Differential Diagnoses

Herpesvirus 6 Infection
Measles
Parvovirus B19 Infection
Pediatric Contact Dermatitis
Pediatric Cytomegalovirus Infection
Pediatric Enteroviral Infections
Pediatric Mononucleosis and Epstein-Barr Virus Infection
Pediatric Mycoplasma Infections
Pediatric Syphilis
Toxoplasmosis

Workup

McLean HQ, Fiebelkorn AP, Temte JL, Wallace GS, Centers for Disease Control and Prevention. Prevention of measles, rubella, congenital rubella syndrome, and mumps, 2013: summary recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2013 Jun 14. 62 (RR-04):1-34. [QxMD MEDLINE Link].
Rubella and congenital rubella syndrome control and elimination - global progress, 2000-2012. MMWR Morb Mortal Wkly Rep. 2013 Dec 6. 62(48):983-6. [QxMD MEDLINE Link].
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.
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. [QxMD MEDLINE Link].
Winter AK, Moss WJ. Rubella. Lancet. 2022 Apr 2. 399 (10332):1336-46. [QxMD MEDLINE Link].
Plotkin SA. Rubella eradication: not yet accomplished, but entirely feasible. J Infect Dis. 2021 Sep 30. 224 (12 Suppl 2):S360-6. [QxMD MEDLINE Link]. [Full Text].
CDC. Summary of notifiable diseases, United States, 1996. MMWR Morb Mortal Wkly Rep. 1997 Oct 31. 45(53):1-87. [QxMD MEDLINE Link].
CDC. Reported Cases of Notifiable Diseases-United States, 1972-2003. MMWR. Apr 2005. 52(54):73-78.
CDC. Provisional cases of infrequently reported notifiable diseases. MMWR. January 9, 2009. 57(53):1420-1431.
CDC. Provisional Cases of Infrequently Reported Notifiable Diseases-United States. MMWR. Jan 2009. 55(19):538.
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. [QxMD MEDLINE Link].
Institute for Clinical Systems Improvement. Immunizations. Bloomington, MN: ICSI; 2008.
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. [QxMD MEDLINE Link].
Hviid A. Measles-mumps-rubella-varicella combination vaccine increases risk of febrile seizure. J Pediatr. 2011 Jan. 158(1):170. [QxMD MEDLINE Link]. [Full Text].
[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. [QxMD MEDLINE Link]. [Full Text].
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):[QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
Siberry GK, Patel K, Bellini WJ, Karalius B, Purswani MU, Burchett SK, et al. Immunity to Measles, Mumps, and Rubella in US Children With Perinatal HIV Infection or Perinatal HIV Exposure Without Infection. Clin Infect Dis. 2015 Sep 15. 61 (6):988-95. [QxMD MEDLINE Link].
Skwarecki B. HIV-Positive Youth May Lack Immunity to MMR Diseases. Medscape Medical News. Available at http://www.medscape.com/viewarticle/849635. August 18, 2015; Accessed: February 9, 2017.
Dontigny L, Arsenault MY, Martel MJ, et al. Rubella in pregnancy. J Obstet Gynaecol Can. 2008 Feb. 30(2):152-68. [QxMD MEDLINE Link].
Atkinson WL, Pickering LK, Schwartz B, Weniger BG, Iskander JK, Watson JC, et al. General recommendations on immunization. Recommendations of the Advisory Committee on Immunization Practices (ACIP) and the American Academy of Family Physicians (AAFP). MMWR Recomm Rep. 2002 Feb 8. 51 (RR-2):1-35. [QxMD MEDLINE Link].

Media Gallery

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.
Number of rubella and congenital rubella syndrome (CRS) cases — United States, 1966–2011. Courtesy of Centers for Disease Control (CDC).

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Table 1. Reported Cases of Rubella, Deaths From Rubella, and Number of Cases of Congenital Rubella Syndrome in the United States From 1969-2007 ^{[7, 8, 9, 10]}

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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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, FPIDS Clinical Professor of Pediatrics, Wayne State University School of Medicine; Professor of Pediatrics, Central Michigan University College of Medicine; Consulting Staff, Division of Infectious Diseases, Children's Hospital of Michigan

Jocelyn Y Ang, MD, FAAP, FIDSA, FPIDS 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.