Talk:Abnormal Development - Rubella Virus

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Cite this page: Hill, M.A. (2024, April 23) Embryology Abnormal Development - Rubella Virus. Retrieved from


George S, Viswanathan R & Sapkal GN. (2019). Molecular aspects of the teratogenesis of rubella virus. Biol. Res. , 52, 47. PMID: 31455418 DOI.

Molecular aspects of the teratogenesis of rubella virus. Abstract Rubella or German measles is an infection caused by rubella virus (RV). Infection of children and adults is usually characterized by a mild exanthematous febrile illness. However, RV is a major cause of birth defects and fetal death following infection in pregnant women. RV is a teratogen and is a major cause of public health concern as there are more than 100,000 cases of congenital rubella syndrome (CRS) estimated to occur every year. Several lines of evidence in the field of molecular biology of RV have provided deeper insights into the teratogenesis process. The damage to the growing fetus in infected mothers is multifactorial, arising from a combination of cellular damage, as well as its effect on the dividing cells. This review focuses on the findings in the molecular biology of RV, with special emphasis on the mitochondrial, cytoskeleton and the gene expression changes. Further, the review addresses in detail, the role of apoptosis in the teratogenesis process. KEYWORDS: Apoptosis; Mitochondria; Rubella; Teratogenesis PMID: 31455418 PMCID: PMC6712747 DOI: 10.1186/s40659-019-0254-3

Zimmermann P, Perrett KP, Messina NL, Donath S, Ritz N, van der Klis FRM & Curtis N. (2019). The Effect of Maternal Immunisation During Pregnancy on Infant Vaccine Responses. EClinicalMedicine , 13, 21-30. PMID: 31517260 DOI. The Effect of Maternal Immunisation During Pregnancy on Infant Vaccine Responses.

INTRODUCTION: Immunisation during pregnancy to protect infants against tetanus, pertussis and influenza is recommended in many countries. However, maternal antibodies can interfere with infant vaccine responses. We investigated the effect of antenatal diphtheria-tetanus-acellular pertussis (dTpa) and trivalent inactivated influenza (TIV) immunisation on specific and heterologous antibody responses to routine immunisations given in the first year of life. METHODS: In total, 471 healthy infants were included. At 7 and 13 months of age, antibodies to the primary course of routine vaccines given at 6 weeks, 4 and 6 months of age (pertussis (pertussis toxin (PT), filamentous haemagglutinin (FHA), pertactin (PRN)), polio (type 1, 2, 3), Haemophilus influenzae type b (Hib), pneumococcus (serotype 1, 3, 4, 5, 6A, 6B, 7F, 9V, 14, 18C, 19A, 19F, 23F)) were measured, and at 13 months of age, antibodies to the 12-month routine vaccines (Hib, meningococcus C, measles, mumps and rubella). The seroprotection rates for each vaccine and the geometric mean concentrations (GMC) of antibodies were compared between infants whose mothers did or did not receive dTpa or TIV immunisation during pregnancy. RESULTS: A total of 369 infants were included in the final analysis. Maternal dTpa immunisation was associated with reduced antibody responses to both specific (diphtheria and pertussis) and heterologous (polio and pneumococcus) vaccine antigens. This effect was stronger for persistence of antibodies at 13 months of age than it was at 7 months of age. At 7 months of age, adjusted average antibody concentrations were significantly lower for diphtheria, pertussis (PT, FHA, PRN) and polio type 2, and at 13 months of age, for diphtheria, pertussis (PT, FHA, PRN), polio type 1-3 and pneumococcal serotypes 1, 4, 5, 6A, 6B, 7F, 18C and 23F. Additionally, at 13 months of age, seroprotection rates for diphtheria, PT, pneumococcal serotype 1, 6A and 6B were significantly lower in infants after maternal dTpa immunisation. In contrast, for Hib, in infants with maternal dTpa immunisation, the adjusted average antibody concentration and the seroprotection rate were higher, particularly at 7 months of age. Maternal TIV immunisation had minimal effect on infant vaccine responses. CONCLUSION: Whilst maternal immunisation protects infants in the first few months of life, it might interfere with both specific and heterologous (unrelated) vaccines responses in infants. RESEARCH IN CONTEXT: Evidence before this study: Maternal immunisation during pregnancy helps to protect infants during the period before they complete their primary immunisations. It has been proven to be safe and beneficial. However, pre-existing maternal antibodies can influence antibody responses following infant immunisation, an effect called 'blunting'. Previous studies have investigated the influence of dTpa but not influenza immunisation during pregnancy on infant vaccine responses. The majority of studies investigated antibody concentrations only to the specific vaccine antigens included in the maternal immunisation, and there is scarce data available on heterologous vaccine responses, particularly pneumococcal responses.Added value of this study: In this study, we have shown that maternal dTpa immunisation during pregnancy is associated with reduced antibody responses to both specific (diphtheria and pertussis) and heterologous (polio and pneumococcus) vaccine antigens. This effect is stronger for persistence of antibodies at 13 months of age than after primary immunisation at 7 months of age. In contrast, for Hib, in infants with maternal dTpa immunisation, antibody concentrations are higher, particularly at 7 months of age. Maternal TIV immunisation has minimal effect on infant vaccine responses.Implications of all the available evidence: Whilst maternal immunisation protects infants in the first few months of life, it might interfere with both specific and heterologous (unrelated) vaccines responses in infants. As most vaccines induce very high antibody responses, small differences in antibody concentrations may not be of clinical significance. However, since maternal immunisation during pregnancy also influences seroprotection rates, strategies, such as additional booster doses in the second year of life, particularly for pertussis and pneumococcus, might need to be considered to address this. KEYWORDS: Adacel; Antibodies; BCG, Bacillus Calmette-Guérin vaccine; Boostrix; CI, confidence interval; FHA, filamentous haemagglutinin; FIM, fimbriae; Flu; GMC, geometric mean antibody concentration; GMR, geometric mean antibody ratio; HepB, hepatitis B; Heterologous; Hib, Haemophilus influenzae type b; Humoral; IPV, inactivated polio vaccine; IgG, immunoglobulin G; Immunisation; Immunoglobulin; Influenza; MIS BAIR, Melbourne Infant Study: BCG for Allergy and Infection Reduction; MMR, measles-mumps-rubella vaccine; MenC, meningococcus type C; Non-specific; PCV13, 13-valent conjugate pneumococcal vaccine; PRN, pertactin; PT, pertussis toxin; TCV, tetanus-containing vaccine; TIV, trivalent inactivated influenza vaccine; Titre; Vaccination; dTpa; dTpa, diphtheria-tetanus-acellular pertussis vaccine PMID: 31517260 PMCID: PMC6733996 DOI: 10.1016/j.eclinm.2019.06.010


MMWR Morb Mortal Wkly Rep. 2017 Nov 17;66(45):1256-1260. doi: 10.15585/mmwr.mm6645a4.

Progress in Rubella and Congenital Rubella Syndrome Control and Elimination - Worldwide, 2000-2016

MMWR Morb Mortal Wkly Rep. 2017 Nov 17;66(45):1256-1260. doi: 10.15585/mmwr.mm6645a4.

Grant GB, Reef SE, Patel M, Knapp JK, Dabbagh A. Abstract Although rubella virus infection usually causes a mild fever and rash illness in children and adults, infection during pregnancy, especially during the first trimester, can result in miscarriage, fetal death, stillbirth, or infants with a constellation of congenital malformations known as congenital rubella syndrome (CRS) (1). Rubella is a leading vaccine-preventable cause of birth defects. Preventing these adverse pregnancy outcomes is the focus of rubella vaccination programs. In 2011, the World Health Organization (WHO) updated guidance on the preferred strategy for introduction of rubella-containing vaccine (RCV) into national immunization schedules and recommended an initial vaccination campaign, usually targeting children aged 9 months-14 years (1). The Global Vaccine Action Plan 2011-2020 (GVAP), endorsed by the World Health Assembly in 2012, includes goals to eliminate rubella in at least five of the six WHO regions by 2020 (2). This report updates a previous report (3) and summarizes global progress toward rubella and CRS control and elimination from 2000 to 2016. As of December 2016, 152 (78%) of 194 countries had introduced RCV into the national immunization schedule, representing an increase of 53 countries since 2000, including 20 countries that introduced RCV after 2012. PMID: 29145358 PMCID: PMC5726242 DOI: 10.15585/mmwr.mm6645a4



Lancet. 2015 Jan 7. pii: S0140-6736(14)60539-0. doi: 10.1016/S0140-6736(14)60539-0. [Epub ahead of print]

Lambert N1, Strebel P2, Orenstein W3, Icenogle J4, Poland GA5.


Rubella remains an important pathogen worldwide, with roughly 100 000 cases of congenital rubella syndrome estimated to occur every year. Rubella-containing vaccine is highly effective and safe and, as a result, endemic rubella transmission has been interrupted in the Americas since 2009. Incomplete rubella vaccination programmes result in continued disease transmission, as evidenced by recent large outbreaks in Japan and elsewhere. In this Seminar, we provide present results regarding rubella control, elimination, and eradication policies, and a brief review of new laboratory diagnostics. Additionally, we provide novel information about rubella-containing vaccine immunogenetics and review the emerging evidence of interindividual variability in humoral and cell-mediated innate and adaptive immune responses to rubella-containing vaccine and their association with haplotypes and single-nucleotide polymorphisms across the human genome. Copyright © 2015 Elsevier Ltd. All rights reserved. PMID 25576992


Measles - The epidemiology of elimination

Vaccine. 2014 Dec 5;32(51):6880-6883. doi: 10.1016/j.vaccine.2014.10.061. Epub 2014 Nov 4.

Durrheim DN1, Crowcroft NS2, Strebel PM3.


Tremendous progress has been made globally to reduce the contribution of measles to the burden of childhood deaths and measles cases have dramatically decreased with increased two dose measles-containing vaccine coverage. As a result the Global Vaccine Action Plan, endorsed by the World Health Assembly, has targeted measles elimination in at least five of the six World Health Organisation Regions by 2020. This is an ambitious goal, since measles control requires the highest immunisation coverage of any vaccine preventable disease, which means that the health system must be able to reach every community. Further, while measles remains endemic in any country, importations will result in local transmission and outbreaks in countries and Regions that have interrupted local endemic measles circulation. One of the lines of evidence that countries and Regions must address to confirm measles elimination is a detailed description of measles epidemiology over an extended period. This information is incredibly valuable as predictable epidemiological patterns emerge as measles elimination is approached and achieved. These critical features, including the source, size and duration of outbreaks, the seasonality and age-distribution of cases, genotyping pointers and effective reproduction rate estimates, are discussed with illustrative examples from the Region of the Americas, which eliminated measles in 2002, and the Western Pacific Region, which has established a Regional Verification Commission to review progress towards elimination in all member countries. Crown Copyright © 2014. Published by Elsevier Ltd. All rights reserved. KEYWORDS: Elimination; Measles; Western Pacific, Americas, Epidemiology PMID 25444814

Identification of ocular and auditory manifestations of congenital rubella syndrome in mbingo

Int J Telemed Appl. 2014;2014:981312. doi: 10.1155/2014/981312. Epub 2014 Nov 25.

Jivraj I1, Rudnisky CJ1, Tambe E2, Tipple G3, Tennant MT1.


Purpose. Congenital rubella syndrome (CRS) is a global cause of preventable hearing impairment, blindness, and intellectual impairment. The present study sought to identify ocular and auditory manifestations of CRS in school-aged children in Mbingo, Cameroon. Design. Cross sectional study. Subjects. Students at two schools, one for children with hearing impairment, were screened for cataract, congenital glaucoma, and pigmentary retinopathy. Methods. Students underwent seven-field digital fundus photography through a dilated pupil using a Topcon NW200 nonmydriatic camera. Images were assessed by retina specialists in Canada via teleophthalmology. Clinical evidence was integrated to form case definitions for CRS based on Center for Disease Control and Prevention guidelines. Serological evidence of rubella infection was obtained using standardized IgG antibody titers. Main Outcome Measure. Number of probable and suspicious cases of CRS. Results. Between September 2009 and May 2010, 320 students participated. There were 28 (10.2%) probable cases, 104 (37.8%) suspects, and 143 (52.0%) unaffected. Rubella IgG serology was positive in 79 (48.7%) of children with hearing impairment and 11 (7.4%) of children with normal hearing. Conclusions. The present study identified 28 probable cases of CRS. Furthermore, 92.6% of students with normal hearing did not possess rubella IgG antibodies making future cases of CRS likely without intervention.

PMID 25525427


Rubella and congenital rubella syndrome control and elimination - global progress, 2000-2012

MMWR Morb Mortal Wkly Rep. 2013 Dec 6;62(48):983-6.

Centers for Disease Control and Prevention (CDC).


Rubella virus usually causes a mild fever and rash in children and adults. However, infection during pregnancy, especially during the first trimester, can result in miscarriage, stillbirth, or infants with congenital malformations, known as congenital rubella syndrome (CRS). In 2011, the World Health Organization (WHO) updated guidance on the preferred strategy for introduction of rubella-containing vaccine (RCV) into national routine immunization schedules with an initial wide-age-range vaccination campaign that includes children aged 9 months-15 years. WHO also urged all member states to take the opportunity offered by accelerated measles control and elimination activities as a platform to introduce RCVs. The Global Measles and Rubella Strategic Plan (2012-2020) published by the Measles Rubella Initiative partners in 2012 and the Global Vaccine Action Plan endorsed by the World Health Assembly in 2012 include milestones to eliminate rubella and CRS in two WHO regions by 2015, and eliminate rubella in five WHO regions by 2020. This report summarizes the global progress of rubella and CRS control and elimination during 2000-2012. As of December 2012, a total of 132 (68%) WHO member states had introduced RCV, a 33% increase from 99 member states in 2000. A total of 94,030 rubella cases were reported to WHO in 2012 from 174 member states, an 86% decrease from the 670,894 cases reported in 2000 from 102 member states. The WHO Region of the Americas (AMR) and European Region (EUR) have established rubella elimination goals of 2010 and 2015, respectively. AMR has started to document the elimination of measles, rubella, and CRS; in EUR, rubella incidence has decreased significantly, although outbreaks continue to occur.

PMID 24304830

Results of the rubella elimination program in Catalonia (Spain), 2002-2011

Hum Vaccin Immunother. 2013 Jan 8;9(3). [Epub ahead of print]

Barrabeig I, Torner N, Martínez A, Carmona G, Ciruela P, Batalla J, Costa J, Hernández S, Salleras L, Domínguez A, Of Catalonia TR. Source Agency of Public Health; Barcelona, Spain.


Rubella is usually a mild disease with nonspecific symptoms, but can cause congenital rubella syndrome (CRS) when infection occurs during pregnancy. The objective of this study was to evaluate the sensitivity and positive predictive value of different data sources used for surveillance purposes in the Rubella Elimination Program of Catalonia between 2002 and 2011. The Urgent Notification to the Statutory Disease Reporting System, the Individualized Disease Reporting System, screening for other viruses included in the Measles Elimination Program, the Microbiological Reporting System and the Minimum Hospital Discharge Data were evaluated. 100 suspected cases of postnatal rubella and 6 suspected cases of CRS were detected. For postnatal rubella, Urgent Notification had the highest sensitivity (32.5%; 95%CI 18.6-49.1), followed by the Microbiological Reporting System (22.5%; 95%CI 10.8-38.5). Virus screening in the Measles Elimination Program had the highest PPV (76.9%; 95%CI 46.1-94.9), followed by the Individualized Statutory Disease Reporting System (57.1%; 95%CI 28.9-82.3). For CRS cases, the Individualized Statutory Reporting System had the highest sensitivity (100%, 95%CI 29.2-100) and the highest PPV (60%; 95%CI 14.7-100). Most confirmed postnatal cases (25 cases, 48.1%) were in the 25-44 y age group followed by the 15-24 y age group (11 cases, 21.2%). The highest values of sensitivity and PPV for the detection of confirmed cases corresponded to activities that were specifically introduced in the measles and rubella elimination programs.

PMID 23299566




Phylogenetic analysis of rubella viruses involved in congenital rubella infections in France between 1995 and 2009

J Clin Microbiol. 2010 Jul;48(7):2530-5. Epub 2010 May 12.

Vauloup-Fellous C, Hübschen JM, Abernathy ES, Icenogle J, Gaidot N, Dubreuil P, Parent-du-Châtelet I, Grangeot-Keros L, Muller CP. Source INSERM U764, Université Paris-Sud, AP-HP, Microbiology Department, Hôpital Antoine Béclère, Clamart, France.


Rubella is an acute infectious disease that normally has a mild clinical course. However, infections during pregnancy, especially before week 12 of gestation (WG), can cause severe birth defects known as congenital rubella syndrome (CRS). The aim of this study was to perform genotyping and molecular characterization of rubella viruses involved in congenital infections in France over the past 15 years (1995 to 2009). Amniotic fluid (AF) specimens (n = 80) from pregnant women with congenital rubella infections (CRI) before week 20 of gestation, and a few other samples available from children/newborns with CRS (n = 26), were analyzed. The coding region of the rubella virus E1 gene was amplified directly from clinical specimens by reverse transcriptase PCR, and the resulting DNA fragments were sequenced. Sequences were assigned to genotypes by phylogenetic analysis with rubella virus reference sequences. Sufficient E1 gene sequences were obtained from 56 cases. Phylogenetic analysis of the sequences showed that at least five different genotypes (1E, 1G, 1B, 2B, and 1h) were present in France and were involved in congenital infections, with a strong predominance of genotype 1E (87%). This is one of the very few comprehensive studies of rubella viruses involved in CRI. The results indicated that over the past 15 years, multiple introductions of the dominant genotype E caused most of the CRI cases in France. A few sporadic cases were due to other genotypes (1B, 1G, 1h, 2B).

PMID: 20463161

Congenital rubella syndrome and delayed manifestations

Int J Pediatr Otorhinolaryngol. 2010 Sep;74(9):1067-70. Epub 2010 Jul 8.

Dammeyer J. Source Department of Psychology, University of Copenhagen, Denmark.


OBJECTIVE: Several hypotheses of different medical and psychological delayed manifestations among people who have congenital rubella syndrome (CRS) have been discussed. This study tests some of these hypotheses of delayed manifestations.

METHODS: Gathering information about 35 individuals who have CRS and who are congenitally deafblind.

RESULTS: None of the hypotheses could be confirmed when individuals with CRS were compared to a control group of individuals who were congenital deafblind with different aetiology than CRS.

CONCLUSIONS: This study concludes that those health related problems which people with CRS face must primarily be understood in relation to congenital deafblindness and dual sensory and communicative deprivation.

Copyright 2010 Elsevier Ireland Ltd. All rights reserved.

PMID: 20619470

Three-dimensional structure of Rubella virus factories

Virology. 2010 Sep 30;405(2):579-91. Epub 2010 Jul 23.

Fontana J, López-Iglesias C, Tzeng WP, Frey TK, Fernández JJ, Risco C. Cell Structure Lab, Centro Nacional de Biotecnología, CSIC, Darwin, Madrid, Spain.

Abstract Viral factories are complex structures in the infected cell where viruses compartmentalize their life cycle. Rubella virus (RUBV) assembles factories by recruitment of rough endoplasmic reticulum (RER), mitochondria and Golgi around modified lysosomes known as cytopathic vacuoles or CPVs. These organelles contain active replication complexes that transfer replicated RNA to assembly sites in Golgi membranes. We have studied the structure of RUBV factory in three dimensions by electron tomography and freeze-fracture. CPVs contain stacked membranes, rigid sheets, small vesicles and large vacuoles. These membranes are interconnected and in communication with the endocytic pathway since they incorporate endocytosed BSA-gold. RER and CPVs are coupled through protein bridges and closely apposed membranes. Golgi vesicles attach to the CPVs but no tight contacts with mitochondria were detected. Immunogold labelling confirmed that the mitochondrial protein p32 is an abundant component around and inside CPVs where it could play important roles in factory activities.

Copyright 2010 Elsevier Inc. All rights reserved.

PMID: 20655079

Congenital rubella syndrome and rubella in Vellore, South India

Epidemiol Infect. 2010 Jul 20:1-5. [Epub ahead of print]

Chandy S, Abraham AM, Jana AK, Agarwal I, Kekre A, Korula G, Selvaraj K, Muliyil JP. Department of Clinical Virology, Christian Medical College, Vellore, India.


Rubella, a mild, vaccine-preventable disease, can manifest as congenital rubella syndrome (CRS), a devastating disease of the fetus. To emphasize the inadequacy of the existing rubella vaccination programme in India, we evaluated epidemiological evidence of rubella virus activity with data available from a tertiary-care centre. The proportion of suspected CRS cases that were laboratory confirmed increased from 4% in 2000 to 11% in 2008. During the same period, 329 clinically suspected postnatal rubella cases were tested of which 65 (20%) were laboratory confirmed. Of women (n=770) of childbearing age, 12.5% were susceptible to rubella.

PMID: 20642875

Controlling rubella and preventing congenital rubella syndrome – global progress, 2009

Wkly Epidemiol Rec. 2010 Oct 15;85(42):413-8.

[Article in English, French] [No authors listed]

"In 2000, WHO published its first position paper on rubella vaccine to guide the introduction of rubella-containing vaccines (RCVs) into national childhood immuni- zation schedules.1 As of December 2009, a total of 130 countries have introduced RCVs, a 57% increase from 83 countries in 1996. In addition, goals to eliminate rubella and congenital rubella syndrome (CRS) by 2010 have been established in the WHO Region of the Americas and by 2015 in the the European Region; the Western Pacific Region has established 2015 as a goal for accelerating rubella control and reducing CRS incidence to <10 cases/million live births. In 2009, a total of 121 344 rubella cases was reported from 167 countries, a 82% decrease from 2000 when 670 894 cases were reported from 102 countries. This report summarizes global data on cases of rubella and CRS and the prog- ress that has been made towards introducing and using RCVs worldwide."

PMID: 20949700


Vaccine preventable diseases and vaccination coverage in Aboriginal and Torres Strait Islander people, Australia 2003 to 2006

Commun Dis Intell. 2008 Jun;32 Suppl:S2-67.

Menzies R, Turnour C, Chiu C, McIntyre P. Source National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, Australia.


This, the second report on vaccine preventable diseases and vaccination coverage in Aboriginal and Torres Strait Islander people, brings together the relevant sources of routinely collected data on vaccine preventable diseases--notifications, hospitalisations, deaths, and childhood and adult vaccination coverage. As a result of continued improvements in the collection of data on Indigenous status, this second report is considerably more comprehensive, with data available from more jurisdictions, and more detailed presentation, including time trends and vaccination coverage by jurisdiction. Vaccination coverage data provide evidence of successful program delivery and highlight some areas for improvement. For universally funded vaccines in children, coverage is similar in Indigenous and non-Indigenous children by 24 months of age. However, delayed vaccination is more common in Indigenous children, with 6%-8% fewer children fully vaccinated at 12 months of age. More timely vaccination, particularly within the first six months of life, is particularly important in reducing the disproportionate burdens of disease due to pertussis and Haemophilus influenzae type b (Hib). For vaccination programs targeted specifically at Aboriginal and Torres Strait Islander children and adults, coverage is substantially lower than for those programs targeted at all Australians. This is true for hepatitis A and polysaccharide pneumococcal vaccine for children, and influenza and polysaccharide pneumococcal vaccine for adults. Targeted vaccination programs present a particular challenge for health services in urban areas. Nevertheless, the impact of vaccination programs in preventing disease and reducing the disparity of disease burden between Aboriginal and Torres Strait Islander and non-Indigenous people has been substantial. This is evident in data on notifications, hospitalisations and deaths. Diseases which, in the past, have had devastating and often disproportionately high impact on Indigenous people, such as diphtheria, measles, poliomyelitis, smallpox and tetanus, are now completely or almost completely absent from Australia. Hepatitis B infection, another disease responsible for high levels of infection and substantial serious illness and death in the pre-vaccine era, is also now well controlled in age groups eligible for vaccination. Although invasive Hib disease is now rare in Australia since the introduction of vaccination in 1993, higher rates of disease persist in Aboriginal and Torres Strait Islander children. More research is needed into the contribution of environmental factors, delayed vaccination and vaccine failure to this continued disparity. Hepatitis A has disproportionately affected Aboriginal and Torres Strait Islander children in the past. Vaccination programs in north Queensland and in various other countries have been very successful in reducing the burden of hepatitis A. It is too early to assess the impact of the vaccination program for Aboriginal and Torres Strait Islander children that commenced in regions outside north Queensland in November 2005. For some other diseases the situation is more complicated. The substantial impact of the national meningococcal C vaccination program since 2003 is evident in this report, although the higher proportion of non-vaccine preventable serotype B disease in Aboriginal and Torres Strait Islander people underlines the need for a new vaccine to cover this serotype. Pneumonia remains the most important communicable disease contributor to premature mortality in Aboriginal and Torres Strait Islander people of all ages. In young Indigenous adults, the eightfold higher rate of hospitalisation compared with their non-Indigenous peers, and the 11-fold higher rate of invasive pneumococcal disease, suggest the need for more widespread use of influenza and pneumococcal vaccines in this age group. Current coverage for Indigenous 15-49 year olds, where influenza and pneumococcal vaccines are funded only for those with risk factors, is low even though some 70% of this age group have one or more risk factors. Overall, the data presented in this report provide powerful evidence for the impact of vaccines in reducing disease in Aboriginal and Torres Strait Islander people, and also point to areas for further improvement. Immunisation programs are an example of how preventive health programs in general can be enhanced to close the gap in morbidity and mortality between Indigenous and non-Indigenous Australians.

PMID: 18711998



Semin Fetal Neonatal Med. 2007 Jun;12(3):182-92. Epub 2007 Mar 2.

Best JM. Source King's College London School of Medicine, Department of Infection, St Thomas' Hospital, London SE1 7EH, UK. Abstract Rubella is associated with an 80% risk of congenital abnormalities if acquired in the first 12 weeks of pregnancy. Reinfection in early pregnancy presents a much smaller risk. Prenatal diagnosis may be useful to assess the risk to the fetus. Congenital rubella is a progressive disease and some abnormalities will not be present at birth. Rubella and congenital rubella are usually diagnosed by detection of rubella-specific IgM; it may be difficult to confirm a diagnosis of congenital rubella in children over 3 months of age. Rubella vaccines are usually combined with measles and mumps vaccines. Their use has enabled some industrialised countries to eliminate rubella and congenital rubella. Countries should ensure that susceptible women of child-bearing age and health care workers are offered a rubella-containing vaccine. Rubella vaccine is contraindicated during pregnancy, but if a pregnant woman is inadvertently vaccinated it is not an indication for termination or prenatal diagnosis.

PMID: 17337363

Prevalence of prelingual deafness in Italy

Acta Otorhinolaryngol Ital. 2007 Feb;27(1):17-21.

Bubbico L, Rosano A, Spagnolo A. Source Department of Biomedical Sciences, Italian Institute of Social Medicine, Rome, Italy.


Neonatal hearing loss is the most frequent sensorial congenital defect in newborns. No data are available on worldwide prevalence of congenital deafness. World Health Organization (WHO) data indicate 1-4 cases per 1000 individuals, with a considerable increase in developing countries. A prevalence exceeding 1 per 1000 however, indicates a serious public health problem calling for urgent attention. Aim of the study was the evaluate the prevalence of prelingual deafness in the Italian population and determine the socio-demographic characteristics of the condition. Data were provided by the National Institute of Social Insurance (INPS) and the Italian Central Statistics Institute (ISTAT) and were collected in 18 out of the 20 Italian regions (98.2% of total population). All subjects recognized as deaf-mute by a special medical committee were included. According to law No. 509/1988, they had to present a mean bilateral sensorineural-hearing impairment, detected in neonatal age, which caused the damage in speech development and equal to 60 dB or more for 500-, 1000- and 2000-Hz frequency tones in the better ear. Prevalence rates were calculated according to region and age bracket using updated population data from census 2001. Statistical analyses were performed using the SPSS statistical software package. A total of 40,887 cases of prelingual profound sensorineural hearing loss > or =60 dB were detected in Italy in 2003, for a total prevalence rate of 0.72 per 1000. The hearing impairment prevalence differs according to sex. The overall prevalence is 0.78 per 1000 for males and 0.69 per 1000 for females (p < 0.001). The hearing impairment prevalence differs according to region of residence (p < 0.001). The geographic distribution of prelingual deafness was found to be: North 15,644 cases (0.63 per 1000), Central Italy 7111 cases (0.64 per 1000), South and Islands 18,132 (0.87 per 1000). The prelingual hearing loss is highly prevalent in South Italy (Basilicata, Calabria and Sicily). For the southern regions of Italy, the rate observed in the 50-64 and >64 age groups reached 1.27 and 1.15, respectively. This phenomenon may have been due, in part, to the epidemic incidence of maternal rubella which occurred in the 40's and 50's (in Italy, the rubella vaccination was only recommended starting from 1972), and, in part, to the habit of contracting consanguineous marriages. Data from the Vatican Archives on 520,492 consanguineous marriages, for which dispensation was requested in the period 1911-1964, indicate that in the years 1935-1939, in small villages in South Italy (Basilicata, Calabria, Sicily) consanguineous marriages accounted for over 40% of marriages.

PMID: 17601206


The history of rubella and rubella vaccination leading to elimination

Clin Infect Dis. 2006 Nov 1;43 Suppl 3:S164-8.

Plotkin SA. Source Department of Pediatrics, University of Pennsylvania, Philadelphia, PA, USA.


Congenital rubella syndrome (CRS) was discovered in the 1940s, rubella virus was isolated in the early 1960s, and rubella vaccines became available by the end of the same decade. Systematic vaccination against rubella, usually in combination with measles, has eliminated both the congenital and acquired infection from some developed countries, most recently the United States, as is confirmed by the articles in this supplement. The present article summarizes the clinical syndrome of CRS, the process by which the vaccine was developed, and the history leading up to elimination, as well as the possible extension of elimination on a wider scale.

PMID 16998777


Maternal rubella and the congenital rubella syndrome

Clin Perinatol. 1988 Jun;15(2):247-57.

Freij BJ, South MA, Sever JL. Source Division of Infectious Diseases, Georgetown University School of Medicine, Washington, D.C.


The major goal of rubella immunization is the prevention of the congenital rubella syndrome. As many as 20 per cent of women in the reproductive age group in the United States continue to be susceptible to rubella despite the immunization programs currently in place. Intensified efforts are therefore needed to identify persons at risk for infection and to vaccinate them. Women who develop a rubella-like illness during pregnancy should have the diagnosis confirmed serologically because a diagnosis based on clinical criteria alone is unreliable and because of the serious implications of gestational rubella infection. The rubella virus can infect the fetus at any stage of pregnancy, but defects are rarely noted when this occurs after the 16th week of gestation. The most common abnormalities in the congenital rubella syndrome are hearing loss, mental retardation, cardiac malformations, and eye defects. Diabetes mellitus, thyroid disease, glaucoma, and other delayed manifestations of congenital rubella syndrome are common, thereby necessitating long-term followup of these patients. The detection of rubella-specific IgM antibodies in fetal blood is helpful in establishing the diagnosis prenatally and can aid in the management of pregnancies complicated by this infection. Susceptible women identified through screening during pregnancy should be immunized in the immediate postpartum or postabortion period. Although the live, attenuated rubella vaccine is contraindicated during pregnancy, pregnant women who are inadvertently immunized are not candidates for pregnancy termination because no defects consistent with congenital rubella have been reported to date in the offspring of other similarly vaccinated women.

PMID: 3288422

Norman Gregg (1892–1966)

Causes of birth defects: lessons from history. Lancaster PA. Congenit Anom (Kyoto). 2011 Mar;51(1):2-5. doi: 10.1111/j.1741-4520.2010.00311.x. Review.

PMID: 21158952

Perinatal lessons from the past: Sir Norman Gregg, ChM, MC, of Sydney (1892-1966) and rubella embryopathy. Dunn PM. Arch Dis Child Fetal Neonatal Ed. 2007 Nov;92(6):F513-4.

PMID: 17951553

Gregg's congenital rubella patients 60 years later. Forrest JM, Turnbull FM, Sholler GF, Hawker RE, Martin FJ, Doran TT, Burgess MA. Med J Aust. 2002 Dec 2-16;177(11-12):664-7.

PMID: 12463994

Congenital cataract following German measles in the mother. Abstracts from the publications of the late Sir Norman McAlister Gregg. Hertzberg R. Aust N Z J Ophthalmol. 1985 Aug;13(3):303-9.

PMID: 3907670

The history and medical consequences of rubella. Cooper LZ. Rev Infect Dis. 1985 Mar-Apr;7 Suppl 1:S2-10.

PMID: 3890105

Norman McAlister Gregg. Med J Aust. 1966 Dec 10;2(24):1166-9. No abstract available.

PMID: 5334682

Related Links

HSTAT Archive Collection [Internet]. Bethesda (MD): National Library of Medicine (US); 1977-2002. (This publication is provided for historical reference only and the information may be out of date or incorrect.) Rubella


Rubella Seropositivity in Pregnant Women After Vaccination Campaign in Brazil's Federal District

Viral Immunol. 2017 Nov;30(9):675-677. doi: 10.1089/vim.2017.0012. Epub 2017 Oct 3.

Nóbrega YKM1, de Carvalho BC2, Nitz N2, Vital TE2, Leite FB3, Sequeira IJ4, Moreira EE4, de Andrade JKB1, Gandolfi L1, Pratesi R1, Hecht MM2. Author information Abstract Rubella is an acute viral disease that usually does not generate sequels; however, in pregnant women the infection can cause serious abnormalities to fetuses, which are collectively called congenital rubella syndrome. In Brazil, population immunization was started in 1992, but few epidemiological studies have been conducted to assess vaccination coverage and seroconversion since then. The aim of this work is to evaluate the seropositivity of pregnant women to rubella virus after vaccination campaign was carried out in 2008. Serological tests for rubella diagnosis were performed in 87 pregnant women who attended the University of Brasilia Hospital, Federal District, Brazil. Antirubella IgG antibodies were detected in 83 out of 87 pregnant women (95.4%), with an age-independent seroprevalence. Only one woman was positive in IgM serological tests. Our data suggest high levels of vaccination coverage and antirubella immunization in the Brazil Federal District population. KEYWORDS: pregnant women; rubella; seropositivity PMID: 28972455 DOI: 10.1089/vim.2017.0012