Rubella is a viral infectious disease caused by the rubella virus. While most children experience mild symptoms and face little threat, infection during the first four months of pregnancy can cause congenital malformations in the fetus, posing significant risks to both the fetus and infant.
After infection with the rubella virus, a 2- to 3-week incubation period is followed by symptoms resembling an upper respiratory infection, such as fever, cough, and runny nose. This is then succeeded by a rash and swollen lymph nodes in the neck.The rash may cover the entire body on the first day, begins to fade on the second day, and typically disappears within three days. Approximately 50% of infected children do not develop a rash, and most adults with rubella also do not exhibit a rash. Clinical manifestations of rubella are often mild and non-specific, making diagnosis challenging. Confirmation requires virological testing.
If a pregnant woman contracts rubella during the first four months of pregnancy, the virus can cross the placenta to the fetus, causing congenital infection. Common fetal abnormalities include ocular damage such as cataracts, cardiovascular system changes, deafness, mental retardation, and microcephaly.Deafness, cataracts, and cardiovascular defects collectively form the triad known as congenital rubella syndrome. Following maternal infection, infants may present in three ways: asymptomatic at birth, exhibit typical clinical symptoms immediately after birth, or appear symptom-free at birth but develop symptoms weeks, months, or even years later. Therefore, long-term follow-up observation of children born to mothers with rubella infection is essential.
Thus, controlling rubella incidence is crucial for preventing fetal infection, protecting women of childbearing age, and preventing birth defects. Since the introduction of the rubella vaccine in 1969, many countries have implemented various immunization strategies.Three primary approaches exist:
(1) Universal vaccination for children aged 1–12 years, exemplified by the United States, aims to boost immunity among susceptible children and curb wild-type virus transmission.
(2) Vaccination exclusively for girls aged 11–14 years, as practiced in the United Kingdom, targets pre-pubertal girls who may conceive in the coming years, thereby protecting future fetuses.
(3) Pre-marital rubella antibody testing followed by vaccination for negative results. This approach is suitable for countries where the majority of women of childbearing age have acquired immunity through prior rubella infection.
Over 80% of women of childbearing age in China have had rubella, aligning with the third approach. Pre-marital rubella antibody testing should be conducted, with vaccination administered if results are negative.While this practice is not yet universally implemented in China, pregnant women with negative rubella antibodies should avoid contact with rubella patients and undergo regular antibody testing. If antibodies become positive, fetal monitoring is required. If rubella infection occurs within the first four months of pregnancy, most medical professionals advocate for therapeutic abortion.