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Find out more about Email Marketing Software
What is Email Marketing Software?
Email marketing software is used by businesses to send out promotional emails to their customers. At the same time, email marketing is an effective method that boost brand awareness with a technique that has the capacity to scale across diverse audiences. This type of marketing includes transaction emails such as approvals and alerts, and promotional emails such as events, newsletters, and ads. Email marketing systems can help a company to target its prospects better, distribute content, and reduce marketing costs. Key features of this software include automation of email tracking and newsletter delivery, designing and sharing of newsletters, creation of permission-based mailing lists, and inbound lead generation. The best way to select the right email marketing app for your needs is to browse our list of top platforms, especially the current category leader HubSpot Marketing.
Top 12 Most Popular Email Marketing Software
Our Score 9.5
User Satisfaction 99%
HubSpot Marketing is an advanced system that brings all of your marketing efforts together, and helps your team grow traffic and increase conversions. Read Reviews
Our Score 9.1
User Satisfaction 91%
Wix ShoutOut is an intuitive marketing email and newsletter builder and editor. Read Reviews
Our Score 8.9
User Satisfaction 100%
Exponea is a marketing software that blends analytics and engagement automation for faster results. Read Reviews
Our Score 8.8
User Satisfaction 100%
Cloud-hosted software with various business management apps for customer service. Read Reviews
Our Score 8.8
User Satisfaction 97%
Dotmailer is a simple email marketing automation platform designed to meet the needs and requirements of top email marketing professionals. Read Reviews
Our Score 9.4
User Satisfaction 96%
Marketo is a software tool that helps marketers master the art and science of digital marketing. Read Reviews
Our Score 9.2
User Satisfaction 100%
ActiveCampaign is a software tool that combines all aspects of small business marketing in a single and easy-to-use platform. Read Reviews
Our Score 9.1
User Satisfaction 100%
iContact Pro is a software solution that makes marketing automation simpler and cost-effective. Read Reviews
Our Score 9.0
User Satisfaction 99%
With this platform, businesses can easily create and maintain a very strong presence in the social media. Read Reviews
Our Score 9.0
User Satisfaction 98%
MailChimp is an email marketing service for small and developing enterprises that can also handle large volumes of emails for big businesses and organizations. Read Reviews
Our Score 9.0
User Satisfaction 100%
Opt-in email marketing service used by over 120,000+ small businesses, bloggers and entrepreneurs around the globe. Read Reviews
Our Score 9.0
User Satisfaction 93%
Constant Contact is a big name in the email marketing business because it is intuitive even for email marketing novices. Read Reviews
Best Email Marketing Software
Email marketing & sales automation
Our Score
User Satisfaction
ActiveCampaign is a software tool that combines all aspects of small business marketing in a single and easy-to-use platform. Read Review
Zoho Campaigns
Winner of our Customer's Choice Award
Our Score
User Satisfaction
Zoho Campaigns is the winner of our Great Customer Support Award. It lets you create, send, and track effective email campaigns and helps you build relationships. Read Review
Campaign Monitor
Elegantly simple email marketing
Our Score
User Satisfaction
A powerful email marketing solution that helps companies perform email marketing functions, achieve business goals, and be on top of their game. Read Review
HubSpot Marketing
All-in-one inbound marketing software
Our Score
User Satisfaction
HubSpot Marketing is an advanced system that brings all of your marketing efforts together, and helps your team grow traffic and increase conversions. Read Review
Great Marketing Automation Platform
Our Score
User Satisfaction
Marketo is a software tool that helps marketers master the art and science of digital marketing. Read Review
iContact Pro
Powerful campaign management
Our Score
User Satisfaction
iContact Pro is a software solution that makes marketing automation simpler and cost-effective. Read Review
How To Choose The Best Email Marketing Software
Most business owners are now becoming increasingly aware of the benefits of email marketing software tools realizing that such solutions will allow them to improve their business communication efforts. For many though, it is still difficult to define a clear list of advantages and profits that would merit adopting such programs in their company. To prove that there is indeed much to gain from professional email marketing platforms we've prepared this guide for you to give you a detailed look at what this type of software has to offer.
Get to know each product with free trial
A good course of action when looking for the best Email Marketing Software for enterprises or smaller businesses is to sign up for at least a few free trials or demo and starter unpaid plans from leading email marketing software providers. With that method you will have the opportunity to test the important elements and you will get a good comparison of the capabilities of the selected apps. You will also be able to understand what is email marketing software better. The best thing to do is to try services that currently have the highest SmartScore rankings and Customer Satisfaction Rating in our email marketing software reviews: RedCappi reviews, Campaign Monitor, ActiveCampaign, AWeber, Constant Contact, HubSpot, and MailChimp.
It may also be a good idea to examine some of the most popular alternatives available on the market. See our Top 10 Alternatives to ActiveCampaign guide for a reliable list of solutions worth trying out.
Targeted Businesses
Email marketing software is welcome in every company handling a large customer database, and looking to summarize contacts under one roof and deliver information in a synchronized manner. The scale and niche of the business are most of the time irrelevant, but there are few specific scenarios where demand generation software is most needed:
- Businesses looking to provide valuable information via email newsletters. It is quite often in every business that customers need a bit of on-boarding in order to make a purchase, which is exactly why email marketing systems exist. Companies use them to provide relevant information to their customer lists via email newsletters, and to allow them to sign up on their platform in order to gather information.
- Businesses looking to provide leads with 'irresistible' and 'one-time' promotional offers. Just as in the case of extended product information, companies can use email marketing systems to provide irresistible offers which can engage leads and convert them into customers.
- Businesses looking to personalize their emails. The biggest advantage of email marketing systems is that they allow companies to personalize the email templates they're using, ideally by including logos, slogans, and relevant information, or by generalizing the content to save time. This helps building a stable and individual relationship with each customer, and make them feel as if they were your most important contacts.
What are Examples of Email Marketing Software?
- AWeber: An outstanding email marketing platform with superior autoresponders and robust feature suite, designed to meet the needs of businesses from all scales and niches.
- Constant Contact: As the name indicates, this effective platform allows companies to improve customer relationships, and it is loaded with templates and learning materials.
- HubSpot: A popular marketing tool packed with all functionalities necessary to create compelling content, and to deliver it in a fast and engaging manner.
- Salesforce Marketing Cloud: Another powerful Salesforce.com member in charge of providing effective marketing solutions, as well as guaranteeing strong marketing presence on social media.
- MailChimp: A well-known email marketing service for small business and mid-sized companies that offers business-enhancing marketing plans and analytics.
For a more detailed list of products you may want to check out our Top 20 Email Marketing Software ranking. You'll find a much wider selection of products for comparisons there.
Types of Email Marketing Software
There are many different types of email marketing software, varying from free and basic tool suites to ultra costly and accurate programs. Features can also be categorization criteria, as certain programs do nothing but summarize contact lists, while others are more robust and they allow marketers to personalize their email newsfeeds, track and compare customer behavior and conversion rates, and even do some custom branding. Deployment is also an important factor based on which there are:
- On-premise email marketing systems. These are covered with a single license, and are hosted on the client's local server. They qualify as the most expensive ones, due the fact that they require complex setup and occasionally some hardware installation.
- Software-as-a-service (SaaS) email marketing systems. These are usually paid per month, and are hosted on the vendor's server. The business owner is not responsible for installation, updating, and maintenance.
- Cloud-hosted email marketing systems. Most of these offer free basic plans, and qualify as the most affordable ones due to their universal access and the fact that the client doesn't need to update them or to pay for maintenance.
Key Features of Email Marketing Software
There are few essential features the best Email Marketing software should have in order to help you generate successful campaigns, namely those which can reach even ambitious prospects that can be measured in future:
- Segregated Email Lists. The email list is the basis of every direct marketing campaign, where the team gathers contacts from different sources. An email marketing tool is supposed to summarize contacts from all possible lists (online databases, association lists, list brokers, trade shows, LinkedIn connections, etc.), and to keep the new one updated with minimal manual effort. At the same time, you should be able to segregate and categorize contacts depending on their location, consumer behavior, age, preferences, or whatever category that may be relevant for you.
- Customizable Design. A big part of any email marketing campaign's success can be prescribed to email design, namely the looks of your layouts, subject lines, and call-to-actions. The ideal email marketing tool should be empowered with large customization capacity that allows you to change these elements in order to eliminate any possibility that your email will be tagged as spam.
- Tracking and Reporting. Most email marketing systems have robust measurement dashboards which allow you to measure your marketing results and to divide budget accordingly. The data can later on be used for generating reports, as for instance sent/unsent emails, open rates, hard/soft bounces, and many others.
- Testing. Using email marketing software, you should be able to test and optimize your campaigns before sending them out to your complete email list. By testing, we refer to standardized A/B standards, which make it possible to examine separate variables rather than the entire content. Both positive and negative click-through rates and spam compliance evaluators serve to indicate whether you should push the campaign through, or to drop it instead.
- AutoResponders. This is one of the most important features every email marketing system should have. It is because auto-responders automate a large portion of your marketing work and increase conversions by simply informing senders that their email has been received. At the same time, auto-responders can be used to notify regular clients on promotions and discounts, and to confirm their subscriptions on your website. Likewise, you can use follow ups to offer free trials or information sheets to unfamiliar audiences.
- CRM Integration. It is absolutely normal for a business to expect the world from its email marketing software – the truth is that the good ones among them are not even close to being cheap, which makes us understand by default that they're going to fit within our software infrastructure. Technically, we should be able to integrate them with any program, but what matters the most is how they'll synchronize with our CRM system. The CRM integration streamlines the relationship between sales and marketing, and increases both ROI and overall positive effects of your campaigns. In the meanwhile, your CRM will be a critical source of customer data and relevant competitive information, which is more than enough to transform your relationship with customers into a productive and entertaining experience.
Check out our What Is Email Marketing Software guide for a more comprehensible list of typical features and modules available in most solutions.
Benefits of Email Marketing Software
Email marketing software is used for commercial communication with individuals/groups, most often in the form of sales, business requests, promotions, advertisement, or any similar activity aimed to improve customer loyalty and overall brand recognition. This being said, email marketing keeps a business connected with its customers even after sales have been completed.
Digital communication on its behalf, allows the business to target literally every audience on low research and production costs, and get to know all of their interests, shopping habits, likes and dislikes by simply holding a list of valuable contacts and maintaining its accuracy. At the same time, customers benefit from a more personalized relationship, and individual treatment for support and important information. Let's see how that works:
- Targeted Marketing. Let's be honest to ourselves: traditional marketing is not targeted marketing. The time of promoting products on popular TV shows is far behind us, because people have changed, the same as their habits. Email marketing allows you to target a specific group of contacts you've chosen on the basis of carefully planned criteria, and to customize the message in accordance with what they'd expect to see. That's how the magic of higher conversions actually happens.
- Measured Effects. You've advertised a service in the local newspaper, and that's great because you know that many people read it. Still, how could you know the exact number of reader that paid attention to it, or at least of those who came and purchased your service based on what they read? That's the miraculous power of email marketing: it helps you forecast results, and measure effects based on them. With an effective EM tool you'll never risk being ambiguous and immodest and you will draw achievable and realistic metrics concerning your open rates, delivery accomplishment, subscriber retention or click-to-deliver rates. Consequently, you will estimate which recipients are most responsive, and you will orientate your next campaign towards that specific group.
- Cost-Effectiveness. ROI may as well be the most appealing and meaningful advantage of email marketing systems, since you're not supposed neither to print anything nor to pay whatever external party to advertise your work. As the Direct Marketing Association claims, email marketing converts $1 of investment into $40 of revenue, so there is no reason not to consider it for your business too.
- Easier Sharing. There is no easier way to share marketing forms than the email one, because it takes few seconds, and a couple of clicks. The purpose is to inspire subscribers to share your content with other users who're not on your contact list, acting as your so-called brand advocates. Of course, you're the ultimate beneficiary in the case, because you become more exposed and gain credibility based on it.
- Brand Awareness. There is nothing bad in reminding customers about your existence, so that they would have you into consideration for future purchases. Each additional email adds value to your marketing strategy, assuming it has been strategically planned and designed to attract enough attention. It is your way of 'staying there' even with no deals on the horizon, and to be in a much more likely position to be chosen than competitors who market the traditional way.
List of Email Marketing Software Companies
Originally published on June 20, 2015, updated
Selected products (0)
Our Score Read More
Our site makes use of our special SmartScore™ algorithm to analyze all the software in the Email Marketing Software category to help you pick the best possible service. It takes into consideration the following metrics: key functionalities, collaboration possibilities, customization, available integrations, intuitiveness, help & support, security, support for smartphones and tablets, ratings in media. As of now, HubSpot Marketing is the leader in this category and is recommended by our experts. Following detailed examination it had the best results among its competitors and we strongly suggest that you consider it as one of the choices for your company.
User Satisfaction Read More
A look at total user satisfaction with the services in our Email Marketing Software category evaluated with our unique algorythm that collects customer reviews, comments and opinions across a broad set of social media sites to help you make an educated purchase choice.
Pricing Read More
Each vendor in the Email Marketing Software category will provide a different set of pricing packages for its app and every plan will include a varied group of features. Below we list the overal pricing for the most affordable package offered for each service. Keep in mind that advanced features may cost extra.
Devices Supported Read More
A summary of what type of devices and operating systems are supported by these B2B tools in the Email Marketing Software category, including mobile platforms and web-based solutions.
Laguages Supported Read More
Learn what languages and geographies are served by the best B2B solutions in the Email Marketing Software category, including solutions designed for international markets and prepared for multi-cultural teams of employees.
Pricing Model Read More
Find out which pricing packages are provided by the vendors in the Email Marketing Software category to check which one suits your business requirements and expenses best. Note that certain services can provide free or freemium accounts for you to test first.
Customer Types Read More
An overview of which kinds of clients a given B2B platform in the Email Marketing Software category aims for, from small businesses and non-profits to big enterprises.
Deployment Read More
A summary of what types of software deployement are offered by every B2B vendor in the Email Marketing Software category. While most of modern SaaS services are cloud-based some services may offer an on-site deployment model too.
Post by Alex Hillsberg


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Combine the cheese and arugula in a bowl. Cut a deep 2-inch-wide pocket in the thickest part of each chicken breast with a paring knife. Stuff with the arugula mixture. Brush with olive oil and season with salt and the Cajun spice blend.
Preheat a grill to high and brush the grates with vegetable oil. Grill the chicken until blackened and a thermometer inserted into the thickest part registers 155 degrees F, 8 to 10 minutes per side. Transfer to a cutting board.
Meanwhile, heat 1 tablespoon olive oil in a skillet over high heat. Add the lima beans, squash and corn, season with salt and cook until the squash is just tender, 2 to 3 minutes. Add the tomatoes and cook 2 more minutes. Remove from the heat and stir in the lime juice. Slice the chicken and serve with the succotash
Photograph by Antonis Achilleos
Courtesy of Food Network Magazine
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subset: commoncrawl


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Looking for job in risk Managament in Saudi Arabia (Jeddah)
Hi, My name is Shoaib Hashmi. I am looking to explore job opportunities in Saudi Arabia. I have a masters degree in finance from Sweden and have 4.5 years experience in Internal Cotrols, Audit and Risk Analysis within Sweden and in Pakistan. Right now in Stockholm Sweden but ready to to move as soon as possible (within 15 days) to a any middle eastern region. Ideal job would be in Bank, consultancy, insuirance within risk analysis, auditing and controls.
Please guide me about the effective ways (channels) of job searching and also please, if anyone interested in helping further, can mention his/her email in personal message or in this thread, so that I can send my CV and they can forward to their contacts.
Efforts will be highly appreciated. Jazakallah
Regards// Shoaib Hashmi


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Istituto Italiano di Tecnologia IIT (http://www.iit.it) is a private law Foundation, created with special Government Law no. 269 dated September 30th 2003 with the objective of promoting Italy's technological development and higher education in science and technology. Research at IIT is carried out in highly innovative scientific fields with state-of-the-art technology.
A postdoctoral position in "Development of novel instrumentation for imaging and microscopy based on coherent and incoherent structured illumination" is going to be available at the Center for Life Nanoscience at Istituto Italiano di Tecnologia (CLNS@SAPIENZA, Rome, Italy). The project connected to the position will involve the study and development of innovative imaging and microscopy techniques capable to achieve increased resolution deep in the volume of a medium through the use of coherent and incoherent structured illumination based on computer- generated holograms, deconvolution and non-conventional non-diffractive excitation patterns.
Ideal candidates have a PhD in Materials Science and a good knowledge of both Italian and English. Additional language skills are encouraged.
The position requires excellent skill levels in the following specific fields:
- Beam propagation in linear and nonlinear media;
- Structured illumination microscopy.
- Temporal and spatial light modulation.
- Light propagation in scattering and disordered media, including localization phenomena.
- Optical field analysis in the direct and Fourier space.
The candidate should be familiar with the basic theoretical instruments of diffractive optics, imaging, nonlinear optics and Fourier optics.
Extensive experience in and competence for software for acquisition, analysis and instrument automation is requested: Matlab and control of liquid-crystal spatial light modulators.
We are looking for scientists with a proactive attitude and results-oriented mindset, good interpersonal and communication skills and ability to work effectively within an interdisciplinary research team. An internationally competitive salary, dependent on experience, will be offered.
Please, quote "Post Doc in Development of novel schemes and instrumentation for imaging and microscopy based on coherent and incoherent structured illumination - BC 67971" in the subject line.
Please apply before: March 23, 2015.
In order to comply with Italian law (art. 23 of Privacy Law of the Italian Legislative Decree n. 196/03), the candidate is kindly asked to give his/her consent to allow Istituto Italiano di Tecnologia to process his/her personal data.
We inform you that the information you provide will be solely used for the purpose of evaluating and selecting candidates in order to meet the requirements of Istituto Italiano di Tecnologia.
Your data will be processed by Istituto Italiano di Tecnologia, with its headquarters in Genoa, Via Morego 30, acting as the Data Holder, using computer and paper-based means, observing the rules on the protection of personal data, including those relating to the security of data, and they will not be communicated to thirds.
Please also note that, pursuant to art.7 of Legislative Decree 196/2003, you may exercise your rights at any time as a party concerned by contacting the Data Holder.
Istituto Italiano di Tecnologia is an Equal Opportunity Employer that actively seeks diversity in the workforce.


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The Australian Immunisation Handbook 10th Edition
PDF printable version of 4.18 Rubella of the 10th edition of the Handbook (PDF 563 KB)
- 4.18.1 Virology
- 4.18.2 Clinical features
- 4.18.3 Epidemiology
- 4.18.4 Vaccines
- 4.18.5 Transport, storage and handling
- 4.18.6 Dosage and administration
- 4.18.7 Recommendations
- 4.18.8 Pregnancy and breastfeeding
- 4.18.9 Contraindictions
- 4.18.10 Precautions
- 4.18.11 Adverse events
- 4.18.12 Public health management of rubella
- 4.18.13 Variations from product information
- References
4.18.1 Virology
Rubella is an enveloped togavirus, genus Rubivirus. The virus has an RNA genome and is closely related to group A arboviruses, but does not require a vector for transmission. It is relatively unstable, and is inactivated by lipid solvents, trypsin, formalin, extremes of heat and pH, and light.1
4.18.2 Clinical features
Rubella is generally a mild and self-limiting infectious disease, spread from person to person by respiratory secretions, possibly including aerosol transmission.1,2 It causes a transient, generalised, erythematous, maculopapular rash; lymphadenopathy involving the post-auricular and sub-occipital glands; and, occasionally, arthritis and arthralgia. Other complications, such as neurological disorders and thrombocytopenia, may occur but are rare. Clinical diagnosis is unreliable since the symptoms are often fleeting and can be caused by other viruses; in particular, the rash is not unique to rubella and may be absent.1,2 Up to 50% of rubella virus infections are subclinical or asymptomatic.1 A history of rubella should, therefore, not be accepted without serological evidence of previous infection.1 The incubation period is 14 to 21 days, and the period of infectivity is from 1 week before until 4 days after the onset of the rash.2
Rubella infection in pregnancy can result in fetal infection, causing congenital rubella syndrome (CRS) in a high proportion of cases. Up to 90% of infants born to women who had rubella infection in the first trimester of pregnancy have abnormalities (often multiple) characteristic of CRS.3-5 The risk of damage declines to 10 to 20% by 16 weeks gestation. After this stage of pregnancy, fetal damage is rare but has been reported up to 20 weeks gestation.3 The characteristics of CRS include intellectual disabilities, cataracts, deafness, cardiac abnormalities, intrauterine growth retardation, and inflammatory lesions of the brain, liver, lungs and bone marrow.3 Any combination of these defects may occur, but defects that commonly occur alone following infection after the first 8 weeks of pregnancy are deafness and pigmentary retinopathy. Some infected infants may appear normal at birth, but defects, especially sensorineural deafness, may be detected later.6
Rubella infection has been reported in some persons who already have either natural or vaccine-induced antibody.3 Occasional cases of CRS after reinfection in pregnancy have been documented. However, fetal damage is very rare in cases of infection in women in whom antibody has previously been detected.4,7-9
4.18.3 Epidemiology
Evidence suggests that endemic rubella is well controlled in Australia.10 The incidence of rubella has fallen rapidly since vaccine registration, and notifications of rubella have been low since high vaccine coverage was achieved with the National Measles Control Campaign in late 1998 and then maintained.10 Since 2003, rubella notifications in Australia have been less than 0.3 per 100 000. There has been a shift in the age distribution of cases, with comparatively more cases seen in older age groups, particularly the 25–29 years age group.10
Rubella vaccines have been registered in Australia since 1970, and mass vaccination of schoolgirls commenced in 1971.1,11 Non-pregnant, seronegative adult women were also vaccinated. These programs were successful and there was a significant reduction in the incidence of CRS from 1977.12-14 Successful vaccination campaigns and high vaccination coverage resulted in no cases of congenital rubella syndrome occurring in infants of Australian-born mothers between 1998 and 2002. However, 5 cases resulting from infection acquired outside of Australia were reported during this time.15 In 2003, 2 cases of CRS occurred in Australian-born mothers from infection that occurred in Australia,16 which reinforces the need for high vaccination coverage of women of child-bearing age. Between 2004 and 2008, 2 confirmed cases of CRS were reported in Australia, in children whose mothers were born outside Australia.17-19
There has also been a significant increase in the percentage of pregnant women immune to rubella (e.g. in New South Wales from 82% in 1971 to 96% in 1983).20 Based on a study conducted in Melbourne in 2000, it was estimated that only 2.5% of women of child-bearing age in Australia were seronegative.21 However, susceptibility was higher among certain groups of women, particularly overseas-born women (refer to 'Women of child-bearing age, including post-partum women' in 4.18.7 Recommendations below).21
Young adult males may not be immune to rubella, because they did not receive a measles-mumps-rubella (MMR) vaccine.22 The MMR vaccination program for all adolescents replaced the rubella program for girls in 1993/94.11 A serosurvey conducted in 1999 showed that only 84% of males aged 14–18 years (compared to 95% of females) and 89% of males aged 19–49 years (compared to 98% of females) were immune to rubella.22 For this reason, young adult males, as well as females, who do not have a documented history of receipt of 2 doses of MMR vaccine should be vaccinated (refer to 4.18.7 Recommendations below). This is both for their own protection and to prevent transmission of the infection in the community.
Goals for the elimination of rubella and CRS have been set by a number of World Health Organization (WHO) regions, and elimination has been declared by the Pan American Health Organization.23 The WHO Western Pacific Region has set goals for increased rubella and CRS control efforts, with a number of member states yet to incorporate rubella vaccination into their routine schedule.24 As with elimination of measles, rubella and CRS elimination requires continued strengthening of immunisation and surveillance efforts, particularly identification of rubella virus genotypes to confirm the absence of an endemic strain.25
4.18.4 Vaccines
Monovalent rubella vaccine is not available in Australia. Rubella vaccination is provided using either MMR or measles-mumps-rubella-varicella (MMRV) vaccines. Two combination vaccines containing live attenuated measles, mumps, rubella and varicella viruses (MMRV) are registered in Australia.
A single dose of rubella vaccine produces an antibody response in over 95% of vaccine recipients, but antibody levels are lower than after natural infection.3,7,8 A 2nd dose aims to confer immunity in those who fail to seroconvert to the 1st dose. Vaccine-induced antibodies have been shown to persist for at least 16 years in the absence of endemic disease.7,8,26,27 Protection against clinical rubella appears to be long-term in those who seroconvert.3
Combination MMRV vaccines have been shown, in clinical trials, to produce similar rates of seroconversion to all four vaccine components compared with MMR and monovalent varicella vaccines administered concomitantly at separate injection sites.28-31
Combination measles–mumps–rubella (MMR) vaccines
- M-M-R II – bioCSL Pty Ltd (live attenuated measles virus (Enders ' attenuated Edmonston strain), mumps virus (Jeryl Lynn B level strain) and rubella virus (Wistar RA 27/3 strain)). Lyophilised pellet in a monodose vial with separate diluent. Each 0.5 mL reconstituted dose contains ≥1000 tissue culture infectious dose 50% (TCID50) of measles virus, ≥12 500 TCID50 of mumps virus, and ≥1000 TCID50 of rubella virus; 14.5 mg sorbitol; 1.9 mg sucrose; 14.5 mg hydrolysed porcine gelatin; ≤0.3 mg recombinant human albumin; <1 ppm fetal bovine serum; 25 �g neomycin.
- Priorix – GlaxoSmithKline Australia Pty Ltd (live attenuated measles virus (Schwarz strain), mumps virus (RIT 4385 strain, derived from the Jeryl Lynn strain) and rubella virus (Wistar RA 27/3 strain)). Lyophilised pellet in a monodose vial with a pre-filled diluent syringe. Each 0.5 mL reconstituted dose contains ≥103.0 cell culture infectious dose 50% (CCID50) of measles virus, ≥103.7 CCID50 of mumps virus, and ≥103.0 CCID50 of rubella virus; lactose; neomycin; sorbitol; mannitol.
Combination measles-mumps-rubella-varicella (MMRV) vaccines
- Priorix-tetra – GlaxoSmithKline Australia Pty Ltd (live attenuated measles virus (Schwarz strain), mumps virus (RIT 4385 strain, derived from the Jeryl Lynn strain), rubella virus [Wistar RA 27/3 strain] and varicella-zoster virus (Oka strain)). Lyophilised pellet in a monodose vial with a pre-filled diluent syringe. Each 0.5 mL reconstituted dose contains ≥103.0 CCID50 of measles virus, ≥104.4 CCID50 of mumps virus, ≥103.0 CCID50 of rubella virus, and ≥103.3 plaque-forming units (PFU) of varicella-zoster virus; lactose; neomycin; sorbitol; mannitol.
- ProQuad – bioCSL Pty Ltd (live attenuated measles virus (Enders' attenuated Edmonston strain), mumps virus (Jeryl Lynn B level strain), rubella virus (Wistar RA 27/3 strain) and varicella-zoster virus (Oka/Merck strain)). Lyophilised powder in a monodose vial with a pre-filled diluent syringe. Each 0.5 mL reconstituted dose contains ≥103.00 TCID50 of measles virus, ≥104.30 TCID50 of mumps virus, ≥103.00 TCID50 of rubella virus, and ≥103.99 PFU of varicella-zoster virus; 20 mg sucrose; 11 mg hydrolysed porcine gelatin; 2.5 mg urea; 16 mg sorbitol; 0.38 mg monosodium L-glutamate; 0.25 mg recombinant human albumin; 5 �g neomycin; residual components of MRC-5 cells; 0.5 �g bovine serum albumin.
4.18.5 Transport, storage and handling
Transport according to National vaccine storage guidelines: Strive for 5.32 Store at +2�C to +8�C. Do not freeze. Protect from light.
Both MMR and MMRV vaccines must be reconstituted by adding the entire contents of the diluent container to the vial containing the pellet and shaking until the pellet is completely dissolved.
Reconstituted Priorix (MMR), M-M-R II (MMR) and Priorix-tetra (MMRV) vaccines should be used as soon as practicable. If storage is necessary, hold at +2�C to +8�C for not more than 8 hours.
Reconstituted ProQuad (MMRV) vaccine should be used immediately. If storage is necessary, hold at +2�C to +8�C for not more than 2.5 hours or at +20�C to +25�C for not more than 1 hour.
4.18.6 Dosage and administration
The dose of Priorix (MMR) vaccine for both children and adults is 0.5 mL, to be given by either SC or IM injection.
The dose of M-M-R II (MMR) vaccine for both children and adults is 0.5 mL, to be given by SC injection.
For children <14 years of age, the dose of MMRV vaccine is 0.5 mL, to be given by SC injection. Priorix-tetra may also be given by IM injection.33
MMRV vaccines are not recommended for use in persons aged ≥14 years.
When 2 doses of MMR-containing vaccine are required, the minimum interval between doses is 4 weeks.
Co-administration with other vaccines
MMR or MMRV vaccines can be given at the same time as other live attenuated parenteral vaccines (e.g. varicella, BCG, yellow fever) or other inactivated vaccines (including DTPa, hepatitis B, Hib, IPV, MenCCV, hepatitis A and pneumococcal conjugate vaccine),34 using separate syringes and injection sites. If MMR or MMRV vaccine is not given simultaneously with other live attenuated parenteral vaccines, they should be given at least 4 weeks apart.
If MMR vaccine is given at the same time as monovalent varicella vaccine (VV), they should be given using separate syringes and injection sites. MMR vaccine and monovalent VV should not be mixed together prior to injection.
Separate administration of measles, mumps or rubella vaccine is not available as an alternative to MMR vaccine, although a monovalent varicella vaccine is available (refer to 4.22 Varicella).
Interchangeability of MMR-containing vaccines
In general, the two brands of MMR vaccine can be considered interchangeable, that is, the 2nd MMR dose does not have to be of the same brand as the 1st. The same principle applies to the two available MMRV vaccines,34 although they are not routinely recommended in a 2-dose schedule.
4.18.7 Recommendations
For further information on the recommendations for MMR and MMRV vaccines, refer to 4.9 Measles and 4.22 Varicella.
The principal aim of rubella vaccination is to prevent congenital rubella syndrome by stopping the circulation of rubella virus in the community. Susceptible pregnant women will continue to be at risk of rubella infection in pregnancy until the transmission of rubella virus is interrupted by continued high-level coverage of rubella-containing vaccine.
A history of rubella is not a contraindication to vaccination. Persons who are already immune to rubella have no increased risk of side effects from vaccination.3,7
Infants aged <12 months
MMR-containing vaccines are not routinely recommended for infants <12 months of age. However, MMR vaccine can be given to children from as early as 9 months of age in high-risk circumstances (refer to 4.9 Measles).
If MMR vaccine is given at <12 months of age, there is still a need for 2 vaccine doses to be administered at ≥12 months of age (refer to 4.9 Measles).
Two doses of rubella-containing vaccine are recommended for all children. The 1st dose should be given at 12 months of age as MMR vaccine. MMRV vaccines are not recommended for use as the 1st dose of MMR-containing vaccine in children <4 years of age, due to a small but increased risk of fever and febrile seizures when given as the 1st MMR-containing vaccine dose in this age group (refer to Table 4.9.1 in 4.9 Measles and Table 4.22.1 in 4.22 Varicella). (Refer also to 4.9.11 Adverse events in 4.9 Measles and 4.22.11 Adverse events in 4.22 Varicella.)
The 2nd dose of rubella-containing vaccine is recommended to be given routinely at 18 months of age as MMRV vaccine. This is to commence from July 2013, once MMRV vaccine(s) are available under the NIP (refer to Table 4.9.1 in 4.9 Measles and Table 4.22.1 in 4.22 Varicella). The recommended age for administration of the 2nd dose of rubella-containing vaccine will be moved down from 4 years of age, to provide earlier 2-dose protection against measles, mumps and rubella, and to improve vaccine uptake (refer to 4.18.3 Epidemiology above).
If MMRV vaccine is inadvertently administered as dose 1 of MMR-containing vaccine, the dose does not need to be repeated (providing it was given at ≥12 months of age); however, parents/carers should be advised regarding the small but increased risk of fever and febrile seizures (compared with that expected following MMR vaccine).
Adults and adolescents
Two doses of rubella-containing vaccine are recommended for all non-immune adolescents and adults (refer to 4.9 Measles). All persons born during or since 1966 who are ≥18 months of age (or, until catch-up following the move of the 2nd NIP dose of measles-containing vaccine to 18 months of age is completed, are ≥4 years of age) should have documented evidence of 2 doses of MMR-containing vaccine (administered at least 4 weeks apart with both doses administered at ≥12 months of age) or have serological evidence of protection for measles, mumps and rubella.
It is particularly important to ensure that women of child-bearing age are immune to rubella (refer to 'Women of child-bearing age, including post-partum women' below).
It is recommended that all males born during or after 1966 (particularly those born from 1966 up to the 1990s) have their vaccination records reviewed to ensure they have received 2 doses of MMR vaccine, as they are more likely, than females, to have not received 2 doses of rubella-containing vaccine (refer to 4.18.3 Epidemiology above).
MMRV vaccines are not recommended for use in persons ≥14 years of age, due to a lack of data on safety and immunogenicity/efficacy in this age group. If a dose of MMRV vaccine is inadvertently given to an older person, this dose does not need to be repeated.
Healthcare workers and those who work with children
All healthcare workers and persons working with children, born during or since 1966, either without vaccination records or seronegative upon screening, should receive 2 doses of MMR vaccine, both for their own protection and to avoid the risk of transmitting rubella to pregnant women35 (refer to 3.3 Groups with special vaccination requirements, Table 3.3.7 Recommended vaccinations for persons at increased risk of certain occupationally acquired vaccine-preventable diseases).
Women of child-bearing age, including post-partum women
Every effort should be made to identify and immunise non-pregnant seronegative women of child-bearing age (refer to 'Serological testing for immunity to rubella' below). The following women are more likely to be seronegative to rubella: women born overseas (especially in Asia, Pacific islands, sub-Saharan Africa and South America) who entered Australia after the age of routine vaccination; Indigenous women living in rural and remote regions; non-English speaking women; women over the age of 35 years; and Australian-born Muslim women.12,13,21,36-38
Seronegative women should be given MMR vaccine and advised to avoid pregnancy for 28 days after vaccination. Vaccinated women should be tested for seroconversion 6 to 8 weeks after vaccination (refer to 'Serological testing for immunity to rubella' below). Women who have negative or very low antibody levels after vaccination should be revaccinated. However, if antibody levels remain low after a 2nd documented vaccination, it is unlikely that further vaccinations will improve this.3 Further testing and vaccination is not usually warranted; however, consultation with the laboratory that performed the serological testing may also be helpful (refer also to 'Serological testing for immunity to rubella' below). Negative serology after 2 documented doses of rubella-containing vaccine may represent a false negative (i.e. an antibody titre too low to be detected using routine commercial assays).
Although 2 doses of MMR vaccine are routinely recommended, if rubella immunity is demonstrated after receipt of 1 dose of a rubella-containing vaccine, no further dose is required, unless indicated by subsequent serological testing (refer to 'Serological testing for immunity to rubella' below) or if indicated for protection against measles and mumps (refer to 4.9 Measles and 4.11 Mumps).
Women found to be seronegative on antenatal testing for rubella immunity should be vaccinated after delivery and before discharge from the maternity unit, as discussed above. These women should be tested for rubella immunity 6 to 8 weeks following vaccination.1,7 (Refer also to 'Serological testing for immunity to rubella' below.)
Serological testing for immunity to rubella
Serological testing for immunity to rubella after routine vaccination of children is not recommended. However, serological testing for rubella immunity can be performed in cases where a history of natural immunity or 2 doses of vaccine administration is uncertain. It is particularly important to ensure that women of child-bearing age are immune to rubella (refer to 'Women of child-bearing age, including post-partum women' above).
A number of commercial assays for testing immunity to rubella are available. These vary according to the method used to determine the positive cut-off value (the WHO cut-off is 10 IU/mL, but, at present, there is no recommended Australian minimal level). Available data support the presumption that an antibody level found by use of a licensed assay to be above the standard positive cut-off for that assay can be considered evidence of past exposure to rubella virus.7 Rubella vaccine induces immune responses that are similar in quality, but lesser in quantity, than those after natural disease.3 Measurement of antibody by commercial assays is not a perfect correlate of protection in vaccinated persons.3 While on the one hand, those with low levels of vaccine-induced antibodies are often protected, conversely, reinfection may take place in some individuals with measurable antibodies. If a person is found to be rubella IgG seronegative, vaccination should be provided according to the recommendations above. Interpretation of the results of serological testing may be enhanced by discussion with the laboratory that performed the test, ensuring that relevant clinical information is provided. In addition, expert consultation and referral of sera to a reference laboratory are recommended if there is difficulty interpreting results, particularly for women of child-bearing age (refer to 'Women of child-bearing age, including post-partum women' above).
All women of child-bearing age should be advised by a medical practitioner of the result of their antibody test, as it is a clinically significant test.39 Women should be screened for rubella antibodies shortly before every pregnancy, or early in the pregnancy, or if pregnancy is contemplated, irrespective of a previous positive rubella antibody result.3,14 Very occasionally, errors may result in patients who are seronegative being reported as seropositive. Specimens from pregnant women are required to be stored until the completion of the pregnancy for parallel serological testing if required.40
4.18.8 Pregnancy and breastfeeding
Rubella-containing vaccines are contraindicated in pregnant women (refer to 4.18.9 Contraindications below). Pregnancy should be avoided for 28 days after vaccination.41
MMR vaccines can be given to breastfeeding women. The rubella vaccine virus may be secreted in human breast milk, and rare cases of transmission of vaccine virus through breast milk have been reported. However, symptoms in the newborn have been absent or mild.42-44 Post-partum vaccination of women without evidence of rubella immunity need not be delayed because of breastfeeding.
MMRV vaccines are not recommended for use in persons aged ≥14 years.
There is no risk to pregnant women from contact with recently vaccinated persons. The vaccine virus is not transmitted from vaccinated persons to susceptible contacts.1
Refer also to 3.3 Groups with special vaccination requirements, Table 3.3.1 Recommendations for vaccination in pregnancy for more information.
4.18.9 Contraindications
Anaphylaxis to vaccine components
MMR and MMRV vaccines are contraindicated in persons who have had:
- anaphylaxis following a previous dose of any MMR-containing vaccine
- anaphylaxis following any vaccine component.
Persons who are immunocompromised
Measles-, mumps-, and rubella-containing vaccines contain live attenuated vaccine viruses and are contraindicated in persons who are immunocompromised. Thus, MMR-containing vaccines are contraindicated in the following groups:
- Persons immunocompromised due to HIV/AIDS. MMR vaccination of asymptomatic HIV-infected persons >12 months of age with an age-specific CD4+ count of ≥15% may be considered45-48 (refer to 'HIV-infected persons' in 3.3.3 Vaccination of immunocompromised persons). Since studies have not been performed using combination MMRV vaccines in asymptomatic HIV-infected persons or persons with an age-specific CD4+ count of ≥15%, it is recommended that only MMR vaccine (and monovalent VV, refer to 4.22 Varicella) be considered for use in this setting.47,49-51
- Persons with other medical conditions associated with significant immunocompromise (refer to 3.3.3 Vaccination of immunocompromised persons)
- Persons receiving high-dose systemic immunosuppressive therapy, such as chemotherapy, radiation therapy or oral corticosteroids. MMR-containing vaccines are contraindicated in persons taking high-dose oral corticosteroids for more than 1 week (in children equivalent to >2 mg/kg per day prednisolone, and in adults >60 mg per day) (refer to 3.3.3 Vaccination of immunocompromised persons). Those who have been receiving high-dose systemic steroids for more than 1 week may be vaccinated with live attenuated vaccines after corticosteroid therapy has been discontinued for at least 1 month52 (refer to 3.3.3 Vaccination of immunocompromised persons).
Refer also to 3.3 Groups with special vaccination requirements and 4.22 Varicella for more information.
Pregnant women
Refer also to 4.18.8 Pregnancy and breastfeeding above.
Rubella-containing vaccines are contraindicated in pregnant women.
This is due to the theoretical risk of transmission of the rubella component of the vaccine to a susceptible fetus. However, no evidence of vaccine-induced CRS has been reported.1 Active surveillance in the United States, the United Kingdom and Germany indicates that no case of vaccine-induced congenital rubella syndrome occurred among more than 500 women inadvertently vaccinated with rubella vaccine during pregnancy, whose pregnancies continued.53 In an Iranian study performed after mass vaccination with a measles–rubella vaccine, 117 susceptible women were inadvertently vaccinated while pregnant or became pregnant within 3 months after vaccination. There were no CRS-related abnormalities among the infants born to these women.54 Based on this evidence, the vaccine cannot be considered to be teratogenic, and termination of pregnancy following inadvertent vaccination is not indicated.1,8 (Refer also to 3.3.2 Vaccination of women who are planning pregnancy, pregnant or breastfeeding, and preterm infants.)
4.18.10 Precautions
For additional precautions related to MMR and MMRV vaccines, refer to 4.9 Measles and 4.22 Varicella.
Vaccination with other live attenuated parenteral vaccines
If MMR or MMRV vaccine is not given simultaneously with other live attenuated parenteral vaccines (e.g. varicella, BCG, yellow fever), the vaccines should be given at least 4 weeks apart.
Vaccination after immunoglobulin or blood product administration
Administration of a MMR or MMRV vaccine should be delayed after administration of immunoglobulin-containing products. After receipt of immunoglobulin-containing blood products, the expected immune response to measles, mumps, rubella and varicella vaccination may be impaired.7,55,56 MMR-containing vaccines should not be given for between 3 and 11 months following the administration of immunoglobulin-containing blood products. The interval between receipt of the blood product and vaccination depends on the amount of immunoglobulin in each product, and is indicated in 3.3 Groups with special vaccination requirements, Table 3.3.6 Recommended intervals between either immunoglobulins or blood products and MMR, MMRV or varicella vaccination.55 For further information, refer to 3.3.4 Vaccination of recent recipients of normal human immunoglobulin and other blood products.
Recent blood transfusion with washed red blood cells is not a contraindication to MMR or MMRV vaccines.
MMR vaccine may be administered concomitantly with, or at any time in relation to, anti-D immunoglobulin, but at a separate injection site. Anti-D immunoglobulin does not interfere with the antibody response to vaccine.1,3,8
Immunoglobulin or blood product administration after vaccination
Immunoglobulin-containing products should not be administered for 3 weeks following vaccination with rubella-containing vaccines, unless the benefits exceed those of vaccination. If immunoglobulin-containing products are administered within this interval, the vaccinated person should either be revaccinated later at the appropriate time following the product (as indicated in Table 3.3.6), or be tested for immunity 6 months later and then revaccinated if seronegative.
Rh (D) immunoglobulin (anti-D) may be given at the same time in different sites with separate syringes or at any time in relation to MMR vaccine, as it does not interfere with the antibody response to the vaccine.
4.18.11 Adverse events
Adverse events following administration of MMR-containing vaccines are generally mild and well tolerated.3 Adverse events are much less common after the 2nd dose of MMR or MMRV vaccine than after the 1st dose.
Mild adverse events such as fever, sore throat, lymphadenopathy, rash, arthralgia and arthritis may occur following MMR vaccination.1,7 Symptoms most often begin 1 to 3 weeks after vaccination and are usually transient.
Thrombocytopenia (usually self-limiting) has been very rarely associated with the rubella or measles component of MMR vaccine, occurring in 3 to 5 per 100000 doses of MMR vaccine administered.7,57-59 This is considerably less frequent than after natural measles, mumps and rubella infections.59
Persons with egg allergy can be safely given MMR or MMRV vaccine (refer to 4.9.11 Adverse events in 4.9 Measles).
For further information on adverse events related to MMR and MMRV vaccines, refer to 4.9 Measles and 4.22 Varicella.
4.18.12 Public health management of rubella
Rubella is a notifiable disease in all states and territories in Australia.
Further instructions about the public health management of rubella, including management of cases of rubella and their contacts, should be obtained from state/territory public health authorities (refer to Appendix 1 Contact details for Australian, state and territory government health authorities and communicable disease control).
Rubella-containing vaccine does not provide protection if given after exposure to rubella.7 However, if the exposure did not result in infection, the vaccine would induce protection against subsequent infection. Normal human immunoglobulin (NHIG) has been shown not to be of value in post-exposure prophylaxis for rubella.7 However, NHIG may be recommended in certain circumstances (refer to 'Use of normal human immunoglobulin in pregnant women exposed to rubella' below).
Suspected rubella contacts
All contacts of persons with suspected rubella infection should be identified, especially those who are pregnant (refer to 'Pregnant women with suspected rubella or exposure to rubella' below).
Contacts >12 months of age without adequate proof of immunity should receive 1 dose of MMR vaccine (or MMRV vaccine, if appropriate). This will not prevent rubella disease if already exposed. If vaccination is refused, the contact should avoid further contact with cases until at least 4 days after onset of the rash in the case. Seronegative women of child-bearing age should be vaccinated and tested for seroconversion 6 to 8 weeks after vaccination (refer to 4.18.7 Recommendations above).
Exposed healthcare workers without adequate proof of immunity should be excluded from work for 21 days from exposure or for at least 4 days after the onset of rash.60
Testing for rubella infection
All cases of suspected rubella infection should be laboratory tested and false positive results excluded (refer to 'Serological testing for immunity to rubella' in 4.18.7 Recommendations above).
Acute rubella infection is indicated by the presence of rubella IgM or a 4-fold or greater increase in rubella IgG. Rubella IgM may not appear until a week after clinical symptoms. Sera for testing should be taken 7 to 10 days after onset of illness and repeated 2 to 3 weeks later. The most recent date of potential exposure should be obtained, if possible, to calculate the potential incubation period. As some patients may have more than one exposure to a person with a rubella-like illness, and because exposure may occur over a prolonged period, it is important to ascertain the dates of the first and last exposures.60 Testing for infection can also be done, particularly early in the course of a clinical illness, using virus-detection methods, such as nucleic acid amplification testing (PCR).60
Infected persons should be excluded from school/work/institution and should avoid contact with women of child-bearing age for at least 4 days after the onset of the rash.60
Pregnant women with suspected rubella or exposure to rubella
All pregnant women with suspected rubella or exposure to rubella should be serologically tested (for IgM and IgG), irrespective of a history of prior vaccination, clinical rubella or a previous positive rubella antibody result (for more details, refer to 'Testing for rubella infection' above). Testing is essential because of the serious consequences of the infection, the rash of rubella is not diagnostic, asymptomatic infection can occur, and the diagnosis requires confirmation by laboratory tests.3,7,8 In addition, infection has been reported in women who have previous evidence of antibody.7
Serologic specimens should include information regarding the date of the last menstrual period and the date of presumed exposure (or date of onset of symptoms).60 If the woman has an antibody titre below the protective level, or a low level of antibodies and remains asymptomatic, a second specimen should be collected 28 days after the exposure (or onset of symptoms) and tested in parallel with the first. Alternatively, if the woman develops symptoms/signs of rubella infection, a second serum specimen should be tested as soon as possible. A third blood specimen may be required in some circumstances.8 Testing for infection can also be done, particularly early in the course of a clinical illness, using virus-detection methods, such as nucleic acid amplification testing (PCR).60
Pregnant women should be counselled to restrict contact with persons with confirmed, probable or suspected rubella for 6 weeks (2 incubation periods).60 Counselling of pregnant women with confirmed rubella regarding the risk to the fetus should be given in conjunction with the woman's obstetric service.
Use of normal human immunoglobulin in pregnant women exposed to rubella
Post-exposure prophylaxis with normal human immunoglobulin (NHIG) does not prevent infection in non-immune contacts and is, therefore, of little value for protection of susceptible contacts exposed to rubella.7 However, it may prolong the incubation period. If given to non-immune pregnant contacts, this may marginally reduce the risk to the fetus. It may also reduce the likelihood of clinical symptoms in the mother. In such cases, IM administration of 20 mL of NHIG within 72 hours of rubella exposure might reduce, but will not eliminate, the risk for rubella.60 Serological follow-up of recipients is essential, and should continue for up to 2 months.
There is some evidence to suggest that, in outbreak situations, pre-exposure NHIG may be effective in preventing infection in women who are likely to be pregnant, and its use may be indicated for such women with low antibody titres in high-risk occupations.61
4.18.13 Variations from product information
The product information for MMR and MMRV vaccines recommends that women of child-bearing age should be advised not to become pregnant for 3 months after vaccination. The ATAGI instead recommends avoiding pregnancy for 28 days after vaccination.41
For further information on MMR and MMRV vaccines, refer to 4.9 Measles and 4.22 Varicella.
- Centers for Disease Control and Prevention (CDC). Rubella. In: Atkinson W, Wolfe C, Hamborsky J, eds. Epidemiology and prevention of vaccine-preventable diseases. 12th ed. Washington, D.C.: Public Health Foundation, 2011.
- Rubella and congenital rubella. In: Heymann DL, ed. Control of communicable diseases manual. 19th ed. Washington, D.C.: American Public Health Association, 2008.
- Plotkin SA, Reef SE. Rubella vaccine. In: Plotkin SA, Orenstein WA, Offit PA, eds. Vaccines. 5th ed. Philadelphia, PA: Saunders Elsevier, 2008.
- Gilbert GL. Infectious disease in pregnancy and the newborn infant. Monographs in clinical pediatrics. Volume 2. Chur, Switzerland: Harwood Academic Publishers, 1991.
- Miller E, Cradock-Watson JE, Pollock TM. Consequences of confirmed maternal rubella at successive stages of pregnancy. The Lancet 1982;2:781-4.
- Menser MA, Forrest JM. Rubella – high incidence of defects in children considered normal at birth. Medical Journal of Australia 1974;1:123-6.
- Centers for Disease Control and Prevention (CDC), Watson JC, Hadler SC, 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 Recommendations and Reports 1998;47(RR-8):1-57.
- American Academy of Pediatrics. Rubella. In: Pickering LK, Baker CJ, Kimberlin DW, Long SS, eds. Red Book: 2009 report of the Committee on Infectious Diseases. 28th ed. Elk Grove Village, IL: American Academy of Pediatrics, 2009.
- Burgess MA. Rubella reinfection – what risk to the fetus? Medical Journal of Australia 1992;156:824-5.
- Chiu C, Dey A, Wang H, et al. Vaccine preventable diseases in Australia, 2005 to 2007. Communicable Diseases Intelligence 2010;34 Suppl:ix-S167.
- Gidding HF, Burgess MA, Kempe AE. A short history of vaccination in Australia. [erratum appears in Med J Aust 2001 Mar 5;174(5):260]. Medical Journal of Australia 2001;174:37-40.
- Condon RJ, Bower C. Rubella vaccination and congenital rubella syndrome in Western Australia. Medical Journal of Australia 1993;158:379-82.
- Cheffins T, Chan A, Keane RJ, Haan EA, Hall R. The impact of rubella immunisation on the incidence of rubella, congenital rubella syndrome and rubella-related terminations of pregnancy in South Australia. British Journal of Obstetrics and Gynaecology 1998;105:998-1004.
- Burgess MA, Forrest JM. Congenital rubella in Australia – 1993 and early reports for 1994. Communicable Diseases Intelligence 1995;19:234-6.
- Elliott E, Rose D. Reporting of communicable disease conditions under surveillance by the APSU, 1 January to 30 June 2004. Communicable Diseases Intelligence 2004;28:529-31.
- Forrest JM, Burgess M, Donovan T. A resurgence of congenital rubella in Australia? Communicable Diseases Intelligence 2003;27:533-6.
- Elliott E, Cronin P, Zurynski Y, eds. Australian Paediatric Surveillance Unit annual report 2004. Sydney: Australian Paediatric Surveillance Unit, 2005.
- Mahajan D, Zurynski Y, Peadon E, Elliott E, eds. Australian Paediatric Surveillance Unit research report 2005–2006. Sydney: Australian Paediatric Surveillance Unit, 2008.
- Ridley G, Zurynski Y, Elliott E, eds. Australian Paediatric Surveillance Unit research report 2007–2008. Sydney: Australian Paediatric Surveillance Unit, 2010.
- Menser MA, Hudson JR, Murphy AM, Cossart YE. Impact of rubella vaccination in Australia. The Lancet 1984;323:1059-62.
- Francis BH, Thomas AK, McCarty CA. The impact of rubella immunization on the serological status of women of childbearing age: a retrospective longitudinal study in Melbourne, Australia. American Journal of Public Health 2003;93:1274-6.
- Gilbert GL, Escott RG, Gidding HF, et al. Impact of the Australian Measles Control Campaign on immunity to measles and rubella. Epidemiology and Infection 2001;127:297-303.
- Castillo-Sol�rzano C, Marsigli C, Bravo-Alc�ntara P, et al. Elimination of rubella and congenital rubella syndrome in the Americas. Journal of Infectious Diseases 2011;204 Suppl 2:S571-8.
- Reef SE, Strebel P, Dabbagh A, Gacic-Dobo M, Cochi S. Progress toward control of rubella and prevention of congenital rubella syndrome – worldwide, 2009. Journal of Infectious Diseases 2011;204 Suppl 1:S24-7.
- Icenogle JP, Siqueira MM, Abernathy ES, et al. Virologic surveillance for wild-type rubella viruses in the Americas. Journal of Infectious Diseases 2011;204 Suppl 2:S647-51.
- Davidkin I, Peltola H, Leinikki P, Valle M. Duration of rubella immunity induced by two-dose measles, mumps and rubella (MMR) vaccination: a 15-year follow-up in Finland. Vaccine 2000;18:3106-12.
- O'Shea S, Best JM, Banatvala JE, Marshall WC, Dudgeon JA. Rubella vaccination: persistence of antibodies for up to 16 years. British Medical Journal (Clinical Research Ed.) 1982;285:253-5.
- Kuter BJ, Hoffman Brown ML, Hartzel J, et al. Safety and immunogenicity of a combination measles, mumps, rubella and varicella vaccine (ProQuad�). Human Vaccines 2006;2:205-14.
- Knuf M, Habermehl P, Zepp F, et al. Immunogenicity and safety of two doses of tetravalent measles-mumps-rubella-varicella vaccine in healthy children. Pediatric Infectious Disease Journal 2006;25:12-8.
- Lieberman JM, Williams WR, Miller JM, et al. The safety and immunogenicity of a quadrivalent measles, mumps, rubella and varicella vaccine in healthy children: a study of manufacturing consistency and persistence of antibody. Pediatric Infectious Disease Journal 2006;25:615-22.
- Schuster V, Otto W, Maurer L, et al. Immunogenicity and safety assessments after one and two doses of a refrigerator-stable tetravalent measles-mumps-rubella-varicella vaccine in healthy children during the second year of life. Pediatric Infectious Disease Journal 2008;27:724-30.
- National vaccine storage guidelines: Strive for 5. 2nd ed. Canberra: Australian Government Department of Health and Ageing, 2013. Available at: (www.immunise.health.gov.au/internet/immunise/publishing.nsf/Content/IMM77-cnt) (accessed Nov 2013).
- Knuf M, Zepp F, Meyer CU, et al. Safety, immunogenicity and immediate pain of intramuscular versus subcutaneous administration of a measles–mumps–rubella–varicella vaccine to children aged 11–21 months. European Journal of Pediatrics 2010;169:925-33.
- Blatter MM, Klein NP, Shepard JS, et al. Immunogenicity and safety of two tetravalent (measles, mumps, rubella, varicella) vaccines coadministered with hepatitis A and pneumococcal conjugate vaccines to children twelve to fourteen months of age. Pediatric Infectious Disease Journal 2012;31:e133-40.
- National Health and Medical Research Council (NHMRC). Australian guidelines for the prevention and control of infection in healthcare. Canberra: Australian Government Department of Health and Ageing, 2010. (accessed Feb 2012).
- Sullivan EM, Burgess MA, Forrest JM. The epidemiology of rubella and congenital rubella in Australia, 1992 to 1997. Communicable Diseases Intelligence 1999;23:209-14.
- Sathanandan D, Gupta L, Liu B, Rutherford A, Lane J. Factors associated with low immunity to rubella infection on antenatal screening. Australian and New Zealand Journal of Obstetrics and Gynaecology 2005;45:435-8.
- Hunt JM, Lumley J. Top End rural and remote Indigenous women: an Australian population group vulnerable to rubella. Communicable Diseases Intelligence 2004;28:499-503.
- Palasanthiran P, Starr M, Jones C, eds. Management of perinatal infections. Sydney: Australasian Society for Infectious Diseases, 2006. Available at: http://www.asid.net.au/downloads/Management-of-Perinatal-Infections-ASID-2002-rev-2007.pdf (accessed Jul 2012).
- National Pathology Accreditation Advisory Council (NPAAC). Requirements for the retention of laboratory records and diagnostic material. Canberra: NPAAC, 2009. Available at: http://www.health.gov.au/internet/main/publishing.nsf/Content/0392138A9970DFD1CA257371000D9200/$File/NPAAC%20Pub%20-%20Ret%20Records%20040110.pdf (accessed Sep 2012).
- Centers for Disease Control and Prevention (CDC). Revised ACIP recommendation for avoiding pregnancy after receiving a rubella-containing vaccine. MMWR Morbidity and Mortality Weekly Report 2001;50:1117.
- Klein EB, Byrne T, Cooper LZ. Neonatal rubella in a breast-fed infant after postpartum maternal infection. Journal of Pediatrics 1980;97:774-5.
- Landes RD, Bass JW, Millunchick EW, Oetgen WJ. Neonatal rubella following postpartum maternal immunization. Journal of Pediatrics 1980;97:465-7.
- Losonsky GA, Fishaut JM, Strussenberg J, Ogra PL. Effect of immunization against rubella on lactation products. II. Maternal-neonatal interactions. Journal of Infectious Diseases 1982;145:661-6.
- Scott P, Moss WJ, Gilani Z, Low N. Measles vaccination in HIV-infected children: systematic review and meta-analysis of safety and immunogenicity. Journal of Infectious Diseases 2011;204 Suppl 1:S164-78.
- World Health Organization (WHO). Global Advisory Committee on Vaccine Safety, report of meeting held 17–18 June 2009. Weekly Epidemiological Record 2009;84:325-32.
- Menson EN, Mellado MJ, Bamford A, et al. Guidance on vaccination of HIV-infected children in Europe. HIV Medicine 2012;13:333-6.
- Centers for Disease Control and Prevention (CDC). Recommended adult immunization schedule — United States, 2012 (QuickGuide). MMWR Morbidity and Mortality Weekly Report 2012;61(4):1-7.
- Centers for Disease Control and Prevention (CDC), Kaplan JE, Benson C, et al. Guidelines for prevention and treatment of opportunistic infections in HIV-infected adults and adolescents: recommendations from CDC, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America. MMWR Recommendations and Reports 2009;58(RR-4):1-207.
- Centers for Disease Control and Prevention (CDC), Mofenson LM, Brady MT, et al. Guidelines for the prevention and treatment of opportunistic infections among HIV-exposed and HIV-infected children: recommendations from CDC, the National Institutes of Health, the HIV Medicine Association of the Infectious Diseases Society of America, the Pediatric Infectious Diseases Society, and the American Academy of Pediatrics. MMWR Recommendations and Reports 2009;58(RR-11):1-166.
- Levin MJ, Gershon AA, Weinberg A, et al. Administration of live varicella vaccine to HIV-infected children with current or past significant depression of CD4+ T cells. Journal of Infectious Diseases 2006;194:247-55.
- American Academy of Pediatrics. Immunization in special clinical circumstances. Immunocompromised children. In: Pickering LK, Baker CJ, Kimberlin DW, Long SS, eds. Red Book: 2009 report of the Committee on Infectious Diseases. 28th ed. Elk Grove Village, IL: American Academy of Pediatrics, 2009.
- Centers for Disease Control and Prevention (CDC). Rubella vaccination during pregnancy – United States, 1971–1988. MMWR Morbidity and Mortality Weekly Report 1989;38:289-93.
- Hamkar R, Jalilvand S, Abdolbaghi MH, et al. Inadvertent rubella vaccination of pregnant women: evaluation of possible transplacental infection with rubella vaccine. Vaccine 2006;24:3558-63.
- Centers for Disease Control and Prevention (CDC), Kroger AT, Sumaya CV, Pickering LK, Atkinson WL. General recommendations on immunization – recommendations of the Advisory Committee on Immunization Practices (ACIP). [erratum appears in MMWR Recomm Rep. 2011 Jul 29;60:993]. MMWR Recommendations and Reports 2011;60(RR-2):1-61.
- Department of Health and Human Services, Centers for Disease Control and Prevention, National Immunization Program. Advisory Committee on Immunization Practices, June 29–30, 2006, Atlanta, Georgia. Record of the proceedings. 2006. (accessed Nov 2012).
- Centers for Disease Control and Prevention (CDC). Measles. In: Atkinson W, Wolfe C, Hamborsky J, eds. Epidemiology and prevention of vaccine-preventable diseases. 12th ed. Washington, D.C.: Public Health Foundation, 2011.
- Black C, Kaye JA, Jick H. MMR vaccine and idiopathic thrombocytopaenic purpura. British Journal of Clinical Pharmacology 2003;55:107-11.
- Miller E, Waight P, Farrington P, et al. Idiopathic thrombocytopenic purpura and MMR vaccine. Archives of Disease in Childhood 2001;84:227-9.
- Centers for Disease Control and Prevention (CDC), Zimmerman LA, Reef SE, McCauley MM. Control and prevention of rubella: evaluation and management of suspected outbreaks, rubella in pregnant women, and surveillance for congenital rubella syndrome. MMWR Recommendations and Reports 2001;50(RR-12):1-23.
- Doege TC, Kim KS. Studies of rubella and its prevention with immune globulin. JAMA 1967;200:584-90.


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Greetings lovely readers/viewers!
Today's post is.....the Random Beauty Tag. I was tagged by the lovely Mel from Melissa Bubbles to do this tag which has been floating around for quite some time. It's more of a chatty video so sit back, relax and enjoy the chatter! You can find the video on my YouTube channel.
Let me know what other videos you'd like to see on KaBOOM! Cosmetics in future.
Stay beautiful!


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Your momma wears combat boots!
It's funny – the PS2 is here, but everybody is still waiting for it, even though
the games look less than stellar. Like goons at a strip club we ask each other,
when's she gonna take it off? When are we gonna see what the PS2 can really
With all eyes on the coy and conservative PS2, it's entirely possible that if
a game as cool as a talking dog came along, we'd merely look at it blankly for
a moment, then give it a quarter and return our eyes to the seductive powers
of the new Playstation. While Command and Conquer: Red Alert 2 is no
talking dog, it is definitely a worthy sequel and eclipses everything the PS2
currently has to offer, except for the hype.
The story is pretty simple and wouldn't be interesting if it weren't for the
characters involved. Basically, we whupped on the Soviets last time and installed
a puppet premier named Romanov. Out of the blue, Romanov goes bad, and sends
everything he's got at the United States. As it turns out, what he's got is
quite a lot. The soviets have perfected psychic technology and use it
to brainwash Americans, who then turn on their own country and begin kicking
ass for the commies. It's a war on American soil.
In the Russian corner is aforementioned Romanov and his psychic sidekick Yuri.
The outlandish Romanov is completely perverse and unhinged. The dude is just
balls out crazy. Yuri is more of a conservative nutball, even though he's bald
with wires popping out of the back of his head. Sort of like if C&C's
Kane was in The Lawnmower Man.
On the US side, there's President Dougan, who sucks, and Tanya (played by
Kari Wuhrer, baby), who rocks. She pretty much just stands around and shows
you her boobs while the President or General guy talks, but they're very nice
boobs and well worth watching. Plus she's tough as nails.
Like all other C&C games, there's plenty of video to keep the story
moving. The presentation and scenarios in general are light-hearted and WAY
over the top, making for a fun, involving game.
The gameplay works along the same lines as its predecessors, but happens to
be a lot more fun. You still have to build a construction yard and mine tiberium.
You build reactors for energy, barracks for troops, and airports for planes,
etc. To win, you have to wipe your enemy off the map. Skeletally, the game is
identical to every other Command and Conquer.
this time around the two sides totally contrast. The checks and balances are
extensive between the units, making most wars of attrition futile and demanding
that the player attack with an assortment of units. This adds intensity to the
battles, since you have to make sure that the units cover each other and carry
out the tasks they're designed to do.
For example, the Americans get the prism tank. This tank does wonders against
buildings and infantry, but is powerless against other tanks and airborne attack.
So you've usually got to protect them with a grip of regular tanks and a fleet
of rocket pack guys (rocketeers). This combo usually works out nicely because
the tanks and rocketeers are extremely vulnerable to certain types of infantry,
which is one of the prism tank's specialties.
The tremendous unit balance is great, because instead of just turning a mob
of guys loose and watching them annihilate everything in their path (which,
I admit, can be enjoyable), you have to coordinate your units and orchestrate
their attacks, making sure they work together as a cohesive force. It makes
the player a part of the victory.
Red Alert was a much faster paced game than original
C&C, and Red Alert 2 carries on this tradition by being extremely
offense-heavy. It's very easy to score monumental damage against your opponent
in a relatively short amount of time. Your critical buildings are pretty easy
to knock out. In a sense, the game almost plays like an action game instead
of just a RTS.
Then again, such vulnerability absolutely demands an offensive strategy and injects an element of madness and instability into the game, which also adds to the fun.
Red Alert 2's graphics are okay, but not a big departure from the other
C&Cs. There are some cool lighting effects and some neat details (like
the huge flash that accompanies a nuclear missile attack), but there's never
anything that makes you say, "Hot damn, that's coooool!" (except for Tanya's
breasts, but those aren't actually a part of the game, and women have had breasts
since at least the 1980's, as far as I know).
The sound is well done, with some violent, aggressive tracks to score your violent, aggressive campaigns, and some cool sound effects to enhance the war-time mayhem.
The best part of Red Alert 2, though, is playing multi-player. While
I'm not a big fan of Westwood's online interface, laying the smack down on another
user is tons of fun and way more difficult than thrashing the computer.
While three human players will be hard pressed to beat a 'hard' computer opponent,
that shouldn't be attributed to AI, but rather to speed. The computer can do
a lot of things at once, but isn't necessarily very smart or cunning.
New to C&C multiplayer is the ability to fight battles as a certain
nationality. This feature is very similar to the ability to choose races in
Age of Empires 2, except that there aren't
any bonuses other than one new specialized unit. While it would have been nice
if the differences between the nations varied more, the new units are cool and
add new spins on already chaotic battles. For example, the Lybians get these
trucks that are packed full of nuclear explosives. While one of them isn't as
intense as a regular nuke, five of the puppies will keep the battlefield aglow
for hours.
Overall, Red Alert 2 not only lives up to its predecessors, but exceeds
them in terms of strategy and general entertainment value. While not totally
original, it's got enough intensity and excitement to have even the most jaded
real-time strategy gamer glued to his computer for hours. Death to the American
dogs, comrade.


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