Rubella

Lilian B . Rosario, MD, FPPS

Rubella
Family: Togaviridae

Genus : Rubivirus

Rubella: latin word

“little red”
 “German Measles” or 3
day measles
 History
As German measles: In mid 18th century, first described by German
physician, Dr. Friedrich Hoffmann ( 1740) , confirmed by Bergen (1752)
and Orlow in 1758
1814 : Dr George de Maton, suggested Rubella as distinct
disease from measles and scarlet fever
Rubella : 1866: Henry Veale, English surgeon, described an outbreak
in India. He coined the name Rubella ( L: little red)
1914 : Dr Alfred Fabian Hess – Rubella was caused by a virus
As 3 day measles : typical course of rubella exanthem 1st day - that
starts on the face and spreads centrifugally to trunk and extremities
w/in 24 hours. 2nd day- begins to fade on the face going downwards
3rd day- disappears through out the body.
1962: virus was isolated
1967: attenuated vaccine
1941: Dr Norman McAllister
Gregg, Australian
Ophthalmologist found 68/ 78
cases of Congenital cataracts in
infants had mothers with
rubella in early trimesters
( teratogenic property of
rubella)
1940-41, epidemic through an
army training camps in
Australia, and many young men
carried infection home on leave
 Epidemiology Determinants
Worldwide in distribution
Occurs round the year
Agent factors
Epidemics occur every 20-25
years
Transmission: air borne Host factors
respiratory route ( replicates in
nasopharynx and lymph nodes)
Environmental
May also be present in urine,
feces, skin
factors
Rubella vaccine (MMR)-
prevented/ eliminated both
epidemic and endemic Rubella :
USA, developed countries
Rubella virus: causative agent
ssRNA Virus
One antigenic type
50- 70 nm in diameter
Enveloped spherical
Virus carry hemagglutinin
Multiply in the cytoplasm
of infected cell
Highly sensitive to heat,
extremes of Ph and UV
light
At 4 deg C, relatively stable
for 24 hours
 Agent / host factors
Source of infection: Period of communicability
Subclinical Probably extends from a
Clinical week before symptoms
Congenital from to about a week after the
infected pregnant appearance of rash
women to fetus Infectivity is highest
No known carrier state when the rash is
erupting
 Agent/ host factors
Age: Immunity:
Most common in Disease results in “life
children 3-10 years of age long “ immunity
Following widespread Infants of immune
immunization campagne mothers are protected
persons older than 15 y.o for 4-6 months
account for 70% cases in
developed countries
 Clinical Manifestations
Generally appear 2-3 weeks after exposure to the virus;
mild signs / symptoms; typically lasts 3 days..
Fever: 38.9 deg C or lower
Headache
Conjunctivitis
Coryza
Lymhadenopathies: pre or post auricular nodes,
cervical, and base of skull
Exanthem : maculo papular rash , centrifugal
distribution “ blue berry muffin lesions”
Joint tenderness in young adults
Clinical Manifestations
Probability of Percentage of Vertical Transmission in Age of Gestation ( AOG)
0-28 days AOG - 43 % transmission

0- 12 weeks AOG - 51%

13- 26 weeks AOG – 23%

Probability of infection is rare if Rubella is contracted

at 3rd trimester
 Maternal Diagnosis:

IgG titer between Acute and Convalescent in serum: 4fold

rise
- obtatined within 7 to 10 days after onset of rash
- Repeated 2 to 3 weeks later
Presence of Rubella specific IgM
Positive Rubella culture
- can be isolated from nasal, blood, throat, urine or
CSF
- isolated from pharynx 1 week before rash and 2 weeks
after the rash
Vaccine: