May 19, 2000
North Carolina Health Department Warns Rubella Is On the Rise
German Measles extremely dangerous for
Raleigh, NC (SafetyAlerts) - With the number of
confirmed rubella cases rising to 43 this week, NC State Health Director Dennis McBride
has asked residents and visitors to be extra diligent in determining their immunization
status and to obtain a Rubella shot if they are not certain whether they have ever been
"It is important for everyone, particularly women of childbearing age, to know
whether they have been vaccinated against rubella," Dr. McBride said. "Anyone
who is not sure whether they have ever been vaccinated - especially if they have come here
from another country - should go to their local health department for a shot as soon as
To date, 43 cases of rubella have been confirmed in 13 counties: Durham, Forsyth,
Guilford, Henderson, Iredell, Jackson, Mecklenburg, Orange, Randolph, Stanly, Union, Wake
and Yadkin. While this number is not statistically alarming, North Carolina's growing
status as a cultural crossroads represents an increasing possibility that there are
newcomers and visitors here who have never been vaccinated.
"Because there are so many people coming here from so many different places, we must
remain ever vigilant in our efforts to raise awareness and reach those who have not been
vaccinated," Dr. McBride said. "Women of childbearing age need to be vaccinated
because the disease is especially harmful to a developing fetus. But it is important that
men and children should be vaccinated as well, because they can pass it on to women who
have not been vaccinated."
Rubella is not the common (red) measles. Rubella - also known as German Measles - is an
illness caused by a virus. It is highly contagious and very dangerous for pregnant women
because it can cause severe damage to the unborn baby. If a pregnant woman contracts
rubella her child can be born with congenital malformations such as mental retardation,
deafness, sight deficiencies or heart defects. Anyone who has not been vaccinated against
rubella can get sick from the virus.
The symptoms of rubella include slight fever, skin rash, joint pain, swollen glands, red
eyes and runny nose. Anyone who has these symptoms should call their local health
department immediately and should stay home to avoid transmitting the disease to others.
Local health departments are now offering the vaccine at no cost. But it is important to
note that up to half of the people with the infection do not show any symptoms at all, but
can still pass the disease to others.
Rubella Background Information
This is the fifth year in a row that rubella outbreaks have been reported in North
Carolina. The numbers of reported cases (by year of onset) were: 87 cases in 1996, 60 in
1997, 15 in 1998, and 37 in 1999. Most cases in the past years have occurred during April
and the following summer months. Therefore, it is expected that we are currently at the
beginning of this year's outbreak and that more cases may be reported. Rubella was brought
under control in the United States with the systematic vaccination of children after a
vaccine became available in 1969. Additional strategies are specially targeted at
preventing rubella congenital syndrome, which can result in death of the fetus or
congenital malformations in newborn children. These strategies include testing all
pregnant women who do not have a documented history of vaccination with a blood test for
evidence of protective antibodies and vaccinating those lacking this protection
immediately after delivery of a child, to protect future pregnancies. (The vaccine cannot
be used during pregnancy.)
Rubella in the United States is a disease that is mostly under control due to the practice
of systematic, ongoing application of preventive measures applied to the general
population. When sufficient levels of vaccinations are reached in the population, the
number of protected persons is enough to break the chain of transmission of the disease
when a case is brought into the community.
However, there are sometimes specific groups in the community where this general level of
protection is not found, because of having not been reached by such a prevention program.
In North Carolina, we have witnessed this phenomenon in the past few years, with repeated
outbreaks of rubella affecting mostly the recently established Hispanic community. Many
were born in places where the vaccination program did not include rubella vaccine.
Rubella is a disease that is often mild in nature. For example, the typical rash is absent
in up to half of the cases. Reported cases are therefore not revealing the whole picture.
Another difficulty may result from unrelated chains of transmission starting when new
cases are arriving from outside the community. This may be the explanation for clusters of
cases appearing at locations distant from an outbreak when no link is found with prior
cases, or when so much time has elapsed between cases that a succession of undiagnosed
cases is a less likely explanation.
The nature of control efforts deployed in response to an outbreak is adapted to the
specific circumstances. Most cases in the recent and current outbreaks of rubella in North
Carolina are among Hispanics and therefore this is where the response is concentrated.
Because this is the fifth consecutive year that outbreaks have occurred, special measures
like outreach immunization campaigns have been applied recently across the state. In some
places, it may be more productive to try and find ways to reach in priority those who
arrived recently from out of state or from out of the country.
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