RUBELLA Dr.RAHUL.K.R DEPT: OF SWASTHAVRITTA
RUBELLADr.RAHUL.K.R DEPT: OF SWASTHAVRITTA
What is Rubella
Rubella (German measles) is a disease caused by the rubella virus. Rubella is usually a mild illness. Most people who have had rubella or the vaccine are protected against the virus for the rest of their life. Because of routine vaccination against rubella since 1970 , rubella is now rarely reported.
History - Rubella
Infection in early pregnancy leads to fetal death or abnormalities.
The Teratogenic property of the infection was documented by an Australian ophthalmologist Norman Gregg in 1941.
Rubella( German Measles ) Rubella is also called as 3
day Measles or German Measles.
Family – Togaviridae Genus - Rubivirus In general belong to
Togavirus group
Rubella Virus
Rubella virus are ss – RNA virus Diameter 50 – 70 nm Spherical Virus carry hemagglutinin Virus multiply in the cytoplasm
of infected cell. Virus can be recovered from
nasopharynx, throat, CSF, urine.
Rashes First indicator of the disease. Minute pinkish, macular rash. First appear in face and spread rapidly to the
extremities and trunk. Disappear altogether by 3rd day. 25% of rubella cases are with out rash (subclinical) Other Enterovirus infections can produce similar
manifestations.
Main Clinical Events
The clinical events occuring in the neonatal age is more important and divided into two major groups
1 Post Natal Rubella 2 Congenital Rubella
Source of infection
There is no carrier state: the reservoir exists entirely in active human cases. The disease has an incubation period of 2 to 3 weeks.
Acquired, (i.e. not congenital), rubella is transmitted via airborne droplet emission from the upper respiratory tract of active cases. The virus may also be present in the urine, faeces and on the skin.
Systemic events of Rubella Infection
Clinical findings
Malaise Low grade fever Morbilliform rash Rash starts on Face
Extremities Rarely lasts more than 5
days No features of the rash
give clues to definitive diagnosis of Rubella.
Other manifestations and complications
May produce transient Arthritis, in women in particular.
Serious complications are Thrombocytopenia
Purpura Encephalitis
Immunity - Rubella Antibodies appear in serum as
rash fades and antibody titers raise
Rapid raise in 1 – 3 weeks Rash in association with
detection of IgM indicates recent infection.
IgG antibodies persist for life. 2nd attack is very rare.
Immunity - Protects
One attack of Rubella infection, protects for life
Immune mothers transfer antibodies to off springs who are in turn are protected for 4 – 6 months.
Post natal Rubella Occurs in Neonates and Childhood Adult infection occurs through
mucosa of the upper respiratory tract spread to cervical lymphnodes
Viremia devlops after 7 – 9 day Lasts for 13 – 15 days Leads to development of antibodies The appearance of antibodies
coincides the appearance of suggestive immulogic basis for the rash
In 20 – 50 % cases of primary infections are subclinical
Diagnosis of Rubella in Adults
Clinical Diagnosis is unreliable Many viral infections mimic Rubella Specific diagnosis of infection with 1 Isolation of virus 2 Evidence of seroconversion
Isolation and Identification of virus
Nasopharyngeal or throat swabs taken 6 days prior or after appearance of rash is a good source of Rubella virus
Using cell cultured in shell vial antigens can be detected by Immunofluorescence method.
Serology In Rubella Hemagglutination inhibition
test for Rubella is of Diagnostic significance
ELISA tests are greater importance
A raise in Antibody titers must be demonostrated between two serum samples taken at least 10 days apart.
Or Detection of Rubella specific IgM must be detected in a single specimen.
Epidemiology
Rubella is world wide in distribution Occurs round the year, Epidemics occur every 20 – 25 years Infection is transmitted by respiratory route The use of Rubella vaccine has now eliminated
both epidemic and endemic Rubella.
Treatment and Prevention
Rubella is a mild self limited illness. No specific treatment or Antiviral treatment is
indicated. However Laboratory proved and clinically missed
Rubella in the Ist 3-4 months of pregnancy is associated with fetal infections.
Congenital Rubella Syndrome(CRS)
Maternal viremia with Rubella infection during pregnancy may result in infection of placenta and fetus (vertical transmission).
The growth rate of fetal cells are reduced. Results in fewer number of cells after the birth. Lead to deranged and hypo plastic organ
development. Results in structural damage and abnormalities
Rubella infection – At various trimesters
Ist trimester infections lead to abnormalities in 85 % of cases. and greater damage to organs
2nd trimester infections lead to defects in 16 % > 20 weeks of pregnancy fetal defects are uncommon However Rubella infection can also lead to fetal
deaths, and spontaneous abortion. The intrauterine infections lead to viral excretion in
various secretion in newborn upto 12-18 months.
Classical Triad of Rubella Classical Triad Cataract Cardiac abnormalities Deafness
Other manifestations Growth retardation
Rash Hepatosplenomegaly
Jaundice Meningoencephalitis
CNS defects lead to moderate to profound mental retardation.
Congenital Rubella syndrome(CRS)
Other Neurological manifestions
Problems in balance Motor skills in
preschool children altered.
A rare complication of encephalitis can occur in second decade with Congenital rubella syndrome may progress to death.
Diagnosis ofCongenital Rubella Syndrome
Demonstration of Rubella antibodies of IgM in a new born is diagnostic value. As IgM group do not cross the placenta and they are produce in the infected fetus,
Treatment, Prevention, Control No specific treatment is availableCRS can be prevented by
effective immunization of the young children and teenage girls, remain the best option to prevent Congenital Rubella Syndrome.
The component of Rubella in MMR vaccine protects the vaccinated.
Dose 0.5ml subcutaneous.
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