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May 19, 2000

North Carolina Health Department Warns Rubella Is On the Rise

German Measles extremely dangerous for pregnant women

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 vaccinated.

"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 possible."

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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