Dr.Wijdan Community Medicne Lec.

Rubella
From Latin meaning "little red"
Discovered in 18th century - thought to be variant of measles
First described as distinct clinical entity in German literature
Congenital rubella syndrome (CRS) described by Gregg in 1941

Rubella Case Definition:

Acute onset of generalized maculopapular rash, and temperature of >
(37.2 °C), and arthralgia or arthritis, lymphadenopathy, or
conjunctivitis
Causative agent:
Rubella virus is an enveloped , positive stranded RNA virus
classified as Rubivirus in the Togaviridae family.
One antigenic type
Rapidly inactivated by chemical agents, ultraviolet light, low pH, and
heat

Epidemiology:
• Reservoir Human
• Transmission Respiratory
Subclinical cases may transmit
• Temporal pattern Peak in late winter and early spring
• Communicability
• 7 days before to 5-7 days after the onset of rash .

Infants with Congenital Rubella Syndrome may shed virus for a year or more.
Occurance:
Before widespread use rubella vaccine, rubella occurred world wide at
endemic levels with epidemics every 5-9 years,with most cases occurring
in children. The incidence of rubella in the United States has decreased by
approximately 99% from the prevaccine era .The risk of acquiring rubella
has decreased in all age groups, including adolescents and young adults

In countries where rubella vaccine has not been introduced, rubella remain
endemic. In 1999, an estimated minimum of 100000 CRS cases occurred
each year in developing countries.

. In the vaccine era , most cases have occurred in young unimmunized adults in
outbreaks on college campuses and in occupational settings .Although the
number of susceptible people has decreased since the introduction and
widespread use of rubella vaccine, recent serologic surveys indicates that
1
 Dr.Wijdan Community Medicne Lec.1

approximately 10% of young adults are susceptible to rubella .

Rubella Pathogenesis:
Respiratory transmission of virus
Replication in nasopharynx and regional lymph nodes
Viremia 5-7 days after exposure with spread to tissues
Placenta and fetus infected during viremia
• .

Rubella Clinical Features:

Incubation period 14 days (range 12-23 days)
Prodrome of low-grade fever
Maculopapular rash 14-17 days after exposure
• Lymphadenopathy in second week
• Rubella Complications:
Arthralgia or arthritis adult female up to 70%
children rare
Thrombocytopenic purpura 1/3000
Encephalitis 1/6000
Neuritis rare
Orchitis rare

Congenital Rubella Syndrome:

Infection may affect all organs May lead to fetal death or premature
delivery
Severity of damage to fetus depends on gestational age
Up to 85% of infants affected if infected during first trimester.
Deafness
Cataracts
Heart defects
Microcephaly
Mental retardation
Bone alterations
Liver and spleen damage

• Rubella Laboratory Diagnosis:

• Isolation of rubella virus from clinical specimen (e.g., nasopharynx,
urine)
• Positive serologic test for rubella IgM antibody
• Significant rise in rubella IgG by any standard serologic assay (e.g.,

2
 Dr.Wijdan Community Medicne Lec.1

enzyme immunoassay)
• Rubella Outbreak Control Guidelines:
• Laboratory diagnosis of rubella and CRS
• Step-by-step guidelines on evaluation and management of outbreak
• Rubella prevention and control among women of childbearing age
• Rubella and CRS surveillance

• Rubella Vaccine:
• CompositionLive virus
• Efficacy 95% (Range, 90%-97%)
• Duration of
Immunity Lifelong
• Schedule At least 1 dose
• Should be administered with measles and mumps as MMR or with
measles, mumps and varicella as MMRV

• Rubella Vaccine (MMR) Indications:

• All infants 12 months of age and older
• Susceptible adolescents and adults without documented evidence of
rubella immunity
• Emphasis on nonpregnant women of childbearing age

• MMR Adverse Reactions:

• Fever 5%-15%
• Rash 5%
• Joint symptoms 25%
• Thrombocytopenia <1/30,000 doses
• Parotitis rare
• Deafness rare
• Encephalopathy <1/1,000,000 doses
• Rubella Vaccine Arthropathy:
• Acute arthralgia in about 25% of vaccinated, susceptible adult
women
• Acute arthritis-like signs and symptoms occurs in about 10% of
recipients
• Rare reports of chronic or persistent symptoms

Population-based studies have not confirmed an association with rubella

3
 Dr.Wijdan Community Medicne Lec.1

vaccine

MMR Vaccine Contraindications and Precautions:

1- Severe allergic reaction to vaccine component or following a prior
dose
2- Pregnancy
3- Immunosuppression.
4- Moderate or severe acute illness.

Vaccination of Women of Childbearing Age:

Ask if pregnant or likely to become so in next 4 weeks
Exclude those who say "yes"
For others
- explain theoretical risks
- vaccinate

Isolation of the hospitalized patients:

For postnatal rubella, droplet precautions are recommended for 7 days after the
onset of rash. Contact isolation is indicated for children with proven or
suspected congenital rubella until they are one year of age, unless
nasopharyngeal and urine culture results after three months of age
repeatedly negative for rubella virus.

Preventive Measures:
1. Educate the general public on mode of transmission , and stress the need for
rubella immunization, health care provider must be aware of the risks
caused by rubella in pregnancy.
2. WHO recommend use of vaccine in all countries where control or
elimination of CRS is considered a public health priority.
Two approaches are recommended to prevent the occurrence of CRS:

a) Prevention of CRS only , through immunization of adolescent girls or

women in childbearing age.
b) Elimination of rubella as well as CRS through universal immunization of
infants and ensuring immunity in women of childbearing age For
increased impact men should be vaccinated
Control of patient, contacts and the immediate enviruments
1. Report to local health authority: in countries where rubella eradication is a
goal, all cases of rubella and CRS should be reported.
2. Isolation: In hospital, patients with rubella should be managed under contact

4
 Dr.Wijdan Community Medicne Lec.1

isolation precautions. Exclude children from school and adult from work
for 7 days after onset of rash.
3. Concurrent disinfection: Not applicable
4. Quarantine : Not applicable

5. Immunization of contacts: Immunization of contacts will not necessarily

prevent the infection or illness . Passive immunization with IG is not
indicated .
6. Investigation of contact and source of infection .
7. Specific treatment : None, only supportive.

Saif AlDeen Adil Kamil