Rubella

RUBELLA
AKSHAYA .G
U21MB017
RUBELLA
(GERMAN MEASLES)
• An acute childhood infection usually mild, of short duration
(approximately 3 days) and accompanied by low-grade fever,
lymphadenopathy and a maculopapular rash.
• Infection in early pregnancy may result in serious congenital
defects, including death of the foetus.
• The disease is worldwide in distribution and tends to occur in
epidemics.
• Worldwide over 100,000 babies are born with congenital rubella
syndrome every year
HISTORY
In 1941, Normal Gregg, reported the teratogenic
property of virus
In 1962, the virus was isolated
In 1967, live attenuated vaccine was prepared
EPIDEMIOLOGICAL DETERMINANTS
AGENT:
• Caused by RNA Virus of togavirus family
AGENT FACTOR
• It can be propagated in cell culture
SOURCE OF INFECTION:
HOST FACTORS • Large number of rubella cases are subclinical
PERIOD OF COMMUNUCABILITY:
ENVIRONMENTAL • A week before symptoms to about a week after rash
FACTORS appears
• Infectivity is greater 1-5 days after the appearance of rash
AGENT FACTOR AGE:

• Mainly a disease of childhood particularly in the
age group 3-10 years
HOST FACTORS • Persons older than 15 years now account for over
70% cases in developed countries
ENVIRONMENTAL Immunity:
FACTORS
• One attack results in life long immunity
• Infants of immune mother are protected for 4-6
months
AGENT FACTOR
HOST FACTORS
• Disease usually occurs in a seasonal pattern
i.e. in temperate zones during the late
ENVIRONMENTAL winter and spring, with epidemics every 4-
FACTORS 9 years
TRANSMISSION
• The virus is transmitted directly from person to person by
droplets from nose and throat, and droplet nuclei
(aerosols),from one week before onset of rash to one week after
it has faded. The portal of entry is via the respiratory route. The
virus is maintained in human population by chain transmission.
• The virus can cross the placenta (vertical transmission) and infect
the foetus in utero, leading to congenital rubella in the newborn.
INCUBATION PERIOD
2 to 3 weeks, average 18 days

CLINICAL FEATURES
• Large percentage of infection is PRODROMAL
asymptomatic SYMPTOMS
• In typical cases the clinical features LYMPHADENOPATHY

comprise the following
RASH
CLINICAL FEATURES
• Coryza, sore throat, low grade fever
PRODROMAL
SYMPTOMS • Mild, insignificant and less frequent in
children
LYMPHADENOPATHY
RASH
CLINICAL FEATURES
• Enlargement of the postauricular, occipital
PRODROMAL and posterior cervical lymph nodes appears
SYMPTOMS as early as 5-10 days before the appearance
of the rash.
LYMPHADENOPATHY • The glands may be found enlarged for 10-14
days after the rash
• This, however, is not pathognomonic since
RASH cases of clinical rubella without enlargement
of lymph nodes have been documented
CLINICAL FEATURES
• The rash is often the first indication of the disease in children.
PRODROMAL • It appears first on the face, usually within 24 hours of the onset
SYMPTOMS of prodromal symptoms.
• It is a minute, discrete, pinkish, macular rash
LYMPHADENOPATHY • Conjunctivitis may occur.
• The rash spreads rapidly to the trunk and extremities
• The rash spreads much faster and clears more rapidly
RASH • It disappears altogether by the third day.
• The rash is an inconstant feature of the disease: it is absent in
subclinical cases.
• The incidence of rubella infection without rash maybe upto 25
per cent
COMPLICATIONS
• Arthralgia
• Encephalitis
• Thrombocytopenic purpura
• Congenital malformation of foetus including death of
foetus
DIAGNOSIS
• Because of its mildness and variability of symptoms, the
disease can go unrecognized unless it is an epidemic
• Virus isolation from throat swabs
• The haemagglutination inhibition (HI) test - standard
serological test for rubella.
RUBELLA DURING
PREGNANCY
Rubella infections in pregnant women
during the first three months of pregnancy
may result in the baby being born with
birth defects or congenital rubella
syndrome
The risk and severity of abnormalities varies with the
time of infection in pregnancy
STAGE OF GESTATION RISK OF ABNORALITIES IN THE
INFANT
(%OF CASES)
First trimester 85
Second trimester 16
After 20 weeks Birth defects are uncommon

CONGENITAL RUBELLA SYNDROME
• Rubella infection inhibits cell division, and this is probably the
reason for congenital malformations and low birth weight
• The classic triad of congenital defects are
1. Deafness
2. Cardiac malformations
3. Cataracts.
Of the pregnancy can result in
spontaneous abortion and
stillbirth/foetal death
Of the babies can be born with

CRS, leading to catracts, learn-
ing disabilities, etc..,
The defects associated with CRS include
• Ophthalmic (e.g. cataracts, microphthalmia, glaucoma, pigmentary retinopathy,
chorioretinitis),
• Auditory (e.g. sensorineural deafness),
• Cardiac (e.g. peripheral pulmonary artery stenosis, patent ductus arteriosus or
ventricular septal defects)
• Craniofacial (e.g. microcephaly) anomalies.
CRS can also present with other manifestations, such as
• Meningoencephalitis
• Hepatosplenomegaly
• Hepatitis
• Thrombocytopenia
• Interstitial pneumonitis
• Radiolucency in the long bones (a characteristic radiological
pattern of CRS)
CONTROL
• Mild self limited illness
• Isolation of case in good ventilation room
• No specific treatment or Antiviral treatment is indicated
• Encourage the patient to rest
• Increase fluid intake
• Provide health teaching about rubella (cause, immunization)
PREVENTION
ACTIVE IMMUNIZATION
• The currently used rubella vaccines are based on the live attenuated
RA 27/3 strain.
• Most rubella vaccines are available in combination with other vaccine
antigens such as measles, mumps and varicella (MR. MMR, MMRV
respectively)
• Also in a monovalent
• The standard volume of a single dose of RCV is 0.5 ml, and the
vaccine is usually injected subcutaneously
Vaccination strategy for Rubella
• First protect women in 15-39 year age

• Second interrupt transmission by vaccinating children aged
1-14 years
• Third, all children at age 1 year
MMR VACCINE
Live attenuated strains of:

• Measles virus
• Mumps virus
• Rubella virus
1st Dose – 9 completed months to 12 months
2nd Dose – 16 to 24 months
PRECAUTIONS AND CONTRAINDICATIONS
• Severe allergic reactions to prior dose or vaccine component
• Pregnancy
• Active TB or Immunodeficiency (including individuals with
symptomatic HIV infection, AlDS, congenital immune disorders,
malignancies or aggressive immunosuppressive therapy)
• Severe acute illness
• Recently received blood products
PASSIVE IMMUNIZTION
• Consider only if pregnant women exposed to rubella and will not
consider termination under any circumstances.
• In these cases, administer immunoglobulin within 72hrs of exposure
• Dose – 20ml in divided doses
GLOBAL MEASLES AND RUBELLA STRATEGIC
FRAMEWORK 2021-2030 (MRSF)
VISION GOAL
“A WORLD FREE OF MEASELES “ACHIEVE AND SUSTAIN THE
AND RUBELLA” REGIONAL MEASLES AND
RUBELLA ELIMINATION GOALS”
THANK YOU

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RUBELLA

AGENT FACTOR AGE:

2 to 3 weeks, average 18 days

• In typical cases the clinical features LYMPHADENOPATHY

After 20 weeks Birth defects are uncommon

Of the babies can be born with

• First protect women in 15-39 year age

Live attenuated strains of:

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