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Rubella in Universities -- Washington, California.

Seattle, Washington: Between April 4 and May 3, 1981, 12 cases of rubella were reported among students at the University of Washington in Seattle. Eight cases were serologically confirmed as rubella by a four-fold or greater rise in hemagglutination-inhibition (HI) antibody titer. The students' ages ranged from 21 to 30 years with a mean of 23 years, and six students attended the same drama class. Nine of the 12 students were female; one, who contracted rubella in her first trimester of pregnancy, chose to have an abortion. No specific control measures were instituted in this outbreak, nor was the index case ever identified. The University of Washington does not require students to prove immunity to rubella before enrollment.

Los Angeles, California: In late November 1981, 10 cases of rubella-like illness were reported among students seen at the University of Southern California student health center. The illnesses were characterized by maculopapular rashes lasting 3-5 days, low grade fever, malaise, arthralgia, and conjunctivitis. Between November 1981 and January 20, 1982, 49 students developed a similar illness, with the peak occurring between November 15 and December 15; two cases were serologically confirmed as rubella. The students' ages ranged from 18 to 34 years with a mean of 21.5 years. Sixty-seven percent of affected students were male; 30% lived in university dormitories or apartments; and 38% were enrolled as business majors. The University of Southern California, which does not require proof of immunity to rubella, did not implement a control program.

Berkeley, California: Between December 21, 1981, and March 23, 1982, 17 cases of rash illness were reported among students at the University of California-Berkeley. Eleven of the cases were serologically confirmed as rubella. The students, who ranged in age from 20 to 34 years, had a mean age of 28.7 years. Twelve of the affected students were male. Although one student was initially hospitalized for diagnostic purposes, no nosocomial spread of rubella occurred. No pregnant students or contacts were identified. The majority of ill students resided in a cooperative residential hall (190 residents). Although rubella cases are reported routinely among students at the University of California-Berkeley, no proof of rubella immunity is required for admission. Reported by J Altman, MD, Student Health Svc, University of Washington, D Hoyt, A Cronin, J Frederickson, C Nolan, Seattle-King County Health Dept, J Allard, PhD, State Epidemiologist, Washington State Dept of Social & Health Svcs; J Chapman, MD, Student Health Svc, University of California-Berkeley, L Dales MD, AJ Ebbin, MD, Student Health Svc, University of Southern California, L Habel MPH, B Weiss, MPH, M Strassburg MD, S Fannin, MD, Los Angeles Dept of Health Svcs, J Chin MD, State Epidemiologist, California State Dept of Health; Immunization Div, Center for Prevention Svcs, CDC.

Editorial Note

Editorial Note: These reports demonstrate the potential for rubella outbreaks among university students. An estimated 10%-20% of persons greater than or equal to 18 years of age remain susceptible (1). Since many students and university personnel are of child-bearing age and some may be pregnant at the time of an outbreak, rubella can pose a serious public health problem.

Although rubella immunization is required for school entrance or attendance in all states, female students greater than or equal to 12 years old are exempted in many states because of the theoretical risk to a fetus associated with vaccinating pregnant women. Existing data, however, show this potential risk, to be minimal (2). Because of continued rubella outbreaks on campuses and exposure of pregnant students, university employees, and contacts, universities should address the issue of rubella immunity among students and staff (3-6). The Immunization Practices Advisory Committee (ACIP) strongly urges educational institutions to consider requiring proof of immunity (documented history of rubella vaccination on or after the first birthday or presence of antibody to rubella) for admission or employment (2). Both male and female students should be included in any such requirement.

References

  1. Dales LG, Chin J. Public health implications of rubella antibody levels in California. Am J Public Health 1982;72:167-72.

  2. ACIP. Rubella prevention. MMWR 1981;30:37-42,47.

  3. CDC. Rubella in Wisconsin--an outbreak on a college campus. In: Rubella surveillance report, January 1976-December 1978. Atlanta: CDC 1980:20-2.

  4. Guyer B, Giandelia JW, Bisno AL, et al. The Memphis State University rubella outbreak. An example of changing rubella epidemiology. JAMA 1974;227:1298-300

  5. Strassburg MA, Marquard JL, Fannin SL, Greenland S. Rubella on a university campus: an evaluation of case immunity histories. Nurs Res 1980;29:390-1.

  6. Chretien JH, Esswein JG, McGarvey MA, deStwolinski A. Rubella: pattern of outbreak in a university. South Med J 1976;69:1042-4



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