GERMAN MEASLES

• Rubella is an acute childood infection,,usually mild and contagious

• Accompanied by low grade fever,lymphadenopathy & maculopapular
rash
 INTRODUCTION
•Rubella is a contagious viral infection that occurs most often in
children and young adults of short duration (3 days) accompanied by
lymphadenopathy and maculopapular rash.
•Rubella is the leading vaccine-preventable cause of birth defects.
Rubella infection in pregnant women may cause fetal death or
congenital defects known as congenital rubella syndrome.worldwide
100,000 babies are born with congenital rubella syndrome
•There is no specific treatment for rubella but the disease is
preventable by vaccination.tends to occur by epidemics( in
prevaccinic era epidemic occurred at every 5-9 years)
•#History of about 150 years.Rubella as diaparaged until
1941.eliminated in the US.most common in asia ,africa,middle east.
•Rubella was considered a mild and benign disease until n
 CAUSATIVE AGENT
TOGAVIRUS IS A SINGLE SEROTYPE,NO CROSS REACT
WITH OTHER STRAINS, SINGLE STRANDED RNA
VIRUS,OF GENUS RUBIVIRUS,
EPIDEMOLOGICAL TRIAD
*AGENT FACTOR
 A)Agent:Rubella is caused by an RNA virus of the
togavirus family.only one antigeni type of the
virus seems to exist.The virus has been recovered
from the nasopharynx ,throat,blood,csf & urine.it
can be propogated in cell culture.
 B)Source of infection:clinical/subclinical cases of
rubella.A large number of rubella infections are ,in
fact,subclinical.This represents one of the major
differences between measles and german measles
or rubella.Their is no known carrier state for
postnatally acquired rubella.Infants born with
congenital rubella may shed the virus for months
the vaccine virus is not communicable.
 D)Period of communicability:rubella is much less
communiable than measles,probably because of
the absence of coughing in rubella.It is difficult to
state the exact period of infectibility.It
probablyextents from a week before symptoms to
about week after rashes appears,infectivity is
greater 1-5 days after appearance of rash.
*ENVIRONMENTAL FACTOR.
usually occurs in a seasonal pattern,in temperate zones during late winter and
spring ,with the epidemics every 4-9 years
*HOST
FACTOR(INTRINSIC)
 A)Age:a disease of childhood
particularly in the age group 3-10
years.Persons older than 15 years now
account for over 70 percentcases
developed in developed countries-
similar to changing epidemological
pattern with measles,following
widespread immunisation campaigns
against the disease.
 B) Immunity:one attack results in life
long immunity;second attacks are
rare.Infants of immune mothers are
protected for 4-6 months.
 *It is estimated that 10 to 40 percet of
thr population could reach adulthood
without experiencing rubella
infectionin abesnce of immunization
 …

Rubella less contagious than measles.

 General Symptom-
• Rash-start on face ;infants rash first occur ,adults symptom may prevail.50% have
no symptoms but could spread to others
• Rash
• Low fever
• Cough
• Sore throat
• Runny nose
• Headache
• Pink eye
• Arthralgia
• Malaise
• lymphadenopathy
The virus is transmitted directly from person to person
MODEbyOFdroplets from
TRANSMISSION
nose and throat and droplet nuclei(aerosol)from direct contact of saliva and
mucus.one week before onset of rash to one week after it has faded.
Portal of entry via respiratory route
The virus is maintained in human population by chain transmission.
Vertical transmission –virus can cross the placenta and infect the foetus in
utero, leading to congenital rubella in newborn.
Viral spread occur 5-7 days after exposure
 INCUBATION PERIOD
2-3 WEEKS ………………….
12-27 days ;18 days.
DUE TO ITS MILDNESS AND VARIABILITY OF
SYMPTOMS THE DISAESE CAN GO UNRECOGNISED
UNTIL ITS IS AN EPIDEMIC .

The virus remains active and contagious in the air or on infected

surfaces for up to 2 hours. It can be transmitted by an infected person
from 4 days prior to the onset of the rash to 4 days after the rash
erupts.
EPIDEMIOLOGY

CLINICAL FEATURES
20-50% Off infections are asympomatic

 PRODROMALThe prodromal symptoms (coryza,sore

throat,low-grade fever) herald the onset of viremia.They
 COMPLICATIONS:In severe cases
are generally mild and insignificant,and less frequent in arthalgia may occur in several joints
children. in adults especially in yongue
 LYMPHADENOPATHY-In susceptable individuals,the
enlargementof the post-auricular,occipital & posterior woman.
cervical lymph nodes appears as early as 5-10 days before
the appearance of the rash.This however,is not
 Encephalitis is very
pathognomonic since cases of clinical rubella without rare,thrombocytopenic purpura has
enlargement of lymphnodes have been documented.the
glands may be found enlarged for 10-14 days after the
also been observed as a
rash. complication.Mention has been made
 )RASH:The rash is often the first indication of the disease
in children.It appears first on the face,usually within 24
already about the congenital
hours of the onset of prodromal symptoms.-its malformations
aminute ,discrete ,pinkish,macular rashof measles and it
might be pruriyic.conjunctivitis may occur .The rash
spreads rapidly to the trunk and extremities,by which time
its no longer apparent on face.The rash spreads much
faster and clear more rapidly than measles.It disappears
altogether by the third day..its an inconstant feature of the
diseases and it is absent in subclinical cases,The incidence
of rubella infection without rash may be upto 25%.
lymphadenopathy
• Blood test-antibody of rubella in blood indicte rubellapositivepositive
• NASAL/THROAT SWAB-Virus isolation.test-
• Serological
o
test-HI –haeagluttination inhibition standard serological test for rubella.(serum
pretreated to remove non specific inhibitors before testing.
• ELISA test –serum pretreatment not required.-Detection of IgG is evidence of
immunity .serotype 1.To accurately confirm a recent rubella infection,rise in antibody
titer,demonstrated between 2 serum samples,10 days apart or rubella specific IgM must be
detected in a single specimen important in pregnant women.
DIAGNOSIS
.
Congenital rubella syndrome.(CRS)

 Refers to infants born with defects secondary to intrautrine infection or

 Who manifests symptoms or signs of intrauterine infection sometime afer birth.
 Congenital infection is considred to have occurred if the infant has IgM rubella
antibodies shortly after birth ( as IgM antibodies do not cross placenta
barrier ,their presence indicate that they might have been synthesized by the
infant in utero)or if IgG antibodies persist for more than 6 months ,by which
time maternally derived antibodies would have been diappeared.
 Intrauterine infection with rubella is associated with chronic persistence of the
virus in the new born.
 At birth virus easily detectable in pharyngeal secretions,,multiple organs
csf,urine & rectal swabs.
 Viral excretion may last for 12-18 months after birth, but the level of
shedding gradually decreases with age..
 Rubella infections inhibits cell division and this is probably
reason for congenital malformations and low birth weight.
 Classic triad of congenital defects ae ;1,deafness
 2,cardiac malformations 3,cataract
 Rubella infection in a women who becomes infected ( with
asympomatic /symptomatic disease)just before
consumption and upto the first 8-10 weeks of gestation
causes multiple congenital malformations in the 90% of
the infections.and may result in miscarriage or still birth..
 Congenital abnormalities related to maternal rubella
infections are rare after 16 th week of pregnancy.
.
 DEFECTS ASSOCIATED WITH
CONGENITAL RUBELLA
SYNDROME.
i. OPTHALMIC;eg-cataract,microphthalmia,glaucoma,pigmentary
retinopathy,chorioretinitis,
ii. AUDITORY;eg,sensoryneural deafness
iii. CARDIAC;eg-peripheral pulmonary artery stenosis,patent ductus
arteriosus, or ventricular septal defects. &
iv. Craniofacial ;microcephaly anomalies.,brain inflammation,learning
and behavioral differences.
Other manifestations-
meningoencephalitis,hepatospleenomegaly,hepatitis,low blood
counts- ,thrombocytopenia haemolytic anaemia-,interstitial
pneumonitis,thyroid disease,radioleucency in long bones,
• Infants who survive neonatal
period may have serious
developmental diasbilities such as

AUTISM,VISUAL AND HEARING IMPAIRMENT &

DEVELOPMENTAL DELAY.

VIRAL SHEDDING MAY CONTINUE >1 YEAR OF AGE LEADING O ITS TRANSMISSION..
All children diagnosed with measles should receive two doses of
vitamin A supplements, given 24 hours apart. This treatment
restores low vitamin A levels during measles that occur even in
well-nourished children and can help prevent eye damage and
blindness. Vitamin A supplements have also been shown to reduce
the number of measles deaths.

Treatement
• Treatment involves,treating complications & secondary infections,
• Quarantine
• Over the countermedicines like,acetaminophen-fever
• All children diagnosed with measles should receive two doses of vitamin A
supplements, given 24 hours apart. This treatment restores low vitamin A levels
during measles that occur even in well-nourished children and can help prevent eye
damage and blindness. Vitamin A supplements have also been shown to reduce the
number of measles deaths.

MEDICATION MANAGEMENT SURGERY

 PREVENTION
quarantine ,vaccination
• VACCINATION
• 1 st dose could be given at 9 months or 12 months
• Vaccination.p-attenuated RA 24/3 strain of rubella along with other vaccine
antigents such as mumps ,measles,varicella(MMR,MR,MMRV,respectively) and also
in monovalent formulation.
• MMR-VACCINE;local reaction;(pain,swelling redness),irritability,malaise,nonspecific
symptoms ,fever10-5%adverse event in immunization-arthralgia join pain,last for
10 days.self limiting ananlgesics given.,serum platelet count thrombocytopenia(15-
35 days) decreasing <50,000/ml-brusing/bleeding.seizures,-febrile seizures,(6-
12days)at temperature<38.,afebrile,at normal temperature.
• -protect against measles mumps and rubella.age above 12 months.

• MMMR-VACCINE-measles,mumps,ubella,chickenpox’age-children 12 months -12

years age

• Use of immunoglobulin-0.25ml/kg1-6 year old affected0.5ml/kg immunosupressed.

• IG general 20 ml
 outbreaks
• Outbreaks
• During outbreaks of measles, RCVs may be administered to
infants as young as 6 months as an offlabel indication.
Because of the possibility of lower levels of seroconversion, the
dose administered
• at 6 months should not be counted as a valid first dose, and
the child should be vaccinated with
• subsequent dose(s) of RCVs according to the national
immunization schedule.
 Co administration
• Co-administration
• RCVs can be administered concurrently with inactivated vaccines. Live vaccines should be
given
• either simultaneously or at least 4 weeks apart. An exception to this rule is oral poliovirus
vaccine,
• which can be given at any time before, at the same time as or after RCV without interfering in
the
• response to either vaccine. WHO recommends co-administration of RCV and YF vaccines.
Although
• there may be immunological interference between the 2 vaccines when they are administered
• simultaneously, resulting in somewhat lower titres of rubella and YF antibodies, the
seroconversion
• rates were found to be the same.
• Precautions and contraindications
• RCVs should not be given to anyone who has experienced a s
Precautions and contraindications
Precautions and contraindications
RCVs should not be given to anyone who has experienced a
severe allergic reaction after a previous
vaccine dose or vaccine component. It is recommended not
to provide the vaccine to those with
active TB or severe immunodeficiency (including individuals
with symptomatic HIV infection, AIDS,
congenital immune disorders, malignancies or aggressive
immunosuppressive therapy).
Rubella vaccination should be avoided in pregnancy because
of a theoretical (but never
demonstrated) risk of teratogenic outcomes. Women
planning
 EXCIPIENTS
LIVE VACCINE HAS NO ADJUVANTS USED
• MMR-<25 micrograms of neomycin per dose.
• storage
• When stored at 4 degree celsius ,most RCVs have shelf life-2-3 years.monovalent rubrlla MR ,MMR should be stored at 2-8 degree
celsius.protected from light.
• Dose
• Standard volume of single dose 0.5 ml. injected subcutaneously.site-anterolateral thigh/outer aspect of upper arm.
 All children diagnosed with measles should receive two doses of
vitamin A supplements, given 24 hours apart. This treatment restores
low vitamin A levels during measles that occur even in well-nourished
children and can help prevent eye damage and blindness. Vitamin A
supplements have also been shown to reduce the number of measles
deaths.
THANK YOU