…        Rubella occurs throughout the world

…        Humans are only host / No known animal reservoir

…        Transmission is person to person, via airborne respiratory droplets; subclinical cases

Ýmay transmit

…        Incidence is highest in late winter and early spring

…        Only moderately contagious; peak communicability from 7 days before rash onset to

7 days after; infected infants shed large quantities of virus

 

National Trends:

 

…        Before 1969 ñ Approx. 57,000 cases reported annually

ÝÝÝÝÝ Epidemics every 6-9 years

ÝÝÝÝÝ Last epidemic in 1964 resulted in 12.5 million infections and

20,000 newborns with CRS; estimated cost was $840

million

ÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝ ÝÝÝÝÝ No predominant age group; equal case distribution among

children <5, 5-19, and adults 20-39 yrs.

 

** 1966 ñ Rubella becomes a nationally reportable disease, as does CRS

** 1969 ñ Vaccine introduced

 

…        After 1969 ñ Rapid fall in incidence

ÝÝ By 1988, fewer than 1,000 reported cases per year

ÝÝ No epidemics have occurred since vaccine licensure

ÝÝ Moderate resurgence 1990-1991; outbreaks in California and

ÝÝÝÝÝÝÝÝ among the Amish in Pennsylvania

ÝÝ Most cases since mid 1990s among Hispanic young adults from

ÝÝÝÝÝÝÝÝ areas where vaccine is not routinely given

ÝÝÝ Since 1994, more than 50% of cases occur in adults 20-39 yrs.

…        CRSÝ ñ Incidence of CRS has paralleled decrease in rubella cases

ÝÝÝÝÝÝ 5-6 reported cases per year since 1980

ÝÝÝÝÝÝ Increase in CRS incidence follows rubella outbreaks

ÝÝÝÝÝÝ All CRS cases since 1996 have occurred in children of

unvaccinated women born in Latin America

ÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝ Ý ÝÝÝ

ÝÝÝ

*Reported Cases of Rubella in Rhode Island, 1993-1998