Outbreak Of Rubella Research Articles

Congenital rubella and diabetes mellitus

To the Editor: In his interesting Editorial on the association between congenital rubella (CR) and diabetes mellitus, Edwin Gale proposes that CR is the only viral infection that can claim, somewhat tenuously, to be a cause of type 1 diabetes [1]. But imbedded in his discussion is the suggestion that this association may have occurred by chance as there are relatively few well-documented reports of individuals with insulin-dependent, childhood-onset, antibody-positive disease in the literature. However, Gale appears to accept an association with type 2 disease. We believe, on the basis of clinical reports and on its pathogenesis, that CR leads to both type 1-like and type 2like diabetes; that the prevalence of diabetes in children and adolescents with CR is higher than the 1% suggested in the Editorial; and that about 20% of CR patients develop type 2-like disease as they age. Congenitally acquired rubella viral infection causes inhibition of intrauterine cellular growth [2]. Live-born infants remain actively infected [3] and are mostly of low birthweight [4, 5]. Some infants also have microvascular disease [6], and most have an altered cellular and humoral immune response to rubella virus [7]. Rubella virus has been isolated from the pancreas of infants at autopsy [3] and intimal proliferation has been documented in pancreatic blood vessels [8]. Between 3 and 12 months of age some infants develop a generalised rash and severe pneumonitis [9]. This condition, which can be fatal, is thought to be due to an immunological process, but may respond to steroids. The first cohort of CR patients to be carefully studied for diabetes was born in 1940–1942 and examined by us as adults [10]. This cohort was drawn partly from the patients first described by the Australian ophthalmologist Dr (later Sir) Norman Gregg [4]. Survival of infants born with CR at that time was far poorer than that of those born following the large worldwide outbreak of rubella in 1964–1965 because more effective neonatal intensive care and surgery increased the survival prospects of affected infants. So long-term survivors of the 1941 and earlier outbreaks have less extensive pathology than many who have survived since then. Our adult cohort has been followed up progressively to the age of 60 years [11]. By then, seven of 32 (22%) had type 2-like diabetes: two of the three requiring insulin had diabetic retinopathy and elevated levels of GAD antibodies and insulin autoantibodies (IAAs); one of the seven had elevated levels of GAD and IAAs. Seven individuals had clinical or biochemical evidence of thyroid disease, and eight of the 11 women in the cohort had experienced early menopause, three before the age of 38 years. We had previously recorded that some of this cohort were found to have pancreatic islet cell antibodies before they had reached the age of 30 years [12]. Diabetologia (2009) 52:369–370 DOI 10.1007/s00125-008-1227-1

Phylogenetic Analysis of Rubella Virus Strains from an Outbreak in Madrid, Spain, from 2004 to 2005

An outbreak of rubella affected 460 individuals in 2004 and 2005 in the community of Madrid, Spain. Most of the patients were nonvaccinated Latin American immigrants or Spanish males. This study presents the first data on rubella virus genotypes in Spain. Forty selected clinical samples (2 urine, 5 serum, 3 blood, 2 saliva, and 28 pharyngeal exudate samples) from 40 cases were collected. The 739-nucleotide sequence recommended by the World Health Organization obtained from viral RNA in these samples was analyzed by using the MEGA v4.0 software. Seventeen isolates were obtained from 40 clinical samples from the outbreak, including two isolated from congenital rubella syndrome cases. Only viral RNA of genotype 1j was detected in both isolates and clinical specimens. Two variations in amino acids, G253C and T394S, which are involved in neutralization epitopes arose during the outbreak, but apparently there was no positive selection of either of them. The origin of the outbreak remains unknown because of poor virologic surveillance in Latin America and the African countries neighboring Spain. On the other hand, this is the first report of this genotype in Europe. The few published sequences of genotype 1j indicate that it comes from Japan and the Philippines, but there are no epidemiological data supporting this as the origin of the Madrid outbreak.

Outbreak of rubella among cadets in an academy

Background: Rubella is traditionally considered a childhood disease, but has the potential to cause outbreaks in closed community of young adults. The present paper describes one such outbreak in a military training establishment. Method: The cases of rubella outbreak were identified by clinical features (fever, rash and lymphadenopathy) and confirmed by detection of high titre of anti-rubella IgM antibodies by enzyme-linked immunosorbent assay. Initial serum samples were also tested for antibodies against measles, scrub typhus and dengue. Salient epidemiological features of the outbreak were studied. Result: 163 cadets were admitted in the local military hospital within two months. The cases presented with fever, coryza, lymphadenopathy and maculopapular rash. 117 (71.78%) of the samples showed presence of anti-rubella IgM antibodies. Conclusion: Rubella outbreaks in military communities have the potential to adversely affect military training/operations. The need for administration of vaccination against rubella in such population may be reviewed.

Use of rubella seroepidemiological data for assessment of previous vaccination policy and for decision making in response to epidemics in Israel

We examined the prevalence of rubella antibodies in a representative sample of the Israeli population. Three thousand three hundred and twenty-six sera collected during 1997 and 1998, from an age-stratified general population sample were tested for specific IgG antibodies against rubella. The sero-positivity rates to rubella were higher among females as compared with males (89.1% versus 82.3%, respectively ( p < 0.001). This difference was the result of much lower sero-positivity rates among males in the age group 13–17, with the lowest value (56.3%) among subjects aged 16. Male subjects of this age group were in 2000 the target of an outbreak of rubella among 18–19-year old male recruits of the Israel Defense Force. The data of this study served to assess previous exposure to the wild virus or vaccine strains, to identify pockets of low level of immunity and contributed to decision making in response to the onset of a rubella outbreak.

Outbreak of rubella in the Madrid region, Spain, 2005

There was an unexpected increase in the number of confirmed rubella cases notified in the autonomous region of Madrid during the first weeks of 2005.

Declining seroprevalence of rubella antibodies among young Israeli adults: a 12-year comparison

Background. In March 2000, the Israel Defense Force (IDF) experienced an outbreak of rubella. No population-based rubella seroepidemiologic data were available for the 13-year period preceding the epidemic. Methods. We conducted a population-based seroprevalence study of rubella antibodies among 289 IDF recruits drafted in 1999. Results. We found that 69.2% of males and 90.8% of females in service were seropositive at recruitment in 1999, immediately before the outbreak. These rates were significantly lower than those last measured in 1987 (88% among males and 98.1% among females). Conclusions. Our findings indicate that this rubella outbreak among young adults was facilitated by a decrease in immunity to levels below those required for herd immunity, at which epidemic virus transmission was no longer blocked. This is most likely due to widespread pediatric vaccination coverage with incomplete catch-up immunization among adolescents and young adults. These findings serve as a reminder that changes to childhood vaccination programs may affect the epidemiology of disease among older segments of the population several years after the change is implemented.

病院職員における風疹アウトブレイクとその後の対策

There is no nationwide outbreak of rubella after 1992 in Japan, but a local outbreak remains. Recently, some cases of congenital rubella syndrome (CRS) were reported after a local outbreak. An outbreak of rubella among hospital personnel occurred in our hospital located on Tanegashima Island on March and April 2003 after a visit of one rubella patient. Fifteen employees, including 7 clerks, 6 nurses, one doctor, and one radiologist, experienced rubella. A total of 259 employees in our hospital employees were examined for anti rubella hemagglutination inhibition (HI) tests with informed consent and recommended to take rubella vaccines. Sixty-seven employees (26%) among 257 examined for tests were found susceptible to rubella, and 53 employees were vaccinated. After vaccination, the outbreak was stamped out immediately. There was no rubella patient infected from employee. Nine among the 15 infected employees had declared to have a history of rubella or rubella vaccines before onsets, suggesting interviews are not reliable. There were many susceptible persons and rubella patients among elderly women and male personnel; therefore, measures are needed for elderly personnel as well as younger employees. In addition, adequate measures should be taken to prevent CRS, because many female personnel capable of pregnancy work in hospitals. The cost of the rubella HI tests and vaccination was approximately yen 200,000 (about dollar 1,600). The absence due to illness per one person was 6 days, and the wage per one day was about yen 12,000 (about dollar 100) on the average. The overall cost required in the outbreak was estimated to be approximate yen 1,400,000 (about dollar 12,000). Considering that an outbreak of rubella causes not only a large amount of expenditure but also loss of hospital income, the investment to prevent a rubella outbreak is quite valuable in the management of a hospital.

An outbreak of rubella aboard a ship of the German Navy.

During May and June 1996, an outbreak of rubella occurred offshore aboard a ship of the German Navy. The outbreak spread among 330 crew members over a period of 9 weeks, ending 2 days after the ship's return. This is the first detailed epidemiological investigation of a rubella outbreak on a ship, describing temporal progression, clinical manifestations, immunization status and seroprevalence of the population exposed. Outbreak investigation using a questionnaire, health records and rubella serology (hemagglutination inhibition (HI) test and EIA). Of the 330 crew members 298 (90%) participated in the investigation. The outbreak was continuous without a peak and ended abruptly after the ship's return. It resulted in 20 cases, 11 of which were clinically symptomatic. A total of 35 (12%) crew members were susceptible to rubella prior to the outbreak, resulting in an attack rate of 57%. The highest risk for infection was linked to accommodation aboard the ratings deck (chi(2)-test, p = 0.004) with most favorable conditions of transmission. Only 9% of the participating crew were able to provide complete proof of their immunization status. The positive predictive value of a past history of rubella for the presence of antibodies against rubella was 59%. The transmission of rubella that we describe aboard a ship was facilitated by the unusually close proximity of the crew and their insufficient immunity. Documentation of immunization was inadequate in this population.

Rubella Outbreak, Fort Bragg, North Carolina, 1995: A Clash of Two Preventive Strategies

An outbreak of rubella occurred among visiting German troops involved in a combined military exercise at Fort Bragg, North Carolina, in April 1995. Public health and military operational concerns centered on the significant contact the German soldiers had had with host battalion dependents and the impact of the outbreak on the exercise. Ten of the 120 German soldiers were found to be nonimmune; six of these soldiers developed clinical rubella. The four nonimmune soldiers who did not develop skin rashes had received serum immune globulin within 12 hours of identification of the index case. The impact of this outbreak on the Fort Bragg community and its military operations, and the methods used to control the outbreak and salvage the military mission, are described.

Implementation and evaluation of a measles/rubella vaccination campaign in a campus university in the UK following an outbreak of rubella.

An age shift in rubella infection to young adults has occurred in Scotland since the introduction of a first dose measles, mumps and rubella (MMR) vaccination in 1988 and a second dose measles/rubella (MR) vaccination in 1994/95. The Health Board was alerted to an outbreak of rubella at Stirling University by the notification of 6 cases amongst male students aged 18-28 years with dates of onset between 3 March and 21 March 1996. In response, a MR vaccination campaign was conducted to enhance population immunity to rubella within the university population and to reduce the likelihood of further cases. A total of 1795 students, staff and visitors were vaccinated. Vaccine coverage of 46% was estimated to be sufficient to boost rubella immunity in full time male students in university accommodation to 88.7-91.0%, just above the upper critical level of herd immunity for rubella of 85-88%. Students in colleges and universities in the UK will remain at increased risk of outbreaks of rubella and measles until the cohort who have received a two dose schedule of MR form the bulk of the college population. It may be prudent for tertiary education colleges and other institutions in the UK with young adults living in shared residential accommodation to offer MR vaccination to new entrants, targeting those who have not previously received the vaccine, between now and the year 2000.

An outbreak of rubella in British troops in Bosnia.

An outbreak of rubella in April 1996 involved four male British soldiers deployed to Bosnia-Herzegovina. All were helicopter ground crew who were members of the same unit and who periodically travelled to and worked at forward air refuelling stations in Bosnia. There was a potential for spread of the infection to adjacent British units, to troops of other nations in the peacekeeping force, and also to the local civilian population. The British force included 620 female personnel, some of whom may have been non-immune to rubella. One pregnant British servicewoman was repatriated to UK for her own protection. There was a potential health risk, including the possibility of congenital rubella syndrome, in the non-immune wives and partners of deployed male personnel, as a result of contact during the mid-tour home leave of the husbands or partners. The outbreak was monitored through a medical surveillance system known as ARRC 97, and was contained by prompt and rigorous control measures. This outbreak shows the importance of effective surveillance and of good microbiology laboratory support during military operations. The role of immunization against rubella during future military deployments is discussed.

Congenital Rubella Syndrome Among the Amish—Pennsylvania, 1991-1992

From February through May 1991, an outbreak of rubella occurred among the Amish in Pennsylvania that was part of a widespread rubella outbreak reported among the Amish in at least six states during 1991 (1). The Pennsylvania Department of Health (PDH), in cooperation with CDC, conducted an investigation to document cases of rubella among pregnant Amish women in Lancaster County and a cohort study to estimate the risk for congenital rubella syndrome (CRS) among infants born to Amish mothers from November 1, 1991, through January 31, 1992. This report summarizes investigation and study findings.

Medical students as sources of rubella and measles outbreaks

Medical students demonstrate a high degree of susceptibility to rubella and measles, and hence are at risk for infection and transmission of these viruses. The purpose of our study was to examine the role medical students play as sources or vectors in rubella and measles outbreaks. We conducted a survey of all US and Canadian public health departments to determine how often students were implicated in outbreaks (response rate, 88.7%). We also performed a literature search to identify any cases not reported to health departments, as well as examined the medical, social, and economic consequences of such outbreaks in the medical setting. Since 1981, 9% of health departments have recorded at least one outbreak of rubella or measles in which medical students were specifically implicated as sources or vectors. Increased morbidity, mortality, and adverse economic consequences resulted from these outbreaks. Our data confirm that medical students are important sources/vectors in rubella and measles outbreaks. We recommend that all medical students be immune to these viruses.

Medical Students as Sources of Rubella and Measles Outbreaks

Medical students demonstrate a high degree of susceptibility to rubella and measles, and hence are at risk for infection and transmission of these viruses. The purpose of our study was to examine the role medical students play as sources or vectors in rubella and measles outbreaks. We conducted a survey of all US and Canadian public health departments to determine how often students were implicated in outbreaks (response rate, 88.7%). We also performed a literature search to identify any cases not reported to health departments, as well as examined the medical, social, and economic consequences of such outbreaks in the medical setting. Since 1981, 9% of health departments have recorded at least one outbreak of rubella or measles in which medical students were specifically implicated as sources or vectors. Increased morbidity, mortality, and adverse economic consequences resulted from these outbreaks. Our data confirm that medical students are important sources/vectors in rubella and measles outbreaks. We recommend that all medical students be immune to these viruses.

Swedish experience of two dose vaccination programme aiming at eliminating measles, mumps, and rubella.

In 1982 a two dose regimen was introduced in Sweden for the combined vaccination against measles, mumps, and rubella of children aged 18 months and 12 years. Since 1977 about half of the preschool children were vaccinated against measles annually, and since 1974 about 80% of 12 year old girls were vaccinated against rubella. During the period 1982 to 1985 90-93% of the eligible age cohorts of 18 month old children and 88-91% of the 12 year old children were immunised with the new combined vaccine. A study in 1982 of about 140 18 month old children who were nearly all seronegative before vaccination showed that 96%, 92%, and 99% seroconverted against measles, mumps, and rubella, respectively. A second study was carried out in 1983 of 247 12 year old children, of whom 11% lacked antibodies to measles, 27% to mumps, and 45% to rubella. This showed seroconversion in 82% and 80% against measles and mumps, respectively, and all children seroconverted against rubella. In the latest study in 1985 of 496 12 year olds 9% and 13% were seronegative against measles and mumps before vaccination, and 41% against rubella. Of these, 88% seroconverted to measles and 80% to mumps, and all converted to rubella when sera were tested by the haemolysis in gel method. After a neutralisation test against measles as well all children showed immunity to the disease. A low incidence of measles and declining figures for mumps and rubella were reported in 1984 to 1986. An outbreak of rubella during 1985 affected mainly boys in age cohorts in which only the girls had been vaccinated during the 1970s.

An outbreak of rubella during 1983-1984: Laboratory findings

An outbreak of rubella during 1983-1984: Laboratory findings

An outbreak of rubella during 1983-1984: epidemiology and clinical

An outbreak of rubella during 1983-1984: epidemiology and clinical

Nosocomial rubella--consequences of an outbreak and efficacy of a mandatory immunization program.

An outbreak of rubella in a large metropolitan hospital is described. Nineteen cases among employees and three secondary cases in family members occurred. Nosocomial cases occurred among the 3,900 employees of an adult medical-surgical unit where a voluntary program of rubella immunization was in effect. No cases occurred among the 1,400 employees of the women's and pediatric units with mandatory policies, despite interfacility and community exposure. Ten pregnant women were among the 377 contacts of the cases. Five were sero-negative to rubella. Two who developed clinical rubella, one asymptomatic sero-conversion and one other, all elected to terminate their pregnancies. The remaining woman, exposed in her third trimester delivered a normal infant. We conclude a policy requiring new employees to be rubella immune is more effective in preventing nosocomial rubella than a voluntary program and is desirable in view of the potential consequences of an outbreak to pregnant employees.

An outbreak of congenital rubella in Chicago: Catherine Lamprecht, Victoria Schauf, Dorra Warren, et al: JAMA 247: 129: 1133, 1982. Reprint requests: Catherine Lamprecht, M.D., Department of Pediatrics, Mount Sinai Hospital, 2755 W. 15th St., Chicago, IL 60608

An outbreak of congenital rubella in Chicago: Catherine Lamprecht, Victoria Schauf, Dorra Warren, et al: JAMA 247: 129: 1133, 1982. Reprint requests: Catherine Lamprecht, M.D., Department of Pediatrics, Mount Sinai Hospital, 2755 W. 15th St., Chicago, IL 60608

An Outbreak of Congenital Rubella in Chicago

After an outbreak of rubella in Chicago in 1978, an intensive survey of local health care personnel and hospital records identified 31 infants with congenital rubella syndrome (CRS). Rubella virus was isolated from 11 infants; rubella-IgM antibodies were demonstrated in seven infants; ten babies had persistent high rubella hemagglutination-inhibition (HI) titers. The incidence of CRS in Chicago between July 1978 and June 1979 was 48.9 per 100,000 live births. Mothers of babies with CRS frequently remembered a crash-illness during pregnancy (56%), were unmarried (74%), and were primigravidas (64%). No mother had received rubella vaccine. Review of prenatal rubella HI testing and follow-up immunization in one hospital showed that only eight (10.8%) of 74 seronegative women received rubella vaccine physicians need to place increased emphasis on detection and vaccination of susceptible adult women.