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Pediatric Rubella

  • Author: Elias Ezike, MD; Chief Editor: Russell W Steele, MD  more...
 
Updated: Dec 18, 2014
 

Background

The name rubella is derived from a Latin term meaning "little red." Rubella is generally a benign communicable exanthematous disease. It is caused by rubella virus, which is a member of the Rubivirus genus of the family Togaviridae. Nearly one half of individuals infected with this virus are asymptomatic. Clinical manifestations and severity of illness vary with age. For instance, infection in younger children is characterized by mild constitutional symptoms, rash, and suboccipital adenopathy; conversely, in older children, adolescents, and adults, rubella may be complicated by arthralgia, arthritis, and thrombocytopenic purpura. Rare cases of rubella encephalitis have also been described in children.

The major complication of rubella is its teratogenic effects when pregnant women contract the disease, especially in the early weeks of gestation. The virus can be transmitted to the fetus through the placenta and is capable of causing serious congenital defects, abortions, and stillbirths. Fortunately, because of the successful immunization program initiated in the United States in 1969, rubella infection and congenital rubella syndrome rarely are seen today. See the images below.

Number of rubella cases per year. Number of rubella cases per year.
Number of congenital rubella syndrome cases per ye Number of congenital rubella syndrome cases per year.
Deaths from rubella per year. Deaths from rubella per year.

The few cases of rubella recorded in recent years involve susceptible individuals who have not been immunized with rubella vaccine and do not have a history of previous rubella infection.

An independent panel convened by the Centers for Disease Control and Prevention (CDC) in 2004 found that about 91% of the US population is immune to rubella. This explains the decreased number of outbreaks of rubella and congenital rubella syndrome reported in the recent years.

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Pathophysiology

Postnatal rubella

The usual portal of entry of rubella virus is the respiratory epithelium of the nasopharynx. The virus is transmitted via the aerosolized particles from the respiratory tract secretions of infected individuals. The virus attaches to and invades the respiratory epithelium. It then spreads hematogenously (primary viremia) to regional and distant lymphatics and replicates in the reticuloendothelial system. This is followed by a secondary viremia that occurs 6-20 days after infection. During this viremic phase, rubella virus can be recovered from different body sites including lymph nodes, urine, cerebrospinal fluid (CSF), conjunctival sac, breast milk, synovial fluid, and lungs. Viremia peaks just before the onset of rash and disappears shortly thereafter. An infected person begins to shed the virus from the nasopharynx 3-8 days after exposure for 6-14 days after onset of the rash.

Congenital rubella syndrome

Fetal infection occurs transplacentally during the maternal viremic phase, but the mechanisms by which rubella virus causes fetal damage are poorly understood. The fetal defects observed in congenital rubella syndrome are likely secondary to vasculitis resulting in tissue necrosis without inflammation. Another possible mechanism is direct viral damage of infected cells. Studies have demonstrated that cells infected with rubella in the early fetal period have reduced mitotic activity. This may be the result of chromosomal breakage or due to production of a protein that inhibits mitosis. Regardless of the mechanism, any injury affecting the fetus in the first trimester (during the phase of organogenesis) results in congenital organ defects.

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Epidemiology

Frequency

United States

During the 1962-1965 worldwide epidemic, an estimated 12.5 million rubella cases occurred in the United States, resulting in 20,000 cases of congenital rubella syndrome. Since the licensing of the live attenuated rubella vaccine in the United States in 1969, a substantial increase has been noted in the vaccination coverage among school-aged children and the population immunity. In 2004, the estimated vaccination coverage among school-aged children was about 95%, and the population immunity was about 91%.

As a result of the progress made in vaccination against rubella, a remarkable drop has occurred in the number of cases of rubella and congenital rubella syndrome. For instance, in 1969, a total of 57,686 cases of rubella and 31 cases of congenital rubella syndrome were recorded. Subsequently, from 1993-2000, the number of cases of rubella recorded annually decreased to a range of 128-364, and cases of congenital rubella syndrome also dropped to 4-9 cases per year. Since 2001, the annual number of rubella cases ranged from a record low of 7 in 2003 to 23 in 2001, and congenital rubella syndrome cases between 0-3 per year (see the images below).

Number of rubella cases per year. Number of rubella cases per year.
Number of congenital rubella syndrome cases per ye Number of congenital rubella syndrome cases per year.

An independent panel convened by the CDC in 2004 to assess progress towards elimination of rubella and congenital rubella syndrome in the United States concluded unanimously that rubella is no longer endemic in the United States. In fact, the pattern of virus genotypes isolated in recent years was consistent with virus originating in other parts of the world.

Following the near record-low levels in rubella incidence in the United States, the occurrence of isolated outbreaks among susceptible adults has also become rare. In fact no outbreak of rubella was reported from 2000-2005, in contrast to the preceding year interval, 1996-1999, when 16 outbreaks were reported. The median number of cases per outbreak was 21. The most recent cases occurred in New York during 1997-1998, Kansas in 1998, Nebraska in 1999, and Arkansas in 1999. Most of these outbreaks were reported in college campuses, military installations, prisons, and workplaces, including health care environments. In most instances, the individuals involved in these outbreaks have no history of rubella immunization. In addition, most of the outbreaks have been reported among persons who emigrated from countries where rubella is not included in the routine immunization schedule.

From 2000 to 2012, rising numbers of WHO member states began using rubella-containing vaccines (RCVs) in their immunization program and began reporting rubella and congenital rubella syndrome (CRS) surveillance data. As of December 2012, 132 (68%) WHO member states had introduced RCV, a 33% increase from 99 member states in 2000. Some 43% of infants had received a RCV dose in 2012, a 96% increase from the 22% of infants who had been vaccinated against rubella in 2000. A total of 94,030 rubella cases were reported to WHO in 2012 from 174 member states, an 86% decrease from the 670,894 cases reported in 2000 from 102 member states.[1, 2]

International

Rubella occurs worldwide.[3] The number of reported cases is high in countries where routine rubella immunization is either not available or was recently introduced. For instance, in Mexico in 1990, a total of 65,591 cases of rubella were reported. After the introduction of rubella vaccine into the childhood immunization schedule in 1998, the number of reported cases declined 68% to 21,173. In Europe, the incidence of rubella remains high. For instance, in 2003, a total of 304,320 cases were reported; 41% of these were from the Russian Federation, and 40% were from Romania.

Although the burden of congenital rubella syndrome is not well characterized in all countries, more than 100,000 cases are estimated to occur each year in developing countries alone. In Europe, a total of 47 cases of congenital rubella syndrome were reported from 2001-2003; 32% were from the Russian Federation, and 36% were from Romania.

Mortality/Morbidity

The morbidity and mortality rates of rubella disease dropped remarkably since the licensing of live attenuated rubella vaccine in 1969. In fact, in 1969, complicated rubella infection caused 29 fatalities in the United States, whereas from 1992-2001, only 0-2 deaths per year were recorded (see the image below).

Deaths from rubella per year. Deaths from rubella per year.

In contrast to postnatal rubella, which is not a debilitating disease, congenital rubella infection may result in growth delay, learning disability, mental retardation, hearing loss, congenital heart disease, and eye, endocrinologic, and neurologic abnormalities.

Table 1. Reported Cases of Rubella, Deaths From Rubella, and Number of Cases of Congenital Rubella Syndrome in the United States From 1969-2007[4, 5, 6, 7] (Open Table in a new window)

Year Number of Cases Number of Deaths Cases of Congenital Rubella Syndrome
1969 57,686 29 31
1970 56,552 31 77
1971 45,086 20 68
1972 25,507 14 42
1973 27,804 16 35
1974 11,917 15 45
1975 16,652 21 30
1976 12,491 12 30
1977 20,395 17 23
1978 18,269 10 30
1979 11,795 1 62
1980 3,904 1 50
1981 2,077 5 19
1982 2,325 4 7
1983 970 3 22
1984 752 1 5
1985 630 1 0
1986 551 1 5
1987 306 0 5
1988 225 1 6
1989 396 4 3
1990 1,125 8 11
1991 1,401 1 47
1992 160 1 11
1993 192 0 5
1994 227 0 7
1995 128 1 6
1996 238 0 4
1997 181 0 5
1998 364 0 7
1999 267 0 9
2000 176 0 9
2001 23 2 3
2002 18 N/A 1
2003 7 N/A 1
2004 10 N/A 0
2005 11 N/A 1
2006 11 N/A 1
2007 12 N/A 0

Race

No ethnic difference in incidence has been clearly demonstrated, although the characteristic rash is more difficult to diagnose in persons with dark skin.

Sex

No appreciable differences in infection rates by sex are apparent in children, but in adults, more cases are reported in women than in men. Rubella arthralgia and arthritis are more frequent in women than in men.

Age

Before licensing of the live attenuated vaccine in 1969, rubella in the United States was primarily a disease of school-aged children, with a peak incidence in children aged 5-9 years. Following widespread use of rubella vaccine in children, peak incidence has shifted to persons older than 20 years, who comprise 62% of cases of rubella reported in the United States.

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Contributor Information and Disclosures
Author

Elias Ezike, MD Consulting Staff, Beaumont Pediatric Center, PLLC

Elias Ezike, MD is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Coauthor(s)

Jocelyn Y Ang, MD, FAAP, FIDSA Associate Professor, Department of Pediatrics, Wayne State University School of Medicine; Consulting Staff, Division of Infectious Diseases, Children's Hospital of Michigan

Jocelyn Y Ang, MD, FAAP, FIDSA is a member of the following medical societies: American Academy of Pediatrics, Infectious Diseases Society of America, Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Chief Editor

Russell W Steele, MD Clinical Professor, Tulane University School of Medicine; Staff Physician, Ochsner Clinic Foundation

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, Southern Medical Association

Disclosure: Nothing to disclose.

Additional Contributors

Leonard R Krilov, MD Chief of Pediatric Infectious Diseases and International Adoption, Vice Chair, Department of Pediatrics, Winthrop University Hospital; Professor of Pediatrics, Stony Brook University School of Medicine

Leonard R Krilov, MD is a member of the following medical societies: American Academy of Pediatrics, American Pediatric Society, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Society for Pediatric Research

Disclosure: Nothing to disclose.

Acknowledgements

Leslie L Barton, MD Professor Emerita of Pediatrics, University of Arizona College of Medicine

Leslie L Barton, MD is a member of the following medical societies: American Academy of Pediatrics, Association of Pediatric Program Directors, Infectious Diseases Society of America, and Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

References
  1. Rubella and congenital rubella syndrome control and elimination - global progress, 2000-2012. MMWR Morb Mortal Wkly Rep. 2013 Dec 6. 62(48):983-6. [Medline].

  2. Henderson D. Ramped-Up Campaign Lowers Global Rubella Cases by 86%. Medscape Medical News. Available at http://www.medscape.com/viewarticle/817409. Accessed: December 18, 2014.

  3. Pandolfi E, Chiaradia G, Moncada M, Rava L, Tozzi AE. Prevention of congenital rubella and congenital varicella in Europe. Euro Surveill. 2009 Mar 5. 14(9):16-20. [Medline].

  4. CDC. Summary of notifiable diseases, United States, 1996. MMWR Morb Mortal Wkly Rep. 1997 Oct 31. 45(53):1-87. [Medline].

  5. CDC. Reported Cases of Notifiable Diseases-United States, 1972-2003. MMWR. Apr 2005. 52(54):73-78.

  6. CDC. Provisional cases of infrequently reported notifiable diseases. MMWR. January 9, 2009. 57(53):1420-1431.

  7. CDC. Provisional Cases of Infrequently Reported Notifiable Diseases-United States. MMWR. Jan 2009. 55(19):538.

  8. Rafiei Tabatabaei S, Esteghamati AR, Shiva F, Fallah F, Radmanesh R, Abdinia B, et al. Detection of serum antibodies against measles, mumps and rubella after primary measles, mumps and rubella (MMR) vaccination in children. Arch Iran Med. 2013 Jan. 16(1):38-41. [Medline].

  9. Institute for Clinical Systems Improvement. Immunizations. Bloomington, MN: ICSI; 2008.

  10. Klein NP, Fireman B, Yih WK, Lewis E, Kulldorff M, Ray P, et al. Measles-mumps-rubella-varicella combination vaccine and the risk of febrile seizures. Pediatrics. 2010 Jul. 126(1):e1-8. [Medline].

  11. Hviid A. Measles-mumps-rubella-varicella combination vaccine increases risk of febrile seizure. J Pediatr. 2011 Jan. 158(1):170. [Medline]. [Full Text].

  12. [Guideline] Marin M, Broder KR, Temte JL, Snider DE, Seward JF. Use of combination measles, mumps, rubella, and varicella vaccine: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2010 May 7. 59:1-12. [Medline]. [Full Text].

  13. Huang LM, Lee BW, Chan PC, Povey M, Henry O. Immunogenicity and safety of combined measles-mumps-rubella-varicella vaccine using new measles and rubella working seeds in healthy children in Taiwan and Singapore: A phase II, randomized, double-blind trial. Hum Vaccin Immunother. 2013 Feb 20. 9(6):[Medline].

  14. O'Leary ST, Suh CA, Marin M. Febrile seizures and measles-mumps-rubella-varicella (MMRV) vaccine: what do primary care physicians think?. Vaccine. 2012 Nov 6. 30(48):6731-3. [Medline].

  15. American Academy of Pediatrics; Committee on Infectious Diseases. Policy Statement--Prevention of Varicella: Update of Recommendations for Use of Quadrivalent and Monovalent Varicella Vaccines in Children. Pediatrics. 2011 Aug 28. [Medline].

  16. Dontigny L, Arsenault MY, Martel MJ, et al. Rubella in pregnancy. J Obstet Gynaecol Can. 2008 Feb. 30(2):152-68. [Medline].

  17. American Academy of Pediatrics. 2003 Red Book: Report of the Committee on Infectious Diseases. 26th ed. American Academy of Pediatrics; 2003.

  18. Bale JF Jr, Murph JR. Congenital infections and the nervous system. Pediatr Clin North Am. 1992 Aug. 39(4):669-90. [Medline].

  19. Bialecki C, Feder HM Jr, Grant-Kels JM. The six classic childhood exanthems: a review and update. J Am Acad Dermatol. 1989 Nov. 21(5 Pt 1):891-903. [Medline].

  20. Bullens D, Smets K, Vanhaesebrouck P. Congenital rubella syndrome after maternal reinfection. Clin Pediatr (Phila). 2000 Feb. 39(2):113-6. [Medline].

  21. CDC. Elimination of rubella and congenital rubella syndrome--United States, 1969-2004. MMWR Morb Mortal Wkly Rep. 2005 Mar 25. 54(11):279-82. [Medline].

  22. CDC. Progress toward elimination of measles and prevention of congenital rubella infection--European region, 1990-2004. MMWR Morb Mortal Wkly Rep. 2005 Feb 25. 54(7):175-8. [Medline].

  23. CDC. Quarterly immunization table. MMWR. July 1997.

  24. CDC. Reportable diseases (1998 provisional data). MMWR. 2000. 48:1183-89.

  25. CDC. Rubella among Hispanic adults--Kansas, 1998, and Nebraska, 1999. MMWR Morb Mortal Wkly Rep. 2000 Mar 24. 49(11):225-8. [Medline].

  26. CDC. Rubella outbreak--Westchester County, New York, 1997-1998. MMWR Morb Mortal Wkly Rep. 1999 Jul 9. 48(26):560-3. [Medline].

  27. Cherry JD. Contemporary infectious exanthems. Clin Infect Dis. February 1993. 16(2):199-205. [Medline].

  28. Cherry JD. Rubella virus. Feigin RD, Cherry JD, eds. Textbook of Pediatric Infectious Diseases. 4th ed. WB Saunders Co; 1998. Vol 2: 1922-49.

  29. Cherry JD. Viral exanthems. Curr Probl Pediatr. 1983 Apr. 13(6):1-44. [Medline].

  30. Editorial. TORCH syndrome and TORCH screening. Lancet. 1990 Jun 30. 335(8705):1559-61. [Medline].

  31. Englund J, Glezen WP, Piedra PA. Maternal immunization against viral disease. Vaccine. August-September 1998. 16(14-15):1456-1463. [Medline].

  32. Freij BJ, South MA, Sever JL. Maternal rubella and the congenital rubella syndrome. Clin Perinatol. 1988 Jun. 15(2):247-57. [Medline].

  33. Giles CL. Uveitis in childhood - Part III Posterior. Ann Ophthalmol. January 1989. 21(1):23-28. [Medline].

  34. Gold E. Almost extinct diseases: measles, mumps, rubella, and pertussis. Pediatr Rev. 1996 Apr. 17(4):120-7. [Medline].

  35. Horstmann DM. Rubella. Evans AS, ed. Viral Infections of Humans, Epidemiology and Control. 3rd ed. Premium Medical Book Co; 1991. 617-30.

  36. Kimberlin DW. Rubella immunization. Pediatr Ann. 1997 Jun. 26(6):366-70. [Medline].

  37. Lindegren ML, Fehrs LJ, Hadler SC, Hinman AR. Update: rubella and congenital rubella syndrome, 1980-1990. Epidemiol Rev. 1991. 13:341-8. [Medline].

  38. Lutwick LI. Postexposure prophylaxis. Infect Dis Clin North Am. 1996 Dec. 10(4):899-915. [Medline].

  39. Maldonado YA. Rubella virus. Long SS, Pickering LK, Prober CG, eds. Principles and Practice of Pediatric Infectious Diseases. Churchill Livingstone; 1997. 1228-37.

  40. Miller E. Rubella reinfection. Arch Dis Child. 1990 Aug. 65(8):820-1. [Medline].

  41. Morgan-Capner P. Diagnosing rubella. BMJ. 1989 Aug 5. 299(6695):338-9. [Medline].

  42. Munoz FM, Englund JA. A step ahead. Infant protection through maternal immunization. Pediatr Clin North Am. 2000 Apr. 47(2):449-63. [Medline].

  43. Parkman PD. Making vaccination policy: the experience with rubella. Clin Infect Dis. 1999 Jun. 28 Suppl 2:S140-6. [Medline].

  44. Powell S, Schochet SS Jr. Selected pediatric viral infections. Semin Pediatr Neurol. 1995 Sep. 2(3):211-9. [Medline].

  45. Reef S, Zimmerman-Swain L, Coronado V. Rubella. VPD Surveillance Manual. 1999. 11.

  46. Robinson J, Lemay M, Vaudry WL. Congenital rubella after anticipated maternal immunity: two cases and a review of the literature. Pediatr Infect Dis J. 1994 Sep. 13(9):812-5. [Medline].

  47. Rosa C. Rubella and rubeola. Semin Perinatol. 1998 Aug. 22(4):318-22. [Medline].

  48. Watson JC, Hadler SC, Dykewicz CA, et al. Measles, mumps, and rubella--vaccine use and strategies for elimination of measles, rubella, and congenital rubella syndrome and control of mumps: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 1998 May 22. 47(RR-8):1-57. [Medline].

  49. Webster WS. Teratogen update: congenital rubella. Teratology. 1998 Jul. 58(1):13-23. [Medline].

  50. Weiter JJ, Roh S. Viral infections of the choroid and retina. Infect Dis Clin North Am. 1992 Dec. 6(4):875-91. [Medline].

  51. Wharton M, Cochi SL, Williams WW. Measles, mumps, and rubella vaccines. Infect Dis Clin North Am. 1990 Mar. 4(1):47-73. [Medline].

 
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Number of rubella cases per year.
Number of congenital rubella syndrome cases per year.
Deaths from rubella per year.
Image in a 4-year-old girl with a 4-day history of low-grade fever, symptoms of an upper respiratory tract infection, and rash. Courtesy of Pamela L. Dyne, MD.
Table 1. Reported Cases of Rubella, Deaths From Rubella, and Number of Cases of Congenital Rubella Syndrome in the United States From 1969-2007 [4, 5, 6, 7]
Year Number of Cases Number of Deaths Cases of Congenital Rubella Syndrome
1969 57,686 29 31
1970 56,552 31 77
1971 45,086 20 68
1972 25,507 14 42
1973 27,804 16 35
1974 11,917 15 45
1975 16,652 21 30
1976 12,491 12 30
1977 20,395 17 23
1978 18,269 10 30
1979 11,795 1 62
1980 3,904 1 50
1981 2,077 5 19
1982 2,325 4 7
1983 970 3 22
1984 752 1 5
1985 630 1 0
1986 551 1 5
1987 306 0 5
1988 225 1 6
1989 396 4 3
1990 1,125 8 11
1991 1,401 1 47
1992 160 1 11
1993 192 0 5
1994 227 0 7
1995 128 1 6
1996 238 0 4
1997 181 0 5
1998 364 0 7
1999 267 0 9
2000 176 0 9
2001 23 2 3
2002 18 N/A 1
2003 7 N/A 1
2004 10 N/A 0
2005 11 N/A 1
2006 11 N/A 1
2007 12 N/A 0
Table 2. Clinicopathologic Abnormalities in Congenital Rubella
Abnormality Common/Uncommon Early/Delayed Comment
General
Intrauterine growth retardation Common Early ...
Prematurity Uncommon Early ...
Stillbirth Uncommon Early ...
Abortion Uncommon Early ...
Cardiovascular system
Patent ductus arteriosus Common Early May occur with pulmonary artery stenosis
Pulmonary artery stenosis Common Early Caused by intimal proliferation
Coarctation of the aorta Uncommon Early ...
Myocarditis Uncommon Early ...
Ventricular septal defect Uncommon Early ...
Atrial septal defect Uncommon Early ...
Eye
Cataract Common Early Unilateral or bilateral
Retinopathy Common Early Salt-and-pepper appearance; visual acuity unaffected; frequently unilateral
Cloudy cornea Uncommon Early Spontaneous resolution
Glaucoma Uncommon Early/Delayed May be bilateral
Microphthalmia Common Early Common in patients with unilateral cataract
Subretinal neovascularization Uncommon Delayed Retinopathy with macular scarring and loss of vision
Ear
Hearing loss Common Early/Delayed Usually bilateral; mostly sensorineural; may be central in origin; rare when maternal rubella occurs >4 months' gestation; sometimes progressive
CNS
Meningoencephalitis Uncommon Early Transient
Microcephaly Uncommon Early May be associated with normal intelligence
Intracranial calcifications Uncommon Early ...
Encephalographic abnormalities Common Early Usually disappear by age 1 y
Mental retardation Common Delayed ...
Behavioral disorders Common Delayed Frequently related to deafness
Autism Uncommon Delayed ...
Chronic progressive panencephalitis Uncommon Delayed Manifest in second decade of life
Hypotonia Uncommon Early Transitory defect
Speech defects Common Delayed Uncommon in absence of hearing loss
Skin
Blueberry muffin spots Uncommon Early Represents dermal erythropoiesis
Chronic rubelliform rash Uncommon Early Usually generalized; lasts several weeks
Dermatoglyphic abnormalities Common Early ...
Lungs
Interstitial pneumonia Uncommon Delayed Generalized; probably immunologically mediated
Liver
Hepatosplenomegaly Common Early Transient
Jaundice Uncommon Early Usually appears in the first day of life
Hepatitis Uncommon Early May not be associated with jaundice
Blood
Thrombocytopenia Common Early Transient; no response to steroid therapy
Anemia Uncommon Early Transient
Hemolytic anemia Uncommon Early Transient
Altered blood group expression Uncommon Early ...
Immune system
Hypogammaglobulinemia Uncommon Delayed Transient
Lymphadenopathy Uncommon Early Transient
Thymic hypoplasia Uncommon Early Fatal
Bone
Radiographic lucencies Common Early Transient; most common in distal femur and proximal tibia
Large anterior fontanel Uncommon Early ...
Micrognathia Uncommon Early ...
Endocrine glands
Diabetes mellitus Common Delayed Usually becomes apparent in second or third decade of life
Thyroid disease Uncommon Delayed Hypothyroidism, hyperthyroidism, and thyroiditis
Growth hormone deficiency Uncommon Delayed ...
Genitourinary system
Cryptorchidism Uncommon Early ...
Polycystic kidney Uncommon Early ...
Table 3. Age-Specific CD4 + T-lymphocyte Count and Percentage of Total Lymphocytes as a Criteria for Severe Immunosuppression in Persons with HIV
  Age Range
< 12 mo 1-5 y 6-12 y ≥13 y
Total CD4+ T-lymphocytes < 750/mcl < 500/mcl < 200/mcl < 200/mcl
CD4+ T-lymphocytes (as % of total lymphocytes) < 15% < 15% < 15% < 14%
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