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The following text is from an archived Red Book^® edition and may not reflect current recommendations or information. To view the current edition, click here.

Section 3. Summaries of Infectious Diseases

Rubella

Clinical Manifestations
Etiology
Epidemiology
Diagnostic Tests
Treatment
Isolation of the Hospitalized Patient
Control Measures

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CLINICAL MANIFESTATIONS:

Postnatal Rubella. Rubella usually is a mild disease characterized by a generalized erythematous maculopapular rash, generalized lymphadenopathy (commonly suboccipital, postauricular, and cervical), and slight fever. Transient polyarthralgia and polyarthritis rarely occur in children but are common in adolescents and adults, especially females. Encephalitis and thrombocytopenia are rare complications. Maternal rubella during pregnancy can result in miscarriage, fetal death, or a constellation of congenital anomalies (congenital rubella syndrome).

Congenital Rubella. The most commonly described anomalies associated with congenital rubella syndrome are ophthalmologic (cataracts, retinopathy, and congenital glaucoma), cardiac (patent ductus arteriosus, peripheral pulmonary artery stenosis), auditory (sensorineural hearing impairment), and neurologic (behavioral disorders, meningoencephalitis, and mental retardation). In addition, infants with congenital rubella syndrome often are growth retarded and may have radiolucent bone disease, hepatosplenomegaly, thrombocytopenia, and purpuric skin lesions (giving a "blueberry muffin" appearance). Mild forms of the disease can be associated with few or no obvious clinical manifestations at birth. The occurrence of congenital defects is as high as 85% if infection occurs during the first 4 weeks of gestation, 20% to 30% during the second month, and 5% during the third or fourth month.

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ETIOLOGY: Rubella virus is an enveloped, positive-stranded RNA virus classified as a Rubivirus in the Togaviridae family.

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EPIDEMIOLOGY: Humans are the only source of infection. Postnatal rubella is transmitted primarily through direct or droplet contact from nasopharyngeal secretions. The peak incidence of infection is during late winter and early spring. Approximately 25% to 50% of infections are asymptomatic. Immunity from wild-type or vaccine virus usually is prolonged, but reinfection on rare occasions has been demonstrated and rarely has resulted in congenital rubella. The period . . . [Go to Full Text]

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• Abbott;, M., Gerber, M. A., Halsey, N. A., Abramson, J. S. (2001). Varicella Vaccine Question. Pediatrics 107: 612-612 [Full Version]  
• Muhle, R., Trentacoste, S. V., Rapin, I. (2004). The Genetics of Autism. Pediatrics 113: e472-e486 [Abstract] [Full Version]  
• TUTTLE, R. (1967). Skin Dimples. Pediatrics 39: 943-944 [Abstract]  
• Perez, E. E., Bokszczanin, A., McDonald-McGinn, D., Zackai, E. H., Sullivan, K. E. (2003). Safety of Live Viral Vaccines in Patients With Chromosome 22q11.2 Deletion Syndrome (DiGeorge Syndrome/Velocardiofacial Syndrome). Pediatrics 112: e325-325 [Abstract] [Full Version]  
• Pool, V., Braun, M. M., Kelso, J. M., Mootrey, G., Chen, R. T., Yunginger, J. W., Jacobson, R. M., Gargiullo, P. M. (2002). Prevalence of Anti-Gelatin IgE Antibodies in People With Anaphylaxis After Measles-Mumps-Rubella Vaccine in the United States. Pediatrics 110: e71-71 [Abstract] [Full Version]  
• Halsey, N. A., Hyman, S. L., the Conference Writing Panel, (2001). Measles-Mumps-Rubella Vaccine and Autistic Spectrum Disorder: Report From the New Challenges in Childhood Immunizations Conference Convened in Oak Brook, Illinois, June 12-13, 2000. Pediatrics 107: 84e-84 [Abstract] [Full Version]  
• Leitch, R., Halsey, N., Hyman, S. L. (2002). MMR--Separate Administration--Has It Been Done?. Pediatrics 109: 172-172 [Full Version]  
• Piedra, P. A., Gaglani, M. J., Riggs, M., Herschler, G., Fewlass, C., Watts, M., Kozinetz, C., Hessel, C., Glezen, W. P. (2005). Live Attenuated Influenza Vaccine, Trivalent, Is Safe in Healthy Children 18 Months to 4 Years, 5 to 9 Years, and 10 to 18 Years of Age in a Community-Based, Nonrandomized, Open-Label Trial. Pediatrics 116: e397-e407 [Abstract] [Full Version]  
• Zimmerman, L., Reef, S. E. (2001). Incidence of Congenital Rubella Syndrome at a Hospital Serving a Predominantly Hispanic Population, El Paso, Texas. Pediatrics 107: 40e-40 [Abstract] [Full Version]  
• Miller, L. C., Comfort, K., Kelly, N. (2001). Immunization Status of Internationally Adopted Children. Pediatrics 108: 1050-1051 [Full Version]  
• Rosenthal, J., Rodewald, L., McCauley, M., Berman, S., Irigoyen, M., Sawyer, M., Yusuf, H., Davis, R., Kalton, G. (2004). Immunization Coverage Levels Among 19- to 35-Month-Old Children in 4 Diverse, Medically Underserved Areas of the United States. Pediatrics 113: e296-e302 [Abstract] [Full Version]  
• Meissner, H. C., Reef, S. E., Cochi, S. (2006). Elimination of Rubella From the United States: A Milestone on the Road to Global Elimination. Pediatrics 117: 933-935 [Full Version]  
• Virtanen, M., Peltola, H., Paunio, M., Heinonen, O. P. (2000). Day-to-Day Reactogenicity and the Healthy Vaccinee Effect of Measles-Mumps-Rubella Vaccination. Pediatrics 106: 62e-62 [Abstract] [Full Version]  
• Nilsson, A., De Milito, A., Engstrom, P., Nordin, M., Narita, M., Grillner, L., Chiodi, F., Bjork, O. (2002). Current Chemotherapy Protocols for Childhood Acute Lymphoblastic Leukemia Induce Loss of Humoral Immunity to Viral Vaccination Antigens. Pediatrics 109: e91-91 [Abstract] [Full Version]  
• Zerr, D. M., Heath, J., Riggert, D., Marcuse, E. K., Zimmerman, L., Reef, S. E. (2001). Congenital Rubella Infection Control Problem. Pediatrics 108: 1389-1390 [Full Version]  
• Bascom, S., Miller, S., Greenblatt, J. (2005). Assessment of Perinatal Hepatitis B and Rubella Prevention in New Hampshire Delivery Hospitals. Pediatrics 115: e594-e599 [Abstract] [Full Version]  
• Patja, A., Mäkinen-Kiljunen, S., Davidkin, I., Paunio, M., Peltola, H. (2001). Allergic Reactions to Measles-Mumps-Rubella Vaccination. Pediatrics 107: 27e-27 [Abstract] [Full Version]  
• Reisinger, K. S., Hoffman Brown, M. L., Xu, J., Sullivan, B. J., Marshall, G. S., Nauert, B., Matson, D. O., Silas, P. E., Protocol 014 Study Group for ProQuad, , Schodel, F., Gress, J. O., Kuter, B. J. (2006). A Combination Measles, Mumps, Rubella, and Varicella Vaccine (ProQuad) Given to 4- to 6-Year-Old Healthy Children Vaccinated Previously With M-M-RII and Varivax. Pediatrics 117: 265-272 [Abstract] [Full Version]  

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