Document Detail


The changing epidemiology of rubella in the 1990s: on the verge of elimination and new challenges for control and prevention.
MedLine Citation:
PMID:  11798368     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
CONTEXT: In 1989, the United States established a goal to eliminate indigenous rubella and congenital rubella syndrome (CRS) by 2000. Reported rubella cases are at record low levels; however, cases and outbreaks have occurred, primarily among unvaccinated foreign-born adults.
OBJECTIVE: To evaluate the current epidemiology of rubella and CRS and assess progress toward elimination.
DESIGN, SETTING, AND SUBJECTS: Analysis of rubella cases reported to the National Notifiable Diseases Surveillance System from 1990 through 1999 and CRS cases reported to the National Congenital Rubella Syndrome Registry from 1990 through 1999. Since 1996, US and international viral isolates have been sequenced.
MAIN OUTCOME MEASURES: Incidence and characteristics of rubella and CRS cases; molecular typing of virus isolates.
RESULTS: Annually from 1990 through 1999, the median number of reported rubella cases was 232 (range, 128-1412), and between 1992 and 1999, fewer than 300 rubella cases were reported annually, except in 1998. During the 1990s, the incidence of rubella in children younger than 15 years decreased (0.63 vs 0.06 per 100 000 in 1990 vs 1999), whereas the incidence in adults aged 15 to 44 years increased (0.13 vs 0.24 per 100 000). In 1992, incidence among Hispanics was 0.06 per 100 000 and increased to a high in 1998 of 0.97 per 100 000. From 1997 through 1999, 20 (83%) of 24 CRS infants were born to Hispanic mothers, and 21 (91%) of 23 CRS infants were born to foreign-born mothers. Molecular typing identified 3 statistically distinct genotypic groups. In group 1, the close relatedness of viruses suggests that a single imported source seeded an outbreak that did not spread beyond the Northeast. Similarly, within groups 2 and 3, relatedness of viruses obtained from clusters of cases suggests that single imported sources seeded each one. Diversity of viruses found in 1 state is consistent with the conclusion that several viruses were imported. Moreover, the similarity of viruses found across the country, combined with a lack of epidemiologic evidence of endemic transmission, support the conclusion that some viruses that are common abroad, particularly in Latin America and the Caribbean, were introduced into the United States on several separate occasions.
CONCLUSIONS: The epidemiology of rubella and CRS has changed significantly in the last decade. These changes and molecular typing suggest that the United States is on the verge of elimination of the disease. To prevent future rubella outbreaks and CRS, current strategies must be enhanced and new strategies developed.
Authors:
Susan E Reef; Teryl K Frey; Katherine Theall; Emily Abernathy; Cindy L Burnett; Joseph Icenogle; Mary Mason McCauley; Melinda Wharton
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  JAMA     Volume:  287     ISSN:  0098-7484     ISO Abbreviation:  JAMA     Publication Date:    2002 Jan 23-30
Date Detail:
Created Date:  2002-01-18     Completed Date:  2002-02-04     Revised Date:  2014-09-17    
Medline Journal Info:
Nlm Unique ID:  7501160     Medline TA:  JAMA     Country:  United States    
Other Details:
Languages:  eng     Pagination:  464-72     Citation Subset:  AIM; IM    
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Child
Child, Preschool
DNA, Viral / analysis
Emigration and Immigration
Female
Humans
Incidence
Infant
Infant, Newborn
Male
Middle Aged
Population Surveillance
RNA, Viral / analysis
Registries
Reverse Transcriptase Polymerase Chain Reaction
Rubella / epidemiology*,  prevention & control
Rubella Syndrome, Congenital / epidemiology,  prevention & control
Rubella virus / genetics*
Sequence Analysis, DNA
United States / epidemiology
Vaccination
Viral Envelope Proteins / genetics
Chemical
Reg. No./Substance:
0/DNA, Viral; 0/RNA, Viral; 0/Viral Envelope Proteins; 131016-01-8/E1 envelope protein, Rubella virus

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