Rubella

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Rubella
Other namesGerman measles, three-day-measles
Rash of rubella on back (crop).JPG
A rash due to rubella on a child's back. The area affected is similar to that of measles but the rash is less intensely red.
Specialty Infectious disease
SymptomsRash, swollen lymph nodes, fever, sore throat, feeling tired [1] [2]
Complications Testicular swelling, inflammation of nerves, congenital rubella syndrome, miscarriage [1] [3]
Usual onset2 weeks after exposure [1]
Duration3 days [1]
Causes Rubella virus (spread through the air) [3] [4]
Diagnostic method Finding the virus in the blood, throat, or urine, antibody tests [1]
Prevention Rubella vaccine [3]
Treatment Supportive care [2]
FrequencyCommon in many areas [2]

Rubella, also known as German measles or three-day measles, [5] is an infection caused by the rubella virus. [3] This disease is often mild with half of people not realizing that they are infected. [1] [6] A rash may start around two weeks after exposure and last for three days. [1] It usually starts on the face and spreads to the rest of the body. [1] The rash is sometimes itchy and is not as bright as that of measles. [1] Swollen lymph nodes are common and may last a few weeks. [1] A fever, sore throat, and fatigue may also occur. [1] [2] In adults joint pain is common. [1] Complications may include bleeding problems, testicular swelling, and inflammation of nerves. [1] Infection during early pregnancy may result in a child born with congenital rubella syndrome (CRS) or miscarriage. [3] Symptoms of CRS include problems with the eyes such as cataracts, ears such as deafness, heart, and brain. [3] Problems are rare after the 20th week of pregnancy. [3]

Infection invasion of a host by disease-causing organisms

Infection is the invasion of an organism's body tissues by disease-causing agents, their multiplication, and the reaction of host tissues to the infectious agents and the toxins they produce. Infectious disease, also known as transmissible disease or communicable disease, is illness resulting from an infection.

<i>Rubella virus</i> species of virus

Rubella virus (RuV) is the pathogenic agent of the disease rubella, and is the cause of congenital rubella syndrome when infection occurs during the first weeks of pregnancy.

Itch disease

Itch is a sensation that causes the desire or reflex to scratch. Itch has resisted many attempts to be classified as any one type of sensory experience. Itch has many similarities to pain, and while both are unpleasant sensory experiences, their behavioral response patterns are different. Pain creates a withdrawal reflex, whereas itch leads to a scratch reflex.

Contents

Rubella is usually spread through the air via coughs of people who are infected. [3] [4] People are infectious during the week before and after the appearance of the rash. [1] Babies with CRS may spread the virus for more than a year. [1] Only humans are infected. [3] Insects do not spread the disease. [1] Once recovered, people are immune to future infections. [3] Testing is available that can verify immunity. [3] Diagnosis is confirmed by finding the virus in the blood, throat, or urine. [1] Testing the blood for antibodies may also be useful. [1]

Airborne disease disease that is caused by pathogens and transmitted through the air

An airborne disease is any disease that is caused by pathogens that can be transmitted through the air. Such diseases include many of considerable importance both in human and veterinary medicine. The relevant pathogens may be viruses, bacteria, or fungi, and they may be spread through breathing, talking, coughing, sneezing, raising of dust, spraying of liquids, toilet flushing or any activities which generates aerosol particles or droplets. Human airborne diseases do not include conditions caused by air pollution such as Volatile Organic Compounds (VOCs), gases and any airborne particles, though their study and prevention may help inform the science of airborne disease transmission.

Rubella is preventable with the rubella vaccine with a single dose being more than 95% effective. [3] Often it is given in combination with the measles vaccine and mumps vaccine, known as the MMR vaccine. [1] When some, but less than 80%, of a population is vaccinated, more women may reach childbearing age without developing immunity by infection or vaccination, thus possibly raising CRS rates. [3] Once infected there is no specific treatment. [2]

Rubella vaccine is a vaccine used to prevent rubella. Effectiveness begins about two weeks after a single dose and around 95% of people become immune. Countries with high rates of immunization no longer see cases of rubella or congenital rubella syndrome. When there is a low level of childhood immunization in a population it is possible for rates of congenital rubella to increase as more women make it to child bearing age without either vaccination or exposure to the disease. Therefore, it is important for more than 80% of people to be vaccinated.

Measles vaccine Vaccine used for eradicating Measles

Measles vaccine is a vaccine that prevents measles. Nearly all of those who do not develop immunity after a single dose develop it after a second dose. When rates of vaccination within a population are greater than 92% outbreaks of measles typically no longer occur; however, they may occur again if rates of vaccination decrease. The vaccine's effectiveness lasts many years. It is unclear if it becomes less effective over time. The vaccine may also protect against measles if given within a couple of days after exposure to measles.

Mumps vaccines are vaccines which prevent mumps. When given to a majority of the population they decrease complications at the population level. Effectiveness when 90% of a population is vaccinated is estimated at 85%. Two doses are required for long term prevention. The initial dose is recommended between the age of 12 and 18 months of age. The second dose is then typically given between two years and six years of age. Usage after exposure in those not already immune may be useful.

Rubella is a common infection in many areas of the world. [2] Each year about 100,000 cases of congenital rubella syndrome occur. [3] Rates of disease have decreased in many areas as a result of vaccination. [2] [6] There are ongoing efforts to eliminate the disease globally. [3] In April 2015 the World Health Organization declared the Americas free of rubella transmission. [7] [8] The name "rubella" is from Latin and means little red. [1] It was first described as a separate disease by German physicians in 1814 resulting in the name "German measles". [1]

World Health Organization Specialized agency of the United Nations

The World Health Organization (WHO) is a specialized agency of the United Nations that is concerned with international public health. It was established on 7 April 1948, and is headquartered in Geneva, Switzerland. The WHO is a member of the United Nations Development Group. Its predecessor, the Health Organization, was an agency of the League of Nations.

Americas Landmass comprising North America, Central America and South America

The Americas comprise the totality of the continents of North and South America. Together, they make up most of the land in Earth's western hemisphere and comprise the New World.

Signs and symptoms

Young boy displaying the characteristic maculopapular rash of rubella 10145 lores.jpg
Young boy displaying the characteristic maculopapular rash of rubella
Generalized rash on the abdomen due to rubella Rubella.jpg
Generalized rash on the abdomen due to rubella

Rubella has symptoms that are similar to those of flu. However, the primary symptom of rubella virus infection is the appearance of a rash (exanthem) on the face which spreads to the trunk and limbs and usually fades after three days (that is why it is often referred to as three-day measles). The facial rash usually clears as it spreads to other parts of the body. Other symptoms include low grade fever, swollen glands (sub-occipital and posterior cervical lymphadenopathy), joint pains, headache, and conjunctivitis. [10]

Lymphadenopathy disorder of lymph nodes

Lymphadenopathy or adenopathy is disease of the lymph nodes, in which they are abnormal in size or consistency. Lymphadenopathy of an inflammatory type is lymphadenitis, producing swollen or enlarged lymph nodes. In clinical practice, the distinction between lymphadenopathy and lymphadenitis is rarely made and the words are usually treated as synonymous. Inflammation of the lymphatic vessels is known as lymphangitis. Infectious lymphadenitis affecting lymph nodes in the neck is often called scrofula.

Arthralgia literally means joint pain. Specifically, arthralgia is a symptom of injury, infection, illness, or an allergic reaction to medication.

Headache Pain in the head or neck

Headache is the symptom of pain anywhere in the region of the head or neck. It occurs in migraines, tension-type headaches, and cluster headaches. Frequent headaches can affect relationships and employment. There is also an increased risk of depression in those with severe headaches.

The swollen glands or lymph nodes can persist for up to a week and the fever rarely rises above 38 °C (100.4 °F). The rash of German measles is typically pink or light red. The rash causes itching and often lasts for about three days. The rash disappears after a few days with no staining or peeling of the skin. When the rash clears up, the skin might shed in very small flakes where the rash covered it. Forchheimer's sign occurs in 20% of cases, and is characterized by small, red papules on the area of the soft palate. [11]

Gland type of organ in an human or animals body

A gland is a group of cells in an animal's body that synthesizes substances for release into the bloodstream or into cavities inside the body or its outer surface.

Fever common medical sign characterized by elevated body temperature

Fever, also known as pyrexia and febrile response, is defined as having a temperature above the normal range due to an increase in the body's temperature set point. There is not a single agreed-upon upper limit for normal temperature with sources using values between 37.5 and 38.3 °C. The increase in set point triggers increased muscle contractions and causes a feeling of cold. This results in greater heat production and efforts to conserve heat. When the set point temperature returns to normal, a person feels hot, becomes flushed, and may begin to sweat. Rarely a fever may trigger a febrile seizure. This is more common in young children. Fevers do not typically go higher than 41 to 42 °C.

Papule

A papule is a circumscribed, solid elevation of skin with no visible fluid, varying in area from a pinhead to 1 cm. It can be brown, purple, pink or red in color, and can cluster into a papular rash. Papules may open when scratched and become infected and crusty. Larger non-blisterform elevated lesions may be termed nodules.

Rubella can affect anyone of any age. Adult women are particularly prone to arthritis and joint pains. [12]

In children rubella normally causes symptoms which last two days and include: [13]

In older children and adults additional symptoms may be present including: [13]

Severe complications of rubella include:

Coryza in rubella may convert to pneumonia, either direct viral pneumonia or secondary bacterial pneumonia, and bronchitis (either viral bronchitis or secondary bacterial bronchitis). [16]

Congenital rubella syndrome

Cataracts due to congenital rubella syndrome Cataracts due to Congenital Rubella Syndrome (CRS) PHIL 4284 lores.jpg
Cataracts due to congenital rubella syndrome

Rubella can cause congenital rubella syndrome in the newborn, the most severe sequela of rubella. The syndrome (CRS) follows intrauterine infection by the rubella virus and comprises cardiac, cerebral, ophthalmic and auditory defects. [17] It may also cause prematurity, low birth weight, and neonatal thrombocytopenia, anemia and hepatitis. The risk of major defects or organogenesis is highest for infection in the first trimester. CRS is the main reason a vaccine for rubella was developed. [18]

Many mothers who contract rubella within the first critical trimester either have a miscarriage or a stillborn baby. If the fetus survives the infection, it can be born with severe heart disorders (patent ductus arteriosus being the most common), blindness, deafness, or other life-threatening organ disorders. The skin manifestations are called "blueberry muffin lesions". [18] For these reasons, rubella is included on the TORCH complex of perinatal infections.

About 100,000 cases of this condition occur each year. [3]

Cause

Transmission electron micrograph of rubella viruses Rubella virus TEM B82-0203 lores.jpg
Transmission electron micrograph of rubella viruses

The disease is caused by rubella virus, a togavirus that is enveloped and has a single-stranded RNA genome. [19] The virus is transmitted by the respiratory route and replicates in the nasopharynx and lymph nodes. The virus is found in the blood 5 to 7 days after infection and spreads throughout the body. The virus has teratogenic properties and is capable of crossing the placenta and infecting the fetus where it stops cells from developing or destroys them. [10] During this incubation period, the patient is contagious typically for about one week before he/she develops a rash and for about one week thereafter.

Increased susceptibility to infection might be inherited as there is some indication that HLA-A1 or factors surrounding A1 on extended haplotypes are involved in virus infection or non-resolution of the disease. [20] [21]

Diagnosis

Rubella virus specific IgM antibodies are present in people recently infected by rubella virus, but these antibodies can persist for over a year, and a positive test result needs to be interpreted with caution. [22] The presence of these antibodies along with, or a short time after, the characteristic rash confirms the diagnosis. [23]

Prevention

Rubella infections are prevented by active immunisation programs using live attenuated virus vaccines. Two live attenuated virus vaccines, RA 27/3 and Cendehill strains, were effective in the prevention of adult disease. However their use in prepubertal females did not produce a significant fall in the overall incidence rate of CRS in the UK. Reductions were only achieved by immunisation of all children. [24]

The vaccine is now usually given as part of the MMR vaccine. The WHO recommends the first dose be given at 12 to 18 months of age with a second dose at 36 months. Pregnant women are usually tested for immunity to rubella early on. Women found to be susceptible are not vaccinated until after the baby is born because the vaccine contains live virus. [25]

The immunisation program has been quite successful. Cuba declared the disease eliminated in the 1990s, and in 2004 the Centers for Disease Control and Prevention announced that both the congenital and acquired forms of rubella had been eliminated from the United States. [26] [27] The World Health Organisation declared Australia rubella free in October 2018. [28]

Screening for rubella susceptibility by history of vaccination or by serology is recommended in the United States for all women of childbearing age at their first preconception counseling visit to reduce incidence of congenital rubella syndrome (CRS). [29] It is recommended that all susceptible non-pregnant women of childbearing age should be offered rubella vaccination. [29] Due to concerns about possible teratogenicity, use of MMR vaccine is not recommended during pregnancy. [29] Instead, susceptible pregnant women should be vaccinated as soon as possible in the postpartum period. [29]

Treatment

There is no specific treatment for rubella; however, management is a matter of responding to symptoms to diminish discomfort. Treatment of newborn babies is focused on management of the complications. Congenital heart defects and cataracts can be corrected by direct surgery. [12] [30]

Management for ocular congenital rubella syndrome (CRS) is similar to that for age-related macular degeneration, including counseling, regular monitoring, and the provision of low vision devices, if required. [31]

Prognosis

Rubella infection of children and adults is usually mild, self-limiting and often asymptomatic. The prognosis in children born with CRS is poor. [32]

Epidemiology

Rubella occurs worldwide. The virus tends to peak during the spring in countries with temperate climates. Before the vaccine against rubella was introduced in 1969, widespread outbreaks usually occurred every 6–9 years in the United States and 3–5 years in Europe, mostly affecting children in the 5-9 year old age group. [33] Since the introduction of vaccine, occurrences have become rare in those countries with high uptake rates.

Vaccination has interrupted the transmission of rubella in the Americas: no endemic case has been observed since February 2009. [34] Vaccination is still strongly recommended as the virus could be reintroduced from other continents should vaccination rates in the Americas drop. [35] During the epidemic in the U.S. between 1962–1965, rubella virus infections during pregnancy were estimated to have caused 30,000 stillbirths and 20,000 children to be born impaired or disabled as a result of CRS. [36] [37] Universal immunisation producing a high level of herd immunity is important in the control of epidemics of rubella. [38]

In the UK, there remains a large population of men susceptible to rubella who have not been vaccinated. Outbreaks of rubella occurred amongst many young men in the UK in 1993 and in 1996 the infection was transmitted to pregnant women, many of whom were immigrants and were susceptible. Outbreaks still arise, usually in developing countries where the vaccine is not as accessible. [39]

In Japan, 15,000 cases of rubella and 43 cases of congenital rubella syndrome were reported to the National Epidemiological Surveillance of Infectious Diseases between October 15, 2012, and March 2, 2014 during the 2012–13 rubella outbreak in Japan. They mainly occurred in men of ages 31 to 51 and young adults aged 24–34. [40]

History

Rubella was first described in the mid-eighteenth century. Friedrich Hoffmann made the first clinical description of rubella in 1740, [41] which was confirmed by de Bergen in 1752 and Orlow in 1758. [42]

In 1814, George de Maton first suggested that it be considered a disease distinct from both measles and scarlet fever. All these physicians were German, and the disease was known as Rötheln (contemporary German Röteln), Rötlich means "redish" or "pink" in German. The fact that three Germans described it led to the common name of "German measles". [43] Henry Veale, an English Royal Artillery surgeon, described an outbreak in India. He coined the name "rubella" (from the Latin word, meaning "little red") in 1866. [41] [44] [45] [46]

It was formally recognised as an individual entity in 1881, at the International Congress of Medicine in London. [47] In 1914, Alfred Fabian Hess theorised that rubella was caused by a virus, based on work with monkeys. [48] In 1938, Hiro and Tosaka confirmed this by passing the disease to children using filtered nasal washings from acute cases. [45]

In 1940, there was a widespread epidemic of rubella in Australia. Subsequently, ophthalmologist Norman McAllister Gregg found 78 cases of congenital cataracts in infants and 68 of them were born to mothers who had caught rubella in early pregnancy. [44] [45] Gregg published an account, Congenital Cataract Following German Measles in the Mother, in 1941. He described a variety of problems now known as congenital rubella syndrome (CRS) and noticed that the earlier the mother was infected, the worse the damage was. Since no vaccine was yet available, some popular magazines promoted the idea of "German measles parties" for infected children to spread the disease to other children (especially girls) to immunize them for life and protect them from later catching the disease when pregnant. [49] The virus was isolated in tissue culture in 1962 by two separate groups led by physicians Paul Douglas Parkman and Thomas Huckle Weller. [44] [46]

There was a pandemic of rubella between 1962 and 1965, starting in Europe and spreading to the United States. [46] In the years 1964–65, the United States had an estimated 12.5 million rubella cases. This led to 11,000 miscarriages or therapeutic abortions and 20,000 cases of congenital rubella syndrome. Of these, 2,100 died as neonates, 12,000 were deaf, 3,580 were blind, and 1,800 were mentally retarded. In New York alone, CRS affected 1% of all births. [50] [51]

In 1969 a live attenuated virus vaccine was licensed. [45] In the early 1970s, a triple vaccine containing attenuated measles, mumps and rubella (MMR) viruses was introduced. [46] By 2006, confirmed cases in the Americas had dropped below 3000 a year. However, a 2007 outbreak in Argentina, Brazil, and Chile pushed the cases to 13,000 that year. [7]

On January 22, 2014, the World Health Organization (WHO) and the Pan American Health Organization declared and certified Colombia free of rubella and became the first Latin American country to eliminate the disease within its borders. [52] [53] On April 29, 2015, the Americas became the first WHO region to officially eradicate the disease. The last non-imported cases occurred in 2009 in Argentina and Brazil. Pan-American Health Organization director remarked "The fight against rubella has taken more than 15 years, but it has paid off with what I believe will be one of the most important pan-American public health achievements of the 21st Century." [54] The declaration was made after 165 million health records and genetically confirming that all recent cases were caused by known imported strains of the virus. Rubella is still common in some regions of the world and Susan E. Reef, team lead for rubella at the C.D.C.’s global immunization division, who joined in the announcement, said there was no chance it would be eradicated worldwide before 2020. [7] Rubella is the third disease to be eliminated from the western hemisphere with vaccination after smallpox and polio. [7] [8]

Etymology

The name rubella is sometimes confused with rubeola, an alternative name for measles in English-speaking countries; the diseases are unrelated. [55] [56] In some other European languages, like Spanish, rubella and rubeola are synonyms, and rubeola is not an alternative name for measles. [57] Thus, in Spanish, "rubeola" refers to rubella and "sarampión" refers to measles.

See also

Related Research Articles

Vaccine biological preparatory medicine that improves immunity to a particular disease

A vaccine is a biological preparation that provides active acquired immunity to a particular disease. A vaccine typically contains an agent that resembles a disease-causing microorganism and is often made from weakened or killed forms of the microbe, its toxins, or one of its surface proteins. The agent stimulates the body's immune system to recognize the agent as a threat, destroy it, and to further recognize and destroy any of the microorganisms associated with that agent that it may encounter in the future. Vaccines can be prophylactic, or therapeutic.

MMR vaccine any of several combined vaccines against measles, mumps, and rubella

The MMR vaccine is a vaccine against measles, mumps, and rubella. The first dose is generally given to children around 9 to 15 months of age, with a second dose at 15 months to 6 years of age, with at least 4 weeks between the doses. After two doses, 97% of people are protected against measles, 88% against mumps, and at least 97% against rubella. The vaccine is also recommended in those who do not have evidence of immunity, those with well controlled HIV/AIDS, and within 72 hours of exposure to measles among those who are incompletely immunized. It is given by injection.

Herd immunity

Herd immunity is a form of indirect protection from infectious disease that occurs when a large percentage of a population has become immune to an infection, thereby providing a measure of protection for individuals who are not immune. In a population in which a large number of individuals are immune, chains of infection are likely to be disrupted, which stops or slows the spread of disease. The greater the proportion of individuals in a community who are immune, the smaller the probability that those who are not immune will come into contact with an infectious individual.

Congenital rubella syndrome human disease

Congenital rubella syndrome (CRS) can occur in a developing fetus of a pregnant woman who has contracted rubella, usually in the first trimester. If infection occurs 0–28 days before conception, the infant has a 43% risk of being affected. If the infection occurs 0–12 weeks after conception, the risk increases to 81%. If the infection occurs 13–26 weeks after conception, the risk is 54% of the infant being affected by the disease. Infants are not generally affected if rubella is contracted during the third trimester, or 26–40 weeks after conception. Problems rarely occur when rubella is contracted by the mother after 20 weeks of gestation and continues to disseminate the virus after birth.

Roseola Human disease caused by human herpesviruses

Roseola is an infectious disease caused by certain types of virus. Most infections occur before the age of three. Symptoms vary from absent to the classic presentation of a fever of rapid onset followed by a rash. The fever generally lasts for three to five days. The rash is generally pink and lasts for less than three days. Complications may include febrile seizures, with serious complications being rare.

Shingles human disease caused by varicella zoster

Shingles, also known as zoster or herpes zoster, is a viral disease characterized by a painful skin rash with blisters in a localized area. Typically the rash occurs in a single, wide stripe either on the left or right side of the body or face. Two to four days before the rash occurs there may be tingling or local pain in the area. Otherwise there are typically few symptoms though some may have fever or headache, or feel tired. The rash usually heals within two to four weeks; however, some people develop ongoing nerve pain which can last for months or years, a condition called postherpetic neuralgia (PHN). In those with poor immune function the rash may occur widely. If the rash involves the eye, vision loss may occur.

Vaccine hesitancy Unsubstantiated scares regarding immunisation

Vaccine hesitancy, a reluctance or refusal to be vaccinated or to have one's children vaccinated, is identified by the World Health Organization as one of the top ten global health threats of 2019. Arguments against vaccination are contradicted by overwhelming scientific consensus about the safety and efficacy of vaccines.

Childhood immunizations in the United States

The schedule of childhood immunizations in the United States is given by the Centers for Disease Control and Prevention (CDC). The vaccination schedule is broken down by age: birth to six years of age, seven to eighteen, and adults nineteen and older. Childhood Immunizations are key in preventing children for diseases that were once epidemics.

MMRV vaccine combination vaccine against measles, mumps, rubella, and varicella viruses

The MMRV vaccine combines the attenuated virus MMR vaccine with the addition of chickenpox vaccine or varicella vaccine. The MMRV vaccine is typically given to children between 1 and 2 years of age.

Claims of a link between the MMR vaccine and autism have been extensively investigated and found to be false. The link was first suggested in the early 1990s and came to public notice largely as a result of the 1998 Lancet MMR autism fraud, characterised as "perhaps the most damaging medical hoax of the last 100 years". The fraudulent research paper authored by Andrew Wakefield and published in The Lancet claimed to link the vaccine to colitis and autism spectrum disorders. The paper was retracted in 2010 but is still cited by anti-vaccinationists.

Eradication of infectious diseases Reduction of an infectious diseases prevalence in the global host population to zero

Eradication is the reduction of an infectious disease's prevalence in the global host population to zero. It is sometimes confused with elimination, which describes either the reduction of an infectious disease's prevalence in a regional population to zero, or the reduction of the global prevalence to a negligible amount. Further confusion arises from the use of the term eradication to refer to the total removal of a given pathogen from an individual, particularly in the context of HIV and certain other viruses where such cures are sought.

Smallpox eradicated viral disease

Smallpox was an infectious disease caused by one of two virus variants, Variola major and Variola minor. The last naturally occurring case was diagnosed in October 1977 and the World Health Organization (WHO) certified the global eradication of the disease in 1980. The risk of death following contracting the disease was about 30%, with higher rates among babies. Often those who survived had extensive scarring of their skin and some were left blind.

Chickenpox Human viral disease

Chickenpox, also known as varicella, is a highly contagious disease caused by the initial infection with varicella zoster virus (VZV). The disease results in a characteristic skin rash that forms small, itchy blisters, which eventually scab over. It usually starts on the chest, back, and face then spreads to the rest of the body. Other symptoms may include fever, tiredness, and headaches. Symptoms usually last five to seven days. Complications may occasionally include pneumonia, inflammation of the brain, and bacterial skin infections. The disease is often more severe in adults than in children. Symptoms begin 10 to 21 days after exposure to the virus.

<i>Zika virus</i> Species of virus

Zika virus (ZIKV) is a member of the virus family Flaviviridae. It is spread by daytime-active Aedes mosquitoes, such as A. aegypti and A. albopictus. Its name comes from the Ziika Forest of Uganda, where the virus was first isolated in 1947. Zika virus is related to the dengue, yellow fever, Japanese encephalitis, and West Nile viruses. Since the 1950s, it has been known to occur within a narrow equatorial belt from Africa to Asia. From 2007 to 2016, the virus spread eastward, across the Pacific Ocean to the Americas, leading to the 2015–16 Zika virus epidemic.

Congenital cytomegalovirus infection mother-to-child transmission of cytomegalovirus occurring in the prenatal period

Congenital cytomegalovirus infection refers to a condition where cytomegalovirus is transmitted in the prenatal period.

Epidemiology of measles

Measles is extremely contagious but infection results in lifelong immunity, so its continued circulation in a community depends on the generation of susceptible hosts by birth of children. In communities which generate insufficient new hosts the disease will die out. This concept was first recognized by Bartlett in 1957, who referred to the minimum number supporting measles as the critical community size (CCS). Analysis of outbreaks in island communities suggested that the CCS for measles is c. 250,000.

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D
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