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P.A. Tookey

and J.M. Best


July 30, 2015: This chapter has been re-evaluated and remains up-to-date. No changes have been necessary.


Epidemiology and prevention in Africa and other developing regions.

Updated on 31 May 2012. The previous version of this content can be found here.
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date: 25 April 2017

Rubella is caused by an enveloped RNA virus, for which humans are the only known host. Transmission is by airborne droplet spread, with infection seen predominantly in spring and early summer in temperate zones.

Postnatally acquired infection—presents after incubation of 14 to 21 days with rash (maculopapular, usually beginning on the face before spreading to the trunk and extremeties), lymphadenopathy (suboccipital and posterior cervical), and mild fever. Sore throat, coryza, cough, conjunctivitis, and arthralgia may be seen. The illness is usually mild. Management is symptomatic.

Rubella in pregnancy—in the first 10 weeks of gestation this is associated with a 90% risk of congenital fetal abnormalities, most typically comprising sensorineural hearing loss, alone or combined with cataracts and/or cardiac anomalies. Clinical diagnosis is unreliable, hence rapid investigation is essential when a woman develops a rubella-like illness in the first 16 weeks of pregnancy, comprising (1) testing of maternal serum for rubella IgG and IgM antibodies; and sometimes (2) amniotic fluid and/or fetal blood testing; and (3) ultrasonography to detect fetal defects. If a fetus is infected, termination of pregnancy is considered.

Prevention—live attenuated rubella vaccines provide protection to about 95% vaccinees and are usually given in combination with measles (MR) or measles and mumps (MMR) vaccines. Vaccination of >80% of children is required to prevent circulation of rubella virus. Health care workers and women of childbearing age whose rubella status is unknown (including recent immigrants) should also be targeted for MMR vaccination. Immunization of pregnant women is contraindicated, but women found to be susceptible at antenatal testing should be offered MMR vaccination after delivery.

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