Rubella( German

measles )

Etiology
Togaviridae family --- genus Rubivirus
single-stranded RNA enveloped virus , Its core
protein is surrounded by a single-layer
lipoprotein envelope with spike-like
projections containing two glycoproteins, E1
and E2.
only one antigenic type
humans are its only known reservoir

Pathogenesis and Pathology

Transmission: respiratory droplets.
Primary implantation and replication in the
nasopharynx are followed by spread to the lymph
nodes. Subsequent viremia occurs, which in
pregnant women often results in infection of the
placenta. Placental virus replication may lead to
infection of fetal organs.
Individuals with acquired rubella may shed virus
from 7 days before rash onset to 57 days
Infants with CRS may shed large quantities of virus
from bodily secretions, particularly from the throat
and in the urine, up to 1 year of age. Outbreaks of
rubella, including some in nosocomial settings,
have originated with index cases of CRS. Thus only
individuals immune to rubella should have contact
with infants who have CRS

Clinical Features: Acquired

Rubella
Up to 50% subclinical or inapparent.
Young chid: generalized maculopapular rash that usually
lasts for up to 3 days . The rash is usually mild and may be
difficult to detect in persons with darker skin
older children and adults: The incubation period is 14 days
(range, 1223 days), 1- to 5-day prodrome often precedes
the rash and may include low-grade fever, malaise, and
upper respiratory symptoms.
Lymphadenopathy, particularly occipital and postauricular,
may be noted during the second week after exposure.
arthralgia and arthritis are common in infected adults,
particularly women
Thrombocytopenia and encephalitis are less common
complications
.

 Congenital Rubella Syndrome

infected during pregnancy(first trimester): miscarriage, fetal death,

premature delivery, or live birth with congenital defects.
commonly relate to the eyes, ears, and heart
Transient Manifestation: Hepatosplenomegaly , Interstitial
pneumonitis, Thrombocytopenia with purpura/petechiae (e.g.,
dermal erythropoiesis, or "blueberry muffin syndrome"), Hemolytic
anemia, Bony radiolucencies, Intrauterine growth retardation,
Adenopathy , Meningoencephalitis
Permanent Manifestations: Hearing impairment/deafness, Congenital
heart defects (patent ductus arteriosus, pulmonary arterial stenosis),
Eye defects (cataracts, cloudy cornea, microphthalmos, pigmentary
retinopathy, congenital glaucoma), Microcephaly, Central nervous
system sequelae (mental and motor delay, autism)

Diagnosis:
acquired

scarle fever, roseola, toxoplasmosis, fifth disease, measles, and

illnesses with suboccipital and postauricular lymphadenopathy
Laboratory :
Serology: acute: 1- IgM antibodies
2- fourfold rise in IgG antibody titer between acuteand convalescent-phase specimens.
3- IgG avidity testing is used in conjunction with IgG
testing. Low-avidity antibodies indicate recent infection. Mature (highavidity) IgG antibodies most likely indicate an infection occurring at
least 2 months previously.
Rubella virus can be isolated from the blood and nasopharynx during
the prodromal period and for as long as 2 weeks after rash onset.
However, as the secretion of virus in individuals with acquired rubella is
maximal just before or up to 4 days after rash onset, this is the optimal
time frame for collecting specimens for viral cultures.
Rubella RNA detection by reverse-transcriptase polymerase chain
reaction (RT-PCR) is a more recently developed technique for rubella
diagnosis.

Congenital Rubella Syndrome

infant presents with a combination of cataracts, hearing
impairment, and heart defects
serologic assays: serum IgM antibodies may be present for up to 1
year after birth. In some instances, IgM may not be detectable until
1 month of age
rubella serum IgG titer persisting beyond the time expected after
passive transfer of maternal IgG antibody (i.e., a rubella titer that
does not decline at the expected rate of a twofold dilution per
month)
virus isolated: throat swabs and less commonly from urine and
cerebrospinal fluid. Infants with congenital rubella may excrete
virus for up to 1 year, but specimens for virus isolation are most
likely to be positive if obtained within the first 6 months after birth.
Rubella virus in infants with CRS can also be detected by RT-PCR.

Pregnant women
screening for rubella IgG antibodies in prenatal care
positive IgG antibody serologic test are considered
immune.
Susceptible pregnant women should be vaccinated
postpartum
A susceptible pregnant woman exposed to rubella virus
should be tested for IgM antibodies and a fourfold rise in
IgG antibody titer between acute- and convalescentphase serum specimens : during the first 11 weeks of
gestation, up to 90% deliver an infant with CRS; for
maternal infection during the first 20 weeks of
pregnancy, the CRS rate is 20%.

Treatment
No specific therapy
Symptom-based treatment
Immunoglobulin does not prevent rubella
virus infection only in pregnant woman who
has been exposed to rubella will not consider
termination of pregnancy under any
circumstances( IM administration of 20 mL of
immunoglobulin within 72 h of rubella
exposure)

Prevention
Rubella vaccine contains live attenuated rubella virus grown in
human diploid cells (RA 27/3). combined with measles and
rubella (MR) or measles, mumps, and rubella (MMR)
formulations, tetravalent measles, mumps, rubella, and varicella
(MMRV) vaccine.
One dose induces seroconversion in 95% of persons >1 year of
age. rubella vaccination in the United States is a first dose of
MMR vaccine at 1215 months of age and a second dose at 46
years.
Indication: children >1 year of age, adolescents and adults
without documented evidence of immunity, individuals in
congregate settings (e.g., college students, military personnel,
child care and health care workers), and susceptible women
before and after pregnancy.
women known to be pregnant should not receive an RCV. In
addition, pregnancy should be avoided for 28 days after receipt
of an RCV. In follow-up studies of 680 unknowingly pregnant
women who received rubella vaccine, no infant was born with
CRS. Receipt of an RCV during pregnancy is not ordinarily a
reason to consider termination of the pregnancy.