-by-step guidelines on evaluation and management of outbreakRubella prevention and control among women of childbearing ageRubella and CRS surveillanceMMWR 2001;50(RR-12)
23 *Only vaccine currently licensed in U.S. Rubella VaccineVaccineGMK-3:RK53HPV-77:DK12HPV-77:DE5RA 27/3*Trade NameCendevaxRubelogenMeruvaxMeruvax IILicensure19691979Only 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.*Only vaccine currently licensed in U.S.
24 Rubella Vaccine Composition Live virus (RA 27/3 strain) Efficacy 95% (Range, 90%-97%)Duration of Immunity LifelongSchedule >1 DoseShould be administered with measles and mumps as MMR
25 Rubella Vaccine (MMR) Indications All infants >12 months of ageSusceptible adolescents and adults without documented evidence of rubella immunityEmphasis on non-pregnant women of childbearing age, particularly those born outside the U.S.
26 Rubella ImmunityDocumentation of one dose of rubella-containing vaccine on or after the first birthdaySerologic evidence of immunityBirth before 1957 (except women of childbearing age)
27 Rubella ImmunityBirth before 1957 is not acceptable evidence of rubella immunity for women who might become pregnantOnly serology or documented vaccination should be accepted
28 MMR Adverse Reactions Fever 5%-15% Rash 5% Joint symptoms 25% Thrombocytopenia <1/30,000 dosesParotitis rareDeafness rareEncephalopathy <1/1,000,000 dosesJoint symptoms usually associated with the rubella component of MMR.
29 Rubella Vaccine Arthropathy Acute joint symptoms in about 25% of susceptable adult womenFrank arthritis occurs in about 10%Rare reports of chronic or persistent symptomsPopulation-based studies have not confirmed association
30 MMR Vaccine Contraindications and Precautions Severe allergic reaction to vaccine component or following prior dosePregnancyImmunosuppressionModerate or severe acute illnessRecent blood product
31 Vaccination of Women of Childbearing Age Ask if pregnant or likely to become so in next 4 weeksExclude those who say "yes"For othersExplain theoretical risksVaccinatePregnancy testing not routinely recommended by ACIP.
32 Vaccination in Pregnancy Study 1971-1989 321 women vaccinated324 live birthsNo observed CRS95% confidence limits 0%-1.2%
33 Rubella Vaccine Recommendations for Increasing Coverage Continued routine vaccination of children at age >12 months with vaccination required for school entryScreen and vaccinate susceptible personshealthcare workerscollege entryprenatal with postpartum vaccinationother healthcare visitsworkplace