RUBELLA

(GERMAN MEASLES)

A mild, febrile viral disease. A fine pinkish, flat

rash begins 1 or 2 days after the onset of
symptoms; it starts on the face and neck and
spreads to the trunk, arms, and legs. A milder
disease than hard measles with fewer
complications. During first trimester of
pregnancy, may cause CONGENITAL RUBELLA
SYNDROME in fetus; this can lead to
intrauterine death, spontaneous abortion, or
congenital malformations of major organ
systems.

Etiologic agent: Rubella virus; a

RNA virus in the family Togaviridae.

The rubella virus is transmitted by

airborne droplets when infected
people sneeze or cough. Humans are
the only known host.

Clinical Manifestations

In children, the disease is usually mild, with symptoms including a

rash, low fever (<39C), nausea and mild conjunctivitis. The rash,
which occurs in 5080% of cases, usually starts on the face and
neck before progressing down the body, and lasts 13 days. Swollen
lymph glands behind the ears and in the neck are the most
characteristic clinical feature. Infected adults, more commonly
women, may develop arthritis and painful joints that usually last
from 310 days.
Once a person is infected, the virus spreads throughout the body in
about 5-7 days. Symptoms usually appear 2 to 3 weeks after
exposure. The most infectious period is usually 15 days after the
appearance of the rash.
When a woman is infected with the rubella virus early in pregnancy,
she has a 90% chance of passing the virus on to her fetus. This can
cause miscarriage, stillbirth or severe birth defects known as CRS.
Infants with CRS may excrete the virus for a year or more.

Congenital rubella syndrome

Children with CRS can suffer hearing impairments,

eye and heart defects and other lifelong disabilities,
including autism, diabetes mellitus and thyroid
dysfunction many of which require costly therapy,
surgeries and other expensive care.
Vaccination: Rubella vaccines are available either
in monovalent formulation (vaccine directed at only
one pathogen) or more commonly in combinations
with other vaccines such as with vaccines against
measles (MR), measles and mumps (MMR), or
measles, mumps and varicella (MMRV).

Management

Pregnant women
-Should be tested for immunity to rubella prior to, or during
early pregnancy. If found not to be immune, MMR
vaccination is given after delivery of the baby but before
discharge from the maternity unit. Rubella vaccine should
not be given to a woman known to be pregnant and
pregnancy should be avoided for one month after
vaccination.
-With suspected rubella or exposure to rubella should seek
specialist obstetric advice, regardless of a history of rubella
or rubella vaccination. Rubella re-infection, often without
symptoms, can occur in individuals who have had previous
infection or vaccination, although fetal damage is very rare
in these cases.

Diagnosis
Rubella is diagnosed by a blood test. Clinical diagnosis
based on the appearance of the rash is unreliable.
Incubation period
(time between becoming infected and developing
symptoms)
16 to 18 days with a range of 14 to 23 days.
Infectious period
(time during which an infected person can infect
others)
Up to 7 days before and at least 4 days after
appearance of the rash.