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US Public Health Service. Office of Disease Prevention and Health Promotion. Clinician's Handbook of Preventive Services. 2nd edition. Washington (DC): Department of Health and Human Services (US); 1999.

  • This publication is provided for historical reference only and the information may be out of date.

This publication is provided for historical reference only and the information may be out of date.

Cover of Clinician's Handbook of Preventive Services

Clinician's Handbook of Preventive Services. 2nd edition.

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51Rubella

The incidence of rubella has decreased markedly since the rubella vaccine was introduced in 1969. However, in the adult population, rubella continues to be a concern for nonimmunized women of child-bearing age. When rubella is contracted during pregnancy, especially during the first trimester, it can result in miscarriage, stillbirth, or the development of congenital rubella syndrome (CRS). CRS develops in an estimated 85% of infants born to women who acquire rubella during the first trimester of pregnancy. The most frequently occurring clinical manifestations of CRS are deafness, low birth weight, hepatomegaly, splenomegaly, ocular defects, psychomotor retardation, congenital heart disease, and petechiae. In 1995, approximately 128 cases of rubella and 6 cases of CRS were reported.

Rubella vaccine is approximately 95% effective at conferring immunity, which is probably lifelong. Screening and subsequent immunization of susceptible women of childbearing age have been shown to decrease the incidence of CRS.

Rubella is currently designated as an infectious disease notifiable at the national level. Refer to Appendix C for further information on nationally notifiable diseases.

See chapter 15 for information on immunization of children and adolescents against measles, mumps, and rubella.

Recommendations of Major Authorities

  • Advisory Committee on Immunization Practices (ACIP), American Academy of Pediatrics (AAP), American College of Obstetricians and Gynecologists, American College of Physicians (ACP), Canadian Task Force on the Periodic Health Examination (CTFPHE), and US Preventive Services Task Force (USPSTF) --
  • Women of childbearing age who lack documented evidence of immunity or prior immunization should be immunized. The CTFPHE and USPSTF state that an acceptable alternative is to offer immunization to all women of childbearing age without consideration of immunity or prior immunization. Some authorities (ACIP, AAP, and ACP) recommend immunization of susceptible males as well. The CTFPHE and USPSTF state that there is insufficient evidence to recommend for or against vaccination of young men in settings where large numbers of susceptible adults of both sexes congregate, such as military bases or colleges, and that men in other settings should not be routinely vaccinated.
  • American College of Physicians --
  • All health care workers should have documented serologic immunity or be vaccinated.
  • American Academy of Family Physicians --
  • Clinicians should assure the immunity of women of childbearing potential by history, serology, or vaccination. All persons needing immunization should be given a single-dose vaccination. Adolescents and young adults in settings where such individuals congregate (eg, high schools, technical schools, and colleges) should be given a second dose at least 1 month after the first dose if they have not previously received a second dose.

Basics of Rubella Immunization

1. Vaccine Types

Rubella vaccine is made from a live virus. The currently available vaccine is designated RA 27/3 and is available in either a monovalent form (rubella only) or in combinations: measles-rubella (MR), rubella-mumps, and measles-mumps-rubella (MMR). Any of these vaccines may be used in adults, but authorities recommend using MMR, unless it is contraindicated.

2. Assessing Immunity

Screen all women of childbearing age for immunity to rubella. Immunize those who have neither documentation of prior immunization after 12 months of age nor documented immunity by antibody testing. Do not accept a reported history of infection as evidence of immunity. Antibody testing may be offered to persons suspected of lacking immunity, but authorities agree that immunization may be provided without such testing. Screening and vaccination may be considered for other adults, especially those living in high-risk settings (eg, colleges, military bases).

3. Dose and Administration

Administer a 0.5-mL dose of reconstituted vaccine (any type) subcutaneously, using a 5/8 in to 3/4 in, 23- to 25-gauge needle.

4. Contraindications/Precautions

Do not administer rubella vaccine to pregnant women, and advise all women receiving the vaccine not to become pregnant for 3 months after vaccination. Counsel women who do become pregnant within 3 months of vaccination that concerns for the fetus exist but that generally interruption of the pregnancy is not necessary. Do not immunize patients who are immunocompromised (except those who are HIV-positive).

Immune globulin-containing preparations, such as immune globulin (IG), hepatitis B immune globulin (HBIG), varicella zoster immune globulin (VZIG), packed red blood cells, whole blood, or plasma, may interfere with the immune response to MMR vaccination. Therefore, do not administer MMR 2 weeks before or 3 to 11 months after such preparations are given (depending on the immune globulin content of the preparation). Repeat vaccination after the window of immune globulin interference has expired, or perform antibody testing to determine the patient's immunity status. The Advisory Committee on Immunization Practices provides detailed information regarding this issue in their general recommendations on immunization (see Selected References).

Do not delay administration of rubella or MMR vaccine to rubella-susceptible postpartum women even if they are receiving treatment for D (formerly Rh) sensitization with anti-Rho (D)IG (human) or any other blood product containing IG. Women who received anti-Rho (D)IG (human) during the last trimester of pregnancy or at the time of delivery and received postpartum rubella immunization should have their immunity confirmed by antibody level testing 3 months after immunization.

Delay immunizing adults who have a febrile illnesses. Use caution when administering rubella vaccine in the form of MMR to adults with a history of allergy to eggs. Do not administer rubella vaccine to adults who have experienced anaphylactic reactions to topically or systemically administered neomycin.

5. Adverse Reactions

Arthralgia develops in approximately 25% of adults immunized with rubella vaccine, and 13% to 15% of immunized adults report arthritis-like symptoms. Such symptoms generally develop 1 to 3 weeks after vaccination, persist for 1 day to 3 weeks, and seldom recur. Rarely, recurrent arthralgia and sometimes arthritis persist for an extended length of time. Paresthesias and pain in the arms and legs may also rarely develop and follow the same course as arthralgias. These adverse reactions seem to occur more often in patients who are nonimmune after vaccination. Other adverse reactions include low-grade fever, rash, and lymphadenopathy.

Any adverse side effects should be reported to the Vaccine Adverse Event Reporting System (VAERS). Refer to Table B.4 for a detailed listing of adverse events. VAERS forms and instructions are available in the FDA Drug Bulletin (Food and Drug Administration) and the Physician's Desk Reference or by calling the 24-hour VAERS information recording at (800)822-7967. Refer to Appendix B for details.

6. Patient Education

The National Childhood Vaccine Injury Act requires health care providers to provide the following information to patients prior to administering MMR: (1) a concise description of the benefits of the vaccine, (2) a concise description of the risks associated with the vaccine, (3) notice of the availability of the National Vaccine Injury Compensation Program. See Appendix B for details. For additional information about this requirement, contact the Training Coordinator, National Immunization Program, Centers for Disease Control and Prevention: (404)639-8226.

7. Vaccine Storage and Handling

Discard reconstituted vaccine that is not used within 8 hours. Store unreconstituted vaccine at 2 ° to 8 ° C (36 ° to 46 ° F) or colder; protect it from light. Handle all vaccine preparations according to manufacturers' instructions.

Patient Resource

Measles, Mumps, and Rubella: What You Need to Know. US Department of Health and Human Services. This material is available from State and local health departments and from the American Academy of Pediatrics, Division of Publications, PO Box 927, Elk Grove Village, IL 60009-0927, (800)433-9016. Internet address: http://www.aap.org

Selected References

  1. Advisory Committee on Immunization Practices (ACIP). General recommendations on immunization. MMWR . 1994; 43(No. RR-1):1–38. [PubMed: 8145710]
  2. Advisory Committee on Immunization Practices (ACIP). Rubella prevention. MMWR . 1990; 39(No. RR-15):1–18. [PubMed: 2174498]
  3. American Academy of Family Physicians. Summary of Policy Recommendations for Periodic Health Examination. Kansas City, Mo: American Academy of Family Physicians; 1997.
  4. American Academy of Pediatrics, Committee on Infectious Diseases. Rubella.In: Report of the Committee on Infectious Diseases. 23rd ed. Elk Grove Village, Ill: American Academy of Pediatrics; 1994.
  5. American College of Obstetricians and Gynecologists. Guidelines for Women's Health Care. Washington, DC: American College of Obstetricians and Gynecologists; 1996.
  6. American College of Physicians. Guide for Adult Immunization .3rd ed. Philadelphia, Pa: American College of Physicians; 1994:36.
  7. American College of Physicians Task Force on Adult Immunization and Infectious Diseases Society of America. Rubella.In: Guide for Adult Immunization. 3rd ed. Philadelphia, Pa: American College of Physicians; 1994:125-129.
  8. Atkinson W, Furphy L, Gantt J, et al, eds. Epidemiology and Prevention of Vaccine-Preventable Diseases . Washington DC: US Dept of Health and Human Services, Public Health Service; 1996: chap 8.
  9. Canadian Task Force on the Periodic Health Examination. Screening and vaccinating adolescents and adults to prevent congenital rubella syndrome. In: The Canadian Guide to Clinical Preventive Health Care. Ottawa, Canada: Minister of Supply and Services; 1994: chap 12.
  10. Canadian Task Force on the Periodic Health Examination. The periodic health examination 1979. Can Med Assoc J . 1979; 121:1193–1254. [PMC free article: PMC1704686] [PubMed: 115569]
  11. Centers for Disease Control and Prevention. General recommendations on immunization: recommendations of the Advisory Committee on Immunization Practices (ACIP) MMWR . 1994; 43(No. RR-1):1–38. [PubMed: 8145710]
  12. Centers for Disease Control. Rubella prevention: recommendations of the Advisory Committee on Immunization Practices (ACIP) MMWR . 1990; 39(No. RR-15):1–13. [PubMed: 17136024]
  13. US Preventive Services Task Force. Screening for vaccinating adolescents and adults to prevent congenital rubella syndrome.In: Guide to Clinical Preventive Services. 2nd ed. Washington, DC: US Department of Health and Human Services; 1996: chap 32.
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