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) .
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