Rubella (German Measles)

Rubella is a contagious viral infection caused by caused by rubella virus that occurs most often in children and young adults. Rubella infection is preventable by vaccine.

Rubella is also called germen measles. Rubella is a disease which have teratogenic (cause abnormal fetal development) affect. It is an acute childhood infection.

Epidemiological Triad

Agent – Rubella disease is caused by caused by rubella virus, RNA virus of Togavirus family. This virus is present in the nasopharynx, throat, CSF, blood and urine of a case of rubella.

Host – Rubella occurs in children in the age group 3 to 10 years.  In developed countries – age is older than 15 years

Environmental factors – It occurs during later winter and spring, in temperate (mild temperature) zone.

Mode of Transmission

Portal of entry – Respiratory route

 1. Droplets form nose, throat

2. Droplet nuclei

3. By Infected person coughs or sneezes

4. By direct contact with an infected individual’s respiratory secretions, mucus.

5. Rubella virus can cross placenta, Spread from pregnant women to their unborn children via the bloodstream.

Rubella virus can cross placenta and can cause congenital rubella in new born.

Incubation Period

Average incubation period is 17 days (with a range of 12 to 32 days).

An individual who has been infected with the rubella virus that causes rubella is contagious for 1 to 2 weeks before the onset of the rash and then rash starts on the face and spreads to the rest of the body.

Pathophysiology of Rubella

1. The infection is transmitted via direct or droplet contact with respiratory secretions.

2. Infects cells in the Upper respiratory tract

2. Rubella virus multiplies in cells of the respiratory system nasopharynx

 3. Viremic spread to target organs, spread to cervical lymphnodes.

4. Rashes and lesion on skin, cough, sore throat, joint pain developed

Congenial Rubella Syndrome (CRS)

1. Rubella virus infection early week of pregnancy by respiratory route.

2. Maternal viremia – Abortion

3. Placental infection – cross the placenta and cause fetal damage

a. Mitotic inhibition – apoptosis

Destruction of the ocular lens

Growth retardation

Bone lesion

b. Damage to vascular endothelium

Encephalitis

Mental retardation

Deafness

Clinical Features of Rubella

1. Post Natal Rubella – Occurs in Neonates and childhood

2. Congenital Rubella – results from maternal infection with rubella virus during pregnancy that infant’s infection.

Signs or Symptoms of Rubella

1. Coryza (Stuffy or runny nose), sore throat, low grade fever as prodormal symptoms.

2. Enlargement of post- Auricular and posterior cervical lymph nodes (found in the neck)

3. Rash which appears first on the face usually within the onset of prodormal symptoms. Minute and pinkish, macular rashes are appeared.

4. Conjunctivitis (Inflamed red eyes) can occur

5. Aching joints

Lab Investigation

1. Throat swabs sample

2. Serological test – Hemagglutination-inhibition test (HI)

3. ELISA test

4. Radioimmunoassay test

Treatment of Rubella

There is no specific medicine to treat rubella infection but the disease is preventable by vaccination and can treat specific symptoms of the disease.

Medicines for fever, such as Acetaminophen

Prevention and Control

1. Live attenuated vaccines–  Against rubella disease, vaccination is given in combined form as MMR.

MMR vaccine –  protects against measles, mumps and rubella infection. 

MMR-V vaccine –  protects against rubella, measles, mumps, and chickenpox

Vaccine                               Dose                        Route                     

RA 27/3                               0.5ml                      subcutaneously        

(Live attenuated)

Reaction – Mild reaction such as malaise, mild fever, mild rash and arthralgia; pain in a joint

Person who receive MMR vaccination according to vaccination schedule are usually considered protected for against measles and rubella diseases.

Note –  Pregnant women should NOT given MMR vaccine. If  rubella or are exposed to rubella during pregnancy, contact doctor immediately.

2. Immunization

3. Isolation

4. Early diagnosis

Complications of Rubella

1. Arthralgia  (pain in a joint)

2. Thrombocytopenic purpura (decrease in the number of platelets in the blood)

3. Encephalitis

Pregnancy and Rubella

Rubella is very dangerous infection for a pregnant woman and her developing baby.

Rubella virus can cross the placenta barrier and causes intra uterine infection and damge the fetus. Rubella infection inhibits cell division.

Rubella infection can cause a miscarriage or serious birth defects in a fetus, if woman is infected during pregnant. The best protection against rubella disease is MMR (measles, mumps, rubella) vaccine.

Up to 80% of infants born to mothers who had rubella during the first 12 weeks of pregnancy develop congenital rubella syndrome and CRS) and Birth Defects. This syndrome can cause one or more problems, including:

1. Growth delays – Mental retardation,  Motor retardation

2. Cataracts

3. Deafness

4. Congenital heart defects

5. Defects in other organs

6. Intellectual disabilities

7. Skin rash at birth

8. Liver and spleen damage

9. Low birth weight

10.  Microcephalus (head is smaller than normal)

11. Cerebral palsy ( disability to move and maintain balance and posture

The highest risk to the fetus is during pregnancy of the first trimester, but exposure later in pregnancy is dangerous.

Measles and Rubella Initiative

The measles and rubella initiative (M and R initiative) launched in 2001, with global partnership led by the American Red Cross, United Nations Foundation, Centres for Disease Control and Prevention (CDC), UNICEF and WHO.

The aim of this initiative is to ensuring that no child dies from measles or is born with congenital rubella syndrome (CRS). 

Rubella FAQ

1. What is congenital rubella syndrome?

Congenital rubella syndrome (CRS) is a disease in infants that results from maternal infection during pregnancy infected with rubella virus.  CRS occurs in a developing baby in the mother womb whose mother is infected with the rubella virus during pregnancy.

When mother infected with rubella infection during early pregnancy, especially during the first trimester, it causes serious consequences such as miscarriages, stillbirths, fetal death,  severe birth defects in infants such as  infants with congenital malformations, known as congenital rubella syndrome (CRS).

2. Can rubella cross the placental barrier?

Rubella virus can cross the placenta barrier from an infected pregnant woman to her developing embryo or fetus.

3.  How rubella is diagnosed?

If have appearance of rubella rash, Rubella infection is diagnosed by a blood test or virus culture, enzyme-linked immunosorbent assay (ELISA, EIA).

4. What is MMR vaccine?

The full form of MMR is Measles, Mumps, and Rubella. MMR vaccine is a vaccine that protects against measles, mumps, and rubella (German measles).