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| __NOTOC__ | | __NOTOC__ |
| {{Rubella}} | | {{Rubella}} |
| {{CMG}} | | {{CMG}}; {{AE}} {{AKI}} |
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| ==Epidemiology== | | ==Overview== |
| Rubella is a disease that occurs worldwide. The virus tends to peak during the spring in countries with temperate climates. Before the vaccine to rubella was introduced in 1969, widespread outbreaks usually occurred every 6-9 years in the United States and 3-5 years in Europe, mostly affecting children in the 5-9 year old age group.<ref name="pmid11798368">{{cite journal
| | In the United States, [[endemic]] [[rubella virus]] [[transmission]] has been eliminated since 2001. From 2004 to 2013, 10 cases of [[rubella]] [[infection]] was diagnosed in the immigrants. |
| |author=Reef SE, Frey TK, Theall K, ''et al''
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| |title=The changing epidemiology of rubella in the 1990s: on the verge of elimination and new challenges for control and prevention
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| |journal=JAMA
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| |volume=287
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| |issue=4
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| |pages=464–72
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| |year=2002
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| |pmid=11798368
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| |doi=
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| |url=http://jama.ama-assn.org/cgi/pmidlookup?view=long&pmid=11798368
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| }}</ref> Since the introduction of vaccine, occurrences have become rare in those countries with high uptake rates. However, in the UK there remains a large population of men susceptible to rubella who have not been vaccinated. Outbreaks of rubella occurred amongst many young men in the UK in 1993 and in 1996 the infection was transmitted to pregnant women, many of whom were immigrants and were susceptible. Outbreaks still arise, usually in developing countries where the vaccine is not as accessible.<ref name="pmid16989272">{{cite journal
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| |author=Reef S
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| |title=Rubella mass campaigns
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| |journal=Curr. Top. Microbiol. Immunol.
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| |volume=304
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| |issue=
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| |pages=221–9
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| |year=2006
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| |pmid=16989272
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| |doi=
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| }}</ref>
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| During the epidemic in the US between 1962-1965, Rubella virus infections during pregnancy were estimated to have caused 30,000 still births and 20,000 children to be born impaired or disabled as a result of CRS.<ref name="pmid11348695">{{cite journal
| | ==Epidemiology and Demographics== |
| |author=Plotkin SA
| | '''Incidence''' |
| |title=Rubella eradication
| | *In the [[United States]], [[endemic]] [[rubella virus]] transmission has been eliminated since 2001. |
| |journal=[[Vaccine]]
| | *From 2004 to 2013, a median of 10 (range, 4–18) imported cases were reported annually in the [[United States]], and 6 cases of [[congenital rubella syndrome]] were reported during the same period. The patients diagnosed with the infection are the immigrants. |
| |volume=19
| | *In 2013, 2 large outbreaks were reported in Poland and Japan; cases were mostly among adolescent boys and adult men, but [[pregnant]] women were also affected, and their children subsequently developed [[congenital rubella syndrome]].<ref name="pmid26233074">{{cite journal| author=Korczyńska MR, Paradowska-Stankiewicz I| title=Rubella in Poland in 2013. | journal=Przegl Epidemiol | year= 2015 | volume= 69 | issue= 2 | pages= 213-8, 341-3 | pmid=26233074 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26233074 }} </ref> |
| |issue=25-26
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| |pages=3311–9
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| |year=2001
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| |pmid=11348695
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| |doi=
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| |url=http://linkinghub.elsevier.com/retrieve/pii/S0264410X01000731
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| }}</ref><ref>Cooper,L.Z. Congenital Rubella in the United States. 1975 In: Krugman,S Gershon,A (eds), Symposium on Infections Of the Fetus and Newborn Infant. New York, Alan R. Liss Inc.,p.1.</ref>
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| Universal immunisation producing a high level of [[herd immunity]] is important in the control of epidemics of rubella.<ref name="pmid11105178">{{cite journal
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| |author=Danovaro-Holliday MC, LeBaron CW, Allensworth C, ''et al'' | |
| |title=A large rubella outbreak with spread from the workplace to the community | |
| |journal=JAMA | |
| |volume=284 | |
| |issue=21 | |
| |pages=2733–9 | |
| |year=2000 | |
| |pmid=11105178 | |
| |doi= | |
| |url=http://jama.ama-assn.org/cgi/pmidlookup?view=long&pmid=11105178 | |
| }}</ref> | |
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| ==United States==
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| Rubella and congenital rubella syndrome became nationally notifiable diseases in 1966. The largest annual total of cases of rubella in the United States was in 1969, when 57,686 cases were reported (58 cases per 100,000 population). Following vaccine licensure in 1969, rubella incidence declined rapidly. By 1983, fewer than 1,000 cases per year were reported (less than 0.5 cases per 100,000 population). A moderate resurgence of rubella occurred in 1990–1991, primarily due to outbreaks in California (1990) and among the Amish in Pennsylvania (1991). In 2003, a record low annual total of seven cases was reported. In October 2004, CDC convened an independent expert panel to review available rubella and CRS data. After a careful review, the panel unanimously agreed that rubella was no longer endemic in the United States.
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| Until recently, there was no predominant age group for rubella cases. From 1982 through 1992, approximately 30% of cases occurred in each of three age groups: younger than 5, 5–14, and 15–39 years. Adults 40 years of age and older typically accounted for less than 10% of cases. However, since 1993, persons 15–39 years of age have accounted for more than half the cases. In 2003, this age group accounted for 71% of all reported cases.
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| Most reported rubella in the United States since the mid-1990s has occurred among Hispanic young adults who were born in areas where rubella vaccine is routinely not given.
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| CRS surveillance is maintained through the National Congenital Rubella Registry, which is managed by the National Center for Immunization and Respiratory Diseases. The largest annual total of reported CRS cases to the registry was in 1970 (67 cases). An average of 5–6 CRS cases have been reported annually since 1980. Although reported rubella activity has consistently and significantly decreased since vaccine has been used in the United States, the incidence of CRS has paralleled the decrease in rubella cases only since the mid-1970s. The decline in CRS since the mid-1970s was due to an increased effort to vaccinate susceptible adolescents and young adults, especially women. Rubella outbreaks are almost always followed by an increase in CRS.
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| Rubella outbreaks in California and Pennsylvania in 1990–1991 resulted in 25 cases of CRS in 1990 and 33 cases in 1991. Two CRS cases were reported in 2001, and in 2004, no cases were reported. Since 1997, the mothers of the majority of infants with CRS were Hispanic women, many of whom were born in Latin American or Caribbean countries where rubella vaccine is routinely not used or has only recently begun to be used.
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| ==References== | | ==References== |
| {{Reflist|2}} | | {{Reflist|2}} |
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| [[Category:Teratogens]] | | [[Category:Teratogens]] |
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| [[Category:Pediatrics]] | | [[Category:Pediatrics]] |
| [[Category:Togaviruses]] | | [[Category:Togaviruses]] |
| [[Category:Infectious disease]]
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| [[Category:Emergency medicine]] | | [[Category:Emergency medicine]] |
| [[Category:primary care]]
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| [[Category:Needs overview]] | | [[Category:Needs overview]] |
| | | [[Category:Emergency mdicine]] |
| {{WH}}
| | [[Category:Disease]] |
| {{WS}}
| | [[Category:Up-To-Date]] |
| | [[Category:Infectious disease]] |
| | [[Category:Dermatology]] |