Rubella: Vaccine Preventable Diseases Surveillance Standards

Overview

Rubella is an acute viral disease traditionally affecting susceptible children and young adults. Its public health importance is due mainly to the teratogenic potential of the virus, causing harm to an embryo or fetus. The incubation period of rubella is 14 days, with a range of 12–23 days. Apart from the congenital infection, rubella is a mild self-limiting illness that usually occurs during childhood. During the second week after exposure, there may be a prodromal illness consisting of fever, malaise and mild conjunctivitis.

Prodromal symptoms are more common in adults than children. Postauricular, occipital and posterior cervical lymphadenopathy is characteristic, and typically precedes the rash by 5–10 days. The maculopapular, erythematous and often pruritic rash occurs in 50–80% of rubella-infected persons. The rash, usually lasting one to three days, starts on the face and neck before progressing down the body. Joint symptoms (arthritis, arthralgias), usually of short duration, may occur in up to 70% of adult women with rubella but are less common in men and children. Post-infectious encephalitis occurs in approximately 1/6000 rubella cases, but occasionally incidences have been reported as high as 1/500 and 1/1600.

Rubella infection occurring just before conception and during early pregnancy often results in miscarriage, fetal or early infant death, or multi-organ congenital defects known as congenital rubella syndrome (CRS). CRS risk is unrelated to severity of symptoms in the mother. Surveillance for CRS is discussed in a different chapter.