Incubation period days

Period of communicability From 7 days before the onset of the rash to 4 days after. CRS infants continue to shed virus for up to 12 months.

Occurrence and distribution Worldwide distribution, but the importance of rubella in developing countries has not been appreciated until comparatively recently. It occurs in an epidemic form probably due to the number of susceptibles in the population, with children becoming infected when they are 2-8 years of age in urban areas and 6-12 years in rural areas.

Control and prevention The objective is to prevent CRS by vaccination of children and adults. Although adolescent girls and women of childbearing age are the target population, just vaccination of this group will never eliminate rubella; therefore, all children of both sexes should ideally be vaccinated. However, if the vaccination programme is far from complete, the effect will be to postpone the age of infection to older and more dangerous ages in women likely to become pregnant. Developing countries, therefore, need to decide between protecting adolescent girls and women of childbearing age only, with no attempt to eliminate rubella or to vaccinate all children aged 9-15 months as part of the routine childhood vaccination programme. If the vaccination programme is considered sufficiently efficient to embark on the latter strategy, then an extra campaign to target all women and girls over 12 years of age should be run at the same time for the first few years of introducing rubella vaccination.

If a policy of childhood vaccination is adopted, then rubella vaccine is best administered with measles vaccine as MR or in combination with measles and mumps as MMR (see Sections 12.2 and 12.4).

Surveillance An estimate of the level of CRS can be obtained from hospital records and MCH records of deaf and blind infants. Measles vaccination records and numbers of cases of measles are good indicators of the efficiency of the childhood vaccination programme in deciding which strategy of rubella vaccination to introduce.

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