Child Development

Cranston, Maurice. The Noble Savage: Jean-Jacques Rousseau, 1754–

1762. Chicago: University of Chicago Press, 1991.
      Cranston, Maurice. The Solitary Self: Jean-Jacques Rousseau in Exile
      and Adversity. Chicago: University of Chicago Press, 1997.
      Dent, N. J. H. Rousseau: An Introduction to his Psychological, Social,
      and Political Theory. New York: Basil Blackwell, 1989.
      Wokler, Robert. Rousseau. Oxford, Eng.: Oxford University Press,


1763. 
      

Publications by Rousseau
Rousseau, Jean-Jacques. Émile, or On Education, translated by Allan
Bloom. New York: Basic, 1979.
Jim Hillesheim

RUBELLA

Rubella is the clinical manifestation of infection
caused by the rubella virus, which was first isolated in

1962. The timing of infection before or after birth de-
      termines the two principal clinical syndromes. Infec-
      tion in the postnatal period produces a relatively mild
      disease that is primarily notable for an erythematous
      rash (a rash caused by capillary congestion) and
      swollen lymph nodes. Infection during pregnancy can
      result in specific fetal anomalies defining the congen-
      ital rubella syndrome.

In postnatal infection (also known as German
measles), the rash of rubella first appears on the face
and spreads to the rest of the body. The rash consists
of combined flat and raised (maculopapular) erythe-
matous lesions that typically resolve after several days.
A low-grade fever may be present. Swollen lymph
nodes, particularly of the head and neck, have been
commonly reported. Cough, sore throat, and head-
ache may precede or accompany the appearance of
rash. Complications of rubella infection in the post-
natal period include joint complaints (arthritis and
arthralgia), central nervous system infection (enceph-
alitis), and a decrease in platelet number (thrombo-
cytopenia). Joint complaints are more common in
females than males and more frequent in older age
groups (i.e., adolescents and adults).

Congenital rubella syndrome refers to specific
birth defects caused by infection of the fetus with the
rubella virus. Since the 1940s, it has been known that
rubella infection in a pregnant woman could have ad-
verse effects on the fetus. The risk to the fetus of de-
veloping congenital rubella syndrome is greatest
when infection occurs early in the pregnancy. In con-
genital rubella syndrome, defects typically affect the
eyes, ears, brain, and heart.

Between 1962 and 1965, an epidemic of rubella
occurred in the United States. In 1964 alone, an esti-
mated twenty to thirty thousand cases of congenital
rubella syndrome occurred. A vaccine against rubella

was licensed in the United States in 1969. Universal

immunization against rubella has resulted in dramat-

ic declines in both postnatal rubella and congenital

rubella syndrome of over 97 percent. Between 1997

and 1999, only 792 cases of laboratory-confirmed ru-

bella and 24 cases of congenital rubella syndrome

were reported in the United States. The National No-

tifiable Diseases Surveillance System along with the

National Congenital Rubella Syndrome Registry

monitor the number of cases of congenital rubella

syndrome.

At the start of the twenty-first century, cases of

postnatal rubella and the congenital rubella syn-

drome occurred primarily because of lapses in vacci-

nation. Prevention of congenital rubella syndrome

requires that immunization rates remain high in

order to prevent the spread of rubella in the commu-

nity. Vaccination is aimed at children and at women

of reproductive age who were not vaccinated as chil-

dren. Children receive a first dose of rubella-

containing vaccine (combined with mumps and mea-

sles vaccines as the MMR) at one year of age and a

second dose between four and six years of age. In the

United States, infants with congenital rubella syn-

drome are often born to mothers who emigrated from

countries that do not routinely immunize against ru-

bella. Because of this, women of reproductive age

should be screened for immunity against the rubella

virus (i.e., tested for the presence of antibodies

against rubella, which indicates protection) during

premarital and prenatal health-care visits.

See also: BIRTH DEFECTS; IMMUNIZATION;

PRENATAL DEVELOPMENT

Bibliography

Centers for Disease Control and Prevention. ‘‘Measles, Rubella,

and Congenital Rubella Syndrome—United States and Mexi-

co, 1997–1999.’’ Morbidity and Mortality Weekly Report 49

(2000):1048–1050, 1059.

Cherry, James D. ‘‘Rubella Virus.’’ In Ralph D. Feigin and James

D. Cherry eds., Textbook of Pediatric Infectious Diseases. Philadel-

phia: Saunders, 1998.

Parkman, P. D. ‘‘Making Vaccination Policy: The Experience

with Rubella.’’ Clinical Infectious Diseases, supplement 2

(1999):140–146.

Alan Uba

RURAL CHILDREN

The delivery of rural mental health services focuses

on understanding and responding to emotional and

behavioral needs of children in the 2,303 ‘‘rural’’

communities that, according to the United States

Census Bureau, have fewer than 2,500 residents. The

proportion of the rural population involved with

350 RUBELLA