Rubella review

[Guest guest]

J Long Term Eff Med Implants. 2005;15(3):319-28.

Rubella and congenital rubella (German measles).

Edlich RF, Winters KL, Long WB 3rd, Gubler KD. Distinguished

Professor Emeritus of Plastic Surgery and Biomedical Engineering, University

of Virginia Health System, Charlottesville, Virginia, USA.

richardedlichmd@...

Rubella, also known as German measles, is usually a very mild infection

that can have devastating effects in certain instances. It is a pleomorphic

RNA virus in the Togaviridae family of the genus Rubivirus. It typically

causes a scarletiniform rash, cervical lymphadenopathy, and mild

constitutional symptoms, but in older children and adults, especially women,

it may be more severe, with joint involvement and purpuric rash. Infection

during the first 12 weeks of pregnancy results in congenital infection

and/or miscarriage in 80-90% of cases. The congenital rubella syndrome (CRS)

involves multiple organ systems and has a long period of active infection

and virus shedding in the postnatal period. For these reasons, the rubella

vaccine program was instituted in 1969, and the incidence of rubella

infection in the United States has since declined by 99%. Rubella has been

recognized as a disease for approximately 200 years, and it has since been

found that humans are the only natural reservoir for the rubella virus.

Virus is present in nasopharyngeal secretions, blood, feces, and urine

during the clinical illness, although patients with subclinical disease are

also infectious. The virus is spread via oral droplets and is shed in the

nasopharynx for approximately 7 days before and after the rash is visible.

CRS includes a configuration of anomalies, including nerve deafness,

cataracts, cardiac anomalies (usually pulmonary artery and valvular

stenosis, and patent ductus arteriosis), and mental retardation, with late

complications including diabetes, thyroid disease, growth hormone

deficiency, and progressive panencephalitis. In 1969, the first rubella

vaccine was licensed for use, and the Centers for Disease Control and

Prevention (CDC) began its National Congenital Rubella Syndrome Registry. As

required under the National Childhood Injury Act, all healthcare providers

in the United States who administer any vaccine shall, prior to

administration of the vaccine, provide a copy of the Vaccine Information

Statements (VIS) produced by the CDC to the parent or legal representative

of any child to whom the provider intends to administer such vaccine, or to

any adult to whom the provider intends to administer such vaccine. Despite

efforts to vaccinate children, CRS continues to occur in the United States.

Hispanic infants have an increased risk of CRS. HIV-1infected children with

a preserved immune system and MMR immunization had a good response to

rubella vaccine. In contrast, those in more advanced categories for HIV

infection responded poorly. Issues of risk, choice, and chance are central

to the controversy over the MMR vaccine that erupted in the UK in 1998, and

has continued into the new millennium. An important contribution to the MMR

controversy has come from the parents of autistic children, some of whom

reject the notion that this disorder is a random genetic misfortune and

insist that it is, at least in part, the result of some environmental

insult, such as MMR vaccinations. PMID: 16022642

[Guest guest]

J Long Term Eff Med Implants. 2005;15(3):319-28.

Rubella and congenital rubella (German measles).

Edlich RF, Winters KL, Long WB 3rd, Gubler KD. Distinguished Professor Emeritus of Plastic Surgery and Biomedical Engineering, University of Virginia Health System, Charlottesville, Virginia, USA. richardedlichmd@...

Rubella, also known as German measles, is usually a very mild infection that can have devastating effects in certain instances. It is a pleomorphic RNA virus in the Togaviridae family of the genus Rubivirus. It typically causes a scarletiniform rash, cervical lymphadenopathy, and mild constitutional symptoms, but in older children and adults, especially women, it may be more severe, with joint involvement and purpuric rash. Infection during the first 12 weeks of pregnancy results in congenital infection and/or miscarriage in 80-90% of cases. The congenital rubella syndrome (CRS) involves multiple organ systems and has a long period of active infection and virus shedding in the postnatal period. For these reasons, the rubella vaccine program was instituted in 1969, and the incidence of rubella infection in the United States has since declined by 99%. Rubella has been recognized as a disease for approximately 200 years, and it has since been found that humans are the only natural reservoir for the rubella virus. Virus is present in nasopharyngeal secretions, blood, feces, and urine during the clinical illness, although patients with subclinical disease are also infectious. The virus is spread via oral droplets and is shed in the nasopharynx for approximately 7 days before and after the rash is visible. CRS includes a configuration of anomalies, including nerve deafness, cataracts, cardiac anomalies (usually pulmonary artery and valvular stenosis, and patent ductus arteriosis), and mental retardation, with late complications including diabetes, thyroid disease, growth hormone deficiency, and progressive panencephalitis. In 1969, the first rubella vaccine was licensed for use, and the Centers for Disease Control and Prevention (CDC) began its National Congenital Rubella Syndrome Registry. As required under the National Childhood Injury Act, all healthcare providers in the United States who administer any vaccine shall, prior to administration of the vaccine, provide a copy of the Vaccine Information Statements (VIS) produced by the CDC to the parent or legal representative of any child to whom the provider intends to administer such vaccine, or to any adult to whom the provider intends to administer such vaccine. Despite efforts to vaccinate children, CRS continues to occur in the United States. Hispanic infants have an increased risk of CRS. HIV-1infected children with a preserved immune system and MMR immunization had a good response to rubella vaccine. In contrast, those in more advanced categories for HIV infection responded poorly. Issues of risk, choice, and chance are central to the controversy over the MMR vaccine that erupted in the UK in 1998, and has continued into the new millennium. An important contribution to the MMR controversy has come from the parents of autistic children, some of whom reject the notion that this disorder is a random genetic misfortune and insist that it is, at least in part, the result of some environmental insult, such as MMR vaccinations. PMID: 16022642