Causative agent
Rubella virus
Clinical description
Rubella is an acute viral infection caused by rubella virus. It is
generally a mild illness, but if acquired by women in early pregnancy
can have devastating effects on the unborn child, leading to congenital
rubella syndrome. The virus affects all fetal organs and can lead to
serious birth defects. These include learning difficulties, cataracts,
deafness, cardiac abnormalities, retardation of intrauterine growth
and inflammatory lesions of the brain, liver, lings and bone marrow.
Non-fetal complications include arthritis and arthralgia in adults,
especially women, and encephalitis (approximately 1 in 6000 cases),
which can be fatal.
Transmission
The rubella virus is transmitted via respiratory droplets from infected individuals. The incubation period is usually 14 to 21 days. A rubella case is infectious for about 1 week before to at least 4 days after the onset of rash.
Surveillance in Scotland
- Statutory notification of rubella by clinical diagnosis
- Laboratory reports for rubella virus
- Laboratory confirmation of notified cases by salivary testing
Clinical Case Definition
Any person with:
- acute onset of generalised maculopapular rash and
- fever (>37.2 °C) and
- cervical, suboccipital or postauricular adenopathy or arthralgia/arthritis
(Source: WHO)
Laboratory criteria for diagnosis
- Isolation of rubella virus from a clinical specimen
- Detection of rubella virus nucleic acid in a clinical specimen
- Rubella virus specific antibody response in serum or saliva
- Detection of rubella virus antigen by direct fluorescent antibody (DFA) in a clinical specimen using rubella specific monoclonal antibodies
Incidence
The introduction of MMR vaccine in October 1988 led to a marked decrease in the incidence of rubella, as the previous policy of selective immunisation had little impact on the circulation of rubella in the community. A salivary surveillance scheme exists for rubella, in which all notifying GPs are strongly encouraged to submit a salivary sample from all notified cases for laboratory confirmation. Additional information such as vaccination history, recent international travel and contact with similar illness is requested for all confirmed cases. Genotyping to determine the possible origin of the virus may also be attempted. It is still important that females of child bearing age are protected by vaccination.
Rubella Notifications and Laboratory Confirmed Cases
Scotland 2000-2010
Year |
Vaccine Uptake* (%) |
Notifications |
Laboratory
Confirmed |
2000 |
93.2 |
349 |
5 |
2001 |
88.5 |
234 |
2 |
2002 |
87.8 |
292 |
7 |
2003 |
86.8 |
130 |
1 |
2004 |
88.3 |
222 |
1 |
2005 |
89.9 |
141 |
4 |
2006 |
92.1 |
153 |
0 |
2007 |
92.1 |
146 |
0 |
2008 |
92.6 |
106 |
4 |
2009 |
93.6 |
93 |
0 |
2010 |
93.2 |
39 |
1 |
* Uptake of one dose of MMR by age 24 months |
Notification and Laboratory confirmation
Most cases of suspected rubella (notifications) turn out not to be genuine rubella after a laboratory test is done. Enhanced surveillance for notifications of rubella is in place, with salivary specimens invited from all notified cases and sent out to the laboratory for confirmation.
Prevention
The primary aim of rubella vaccination is to protect pregnant women
from rubella infection, resultant congenital infection, and fetal damage.
This is why UK policy, when the vaccine was originally introduced in
1970, was for selective immunisation of pre-adolescent girls and non-immune
women of child bearing age.
However, as this strategy has little impact on the circulation of
rubella virus in the community, rubella vaccination was offered to both
boys and girls with the introduction of MMR vaccine in 1988. Rubella
antigen was also include in the 1994 schools campaign against measles,
as MR vaccine, with the specific aim of reducing susceptibility among
young men, who may be in close contact with pregnant women.
Rubella vaccine is included in the UK Childhood Immunisation schedule, with routine vaccination recommended between 12 and 13 months, and again at around 3 and a half years. Any pregnant women found to be susceptible to rubella in antenatal screening are also recommended to receive MMR vaccine, after delivery, as are any other women of child-bearing age.
Further Information
Historic data
Vaccine Uptake
Vaccine update data is compiled by Information Services Division (ISD). Further information can be found on their website:
European Centre for Disease Prevention and Control
ECDC is the public health surveillance network for vaccine preventable infectious diseases in Europe. Previously this work was carried out by EUVAC.NET.
Images of Rubella Infection
Surveillance of Congenital Rubella
Surveillance of congenital rubella in the UK is performed via the British Paediatric Surveillance Unit
General Information about Measles
Immunisation Against Infectious Diesase (The Green Book) provides background information and vaccination details about all vaccine preventable diseases. This is regularly updated. It is written and maintained by the UK Department of Health, but is used throughout the UK.
NHS Inform provides information about measles including symptoms, causes, complications and prevention.
Last reviewed: 2 February 2012
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