Rubella in pregnancy
- Laura E Riley, MD
Laura E Riley, MD
- Assistant Professor of Obstetrics, Gynecology and Reproductive Biology
- Harvard Medical School
- Section Editors
- Martin S Hirsch, MD
Martin S Hirsch, MD
- Editor-in-Chief — Infectious Diseases
- Section Editor — Viral Infections
- Professor of Medicine
- Harvard Medical School
- Charles J Lockwood, MD, MHCM
Charles J Lockwood, MD, MHCM
- Section Editor — Obstetrics
- Senior Vice President, USF Health
- Dean, Morsani College of Medicine
- Professor, Obstetrics and Gynecology
- University of South Florida
Rubella, also known as German measles, was a disease of childhood that has markedly declined in incidence in the United States since the introduction of routine childhood rubella vaccination. This virus causes a self-limited infection in most hosts, but can have potentially devastating effects on the developing fetus. Screening for antibodies to rubella is routinely performed by obstetricians.
Rubella virus is a member of the togavirus family, genus Rubivirus, and humans are the only reservoir for rubella infection. The virus is transmitted by direct droplet contact from nasopharyngeal secretions, replicates in the lymph tissue of the upper respiratory tract, and spreads hematogenously. Congenital infection occurs when maternal viremia allows hematogenous spread of the virus across the placenta.
Rubella in pregnancy will be reviewed here. The virology, pathogenesis, clinical manifestations, diagnosis, treatment, and prevention through vaccination are discussed separately. (See "Rubella".)
Rubella and the congenital rubella syndrome (CRS) have largely been eliminated in the United States. The incidence of rubella has declined from 0.45 per 100,000 in 1990 to 0.1 per 100,000 in 1999 . However, rubella outbreaks continue to occur in other parts of the world, and CRS remains a concern.
United States — Prior to the introduction of the rubella vaccine in 1969, epidemics of rubella occurred in six to nine year cycles, usually in the late winter and early spring. In 1964, a major worldwide pandemic spread to the United States resulting in approximately 12.5 million cases of rubella, as many as 11,000 fetal deaths, and approximately 20,000 cases of congenital rubella syndrome (CRS) .To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
- Reef SE, Frey TK, Theall K, et al. The changing epidemiology of rubella in the 1990s: on the verge of elimination and new challenges for control and prevention. JAMA 2002; 287:464.
- Orenstein WA, Bart KJ, Hinman AR, et al. The opportunity and obligation to eliminate rubella from the United States. JAMA 1984; 251:1988.
- Reef SE, Redd SB, Abernathy E, et al. The epidemiological profile of rubella and congenital rubella syndrome in the United States, 1998-2004: the evidence for absence of endemic transmission. Clin Infect Dis 2006; 43 Suppl 3:S126.
- Aksit S, Egemen A, Ozacar T, et al. Rubella seroprevalence in an unvaccinated population in Izmir: recommendations for rubella vaccination in Turkey. Pediatr Infect Dis J 1999; 18:577.
- Onyenekwe CC, Kehinde-Agbeyangi TA, Ofor US, Arinola OG. Prevalence of rubella-IgG antibody in women of childbearing age in Lagos, Nigeria. West Afr J Med 2000; 19:23.
- Semerikov VV, Lavrentyeva IN, Popov VF, et al. Rubella in the Russian Federation: epidemiological features and control measures to prevent the congenital rubella syndrome. Epidemiol Infect 2000; 125:359.
- Ballal M, Shivananda PG. Prevalence of rubella virus in suspected cases of congenital infections. Indian J Pediatr 1997; 64:231.
- Centers for Disease Control and Prevention (CDC). Progress toward elimination of rubella and congenital rubella syndrome--the Americas, 2003-2008. MMWR Morb Mortal Wkly Rep 2008; 57:1176.
- http://wwwnc.cdc.gov/travel/notices/alert/rubella-poland (Accessed on March 04, 2014).
- http://wwwnc.cdc.gov/travel/notices/alert/rubella-japan (Accessed on March 04, 2014).
- Sheridan E, Aitken C, Jeffries D, et al. Congenital rubella syndrome: a risk in immigrant populations. Lancet 2002; 359:674.
- McElroy R, Laskin M, Jiang D, et al. Rates of rubella immunity among immigrant and non-immigrant pregnant women. J Obstet Gynaecol Can 2009; 31:409.
- Mehta NM, Thomas RM. Antenatal screening for rubella-infection or immunity? BMJ 2002; 325:90.
- Robertson SE, Cutts FT, Samuel R, Diaz-Ortega JL. Control of rubella and congenital rubella syndrome (CRS) in developing countries, Part 2: Vaccination against rubella. Bull World Health Organ 1997; 75:69.
- Cutts FT, Vynnycky E. Modelling the incidence of congenital rubella syndrome in developing countries. Int J Epidemiol 1999; 28:1176.
- Panagiotopoulos T, Antoniadou I, Valassi-Adam E. Increase in congenital rubella occurrence after immunisation in Greece: retrospective survey and systematic review. BMJ 1999; 319:1462.
- Louie JK, Shaikh-Laskos R, Preas C, et al. Re-emergence of another vaccine-preventable disease?-Two cases of rubella in older adults. J Clin Virol 2009; 46:98.
- JOHNSON RE, HALL AP. Rubella arthritis; report of cases studied by latex tests. N Engl J Med 1958; 258:743.
- Ozsoylu S, Kanra G, Savaş G. Thrombocytopenic purpura related to rubella infection. Pediatrics 1978; 62:567.
- Bayer WL, Sherman FE, Michaels RH, et al. Purpura in congenital and acquired rubella. N Engl J Med 1965; 273:1362.
- Webster WS. Teratogen update: congenital rubella. Teratology 1998; 58:13.
- Miller E, Cradock-Watson JE, Pollock TM. Consequences of confirmed maternal rubella at successive stages of pregnancy. Lancet 1982; 2:781.
- Morgan-Capner P, Miller E, Vurdien JE, Ramsay ME. Outcome of pregnancy after maternal reinfection with rubella. CDR (Lond Engl Rev) 1991; 1:R57.
- Grillner L, Forsgren M, Barr B, et al. Outcome of rubella during pregnancy with special reference to the 17th-24th weeks of gestation. Scand J Infect Dis 1983; 15:321.
- Peckham C. Congenital rubella in the United Kingdom before 1970: the prevaccine era. Rev Infect Dis 1985; 7 Suppl 1:S11.
- Peckham CS. Clinical and laboratory study of children exposed in utero to maternal rubella. Arch Dis Child 1972; 47:571.
- Enders G, Nickerl-Pacher U, Miller E, Cradock-Watson JE. Outcome of confirmed periconceptional maternal rubella. Lancet 1988; 1:1445.
- Bullens D, Smets K, Vanhaesebrouck P. Congenital rubella syndrome after maternal reinfection. Clin Pediatr (Phila) 2000; 39:113.
- Paludetto R, van den Heuvel J, Stagni A, et al. Rubella embryopathy after maternal reinfection. Biol Neonate 1994; 65:340.
- Aboudy Y, Fogel A, Barnea B, et al. Subclinical rubella reinfection during pregnancy followed by transmission of virus to the fetus. J Infect 1997; 34:273.
- Robinson J, Lemay M, Vaudry WL. Congenital rubella after anticipated maternal immunity: two cases and a review of the literature. Pediatr Infect Dis J 1994; 13:812.
- Best JM, O'Shea S, Tipples G, et al. Interpretation of rubella serology in pregnancy--pitfalls and problems. BMJ 2002; 325:147.
- Frey TK, Abernathy ES. Identification of strain-specific nucleotide sequences in the RA 27/3 rubella virus vaccine. J Infect Dis 1993; 168:854.
- Manual for the Surveillance of Vaccine-Preventable Diseases, 5th, 2012.
- Bosma TJ, Corbett KM, O'Shea S, et al. PCR for detection of rubella virus RNA in clinical samples. J Clin Microbiol 1995; 33:1075.
- Bosma TJ, Corbett KM, Eckstein MB, et al. Use of PCR for prenatal and postnatal diagnosis of congenital rubella. J Clin Microbiol 1995; 33:2881.
- Ho-Terry L, Terry GM, Londesborough P. Diagnosis of foetal rubella virus infection by polymerase chain reaction. J Gen Virol 1990; 71 ( Pt 7):1607.
- Tanemura M, Suzumori K, Yagami Y, Katow S. Diagnosis of fetal rubella infection with reverse transcription and nested polymerase chain reaction: a study of 34 cases diagnosed in fetuses. Am J Obstet Gynecol 1996; 174:578.
- Tang JW, Aarons E, Hesketh LM, et al. Prenatal diagnosis of congenital rubella infection in the second trimester of pregnancy. Prenat Diagn 2003; 23:509.
- Rubella prevention. Recommendations of the Immunization Practices Advisory Committee (ACIP). MMWR Recomm Rep 1990; 39(RR-15):1.
- Chang TW, DesRosiers S, Weinstein L. Clinical and serologic studies of an outbreak of rubella in a vaccinated population. N Engl J Med 1970; 283:246.
- Davis WJ, Larson HE, Simsarian JP, et al. A study of rubella immunity and resistance to infection. JAMA 1971; 215:600.
- Greaves WL, Orenstein WA, Hinman AR, Nersesian WS. Clinical efficacy of rubella vaccine. Pediatr Infect Dis 1983; 2:284.
- Watson JC, Hadler SC, Dykewicz CA, et al. Measles, mumps, and rubella--vaccine use and strategies for elimination of measles, rubella, and congenital rubella syndrome and control of mumps: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 1998; 47:1.
- Haas DM, Flowers CA, Congdon CL. Rubella, rubeola, and mumps in pregnant women: susceptibilities and strategies for testing and vaccinating. Obstet Gynecol 2005; 106:295.
- Immunization during pregnancy. American College of Obstetricians and Gynecologists Technical Bulletin, #160 October 1991. In compendium of selected publications. p. 528-537.
- Bart SW, Stetler HC, Preblud SR, et al. Fetal risk associated with rubella vaccine: an update. Rev Infect Dis 1985; 7 Suppl 1:S95.
- Centers for Disease Control (CDC). Rubella vaccination during pregnancy--United States, 1971-1988. MMWR Morb Mortal Wkly Rep 1989; 38:289.
- Badilla X, Morice A, Avila-Aguero ML, et al. Fetal risk associated with rubella vaccination during pregnancy. Pediatr Infect Dis J 2007; 26:830.
- Centers for Disease Control and Prevention (CDC). Revised ACIP recommendation for avoiding pregnancy after receiving a rubella-containing vaccine. MMWR Morb Mortal Wkly Rep 2001; 50:1117.