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Rubella and Rubella Vaccine
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tarix | 20.02.2017 | ölçüsü | 461 b. | | #9160 |
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Rubella and Rubella Vaccine
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 described by Gregg in 1941
Rubella Virus Togavirus RNA virus One antigenic type Rapidly inactivated by chemical agents, low pH, heat and ultraviolet light
Rubella Pathogenesis Respiratory transmission of virus Replication in nasopharynx and regional lymph nodes Placenta and fetus infected during viremia
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
Congenital Rubella Syndrome Infection may affect all organs May lead to fetal death or premature delivery Up to 85% of infants affected if infected during first trimester
Congenital Rubella Syndrome Deafness Cataracts Heart defects Microcephaly Mental retardation Bone alterations Liver and spleen damage
Epidemic Rubella – United States, 1964-1965 12.5 million rubella cases 2,000 encephalitis cases 11,250 abortions (surgical/spontaneous) 2,100 neonatal deaths - Deaf - 11,600
- Blind - 3,580
- Mentally retarded - 1,800
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
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, 1966-2001*
Rubella - United States, 1980-2001* Rubella - United States, 1980-2001*
Rubella - United States, 1980-2000 Age Distribution of Reported Cases
Rubella and CRS in the United States, 1990s Most reported rubella in the U.S. since the mid-1990s has occurred among foreign-born Hispanic adults Rubella outbreaks have occurred in workplaces where most employees are foreign-born 83% of CRS since 1997 occurred in children of unvaccinated women born to Hispanic women, most born in Latin America
Rubella Case Definition Acute onset of generalized maculopapular rash, and Temperature of >37.2 C (>99 F), if measured, and Arthritis/arthralgia or lymphadenopathy or conjunctivitis
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
Rubella Vaccine
Rubella Vaccine Composition Live virus (RA 27/3 strain) Efficacy 95% (Range, 90%-97%) Schedule 1 Dose Should be administered with measles and mumps as MMR
Rubella Vaccine (MMR) Indications All infants >12 months of age Susceptible adolescents and adults without documented evidence of rubella immunity Emphasis on non-pregnant 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)
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
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
Rubella Vaccine Arthropathy Acute joint symptoms in about 25% of susceptable adult women Frank arthritis occurs in about 10% Rare reports of chronic or persistent symptoms Population-based studies have not confirmed association
MMR Vaccine Contraindications and Precautions Severe allergic reaction to prior dose or vaccine component Pregnancy Immunosuppression Moderate or severe acute illness
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
Vaccination in Pregnancy Study 1971-1989 321 women vaccinated 324 live births No observed CRS 95% confidence limits 0%-1.2%
Rubella Vaccine Recommendations for Increasing Coverage Continued routine vaccination of children at age >12 months with vaccination required for school entry - health care workers
- college entry
- prenatal with postpartum vaccination
- other health care visits
- workplace
National Immunization Program Hotline 800.232.2522 Email nipinfo@cdc.gov Website www.cdc.gov/nip
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