Difference between revisions of "Rubella" - New World Encyclopedia

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{{Infobox_Disease
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  Name       = Rubella |
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| Name          = Rubella
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  ICD10       = {{ICD10|B|06||b|00}} |
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  ICD9       = {{ICD9|056}} |
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  eMedicine_mult = {{eMedicine2|peds|2025}} {{eMedicine2|derm|259}} |  
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| name = ''Rubella virus''
 
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'''Rubella''', commonly known as '''German measles''', is a [[disease]] caused by the '''''rubella virus'''''. It is often mild and an attack can pass unnoticed. However, this can make the virus difficult to diagnose. The virus usually enters the body through the [[nose]] or [[throat]]. The disease can last 1-5 days. Children recover more quickly than adults. Like most viruses living along the respiratory tract, it is passed from person to person by tiny droplets in the air that are breathed out. Rubella can pose a serious risk as it can also be transmitted from a mother to her developing baby through the bloodstream via the [[placenta]]. If the mother is infected within the first 20 weeks of pregnancy, the child may be born with [[congenital rubella syndrome]], which includes a range of birth defects. The virus has an [[incubation period]] of 2 to 3 weeks during which it becomes established.
  
 +
==Symptoms==
 +
[[Image:Rubella.JPG|thumb|Rubella rash on the abdomen]]
 +
Symptoms of rubella include:
  
−
==RUBELLA==
+
Children: Low grade fever, swollen glands, joint pain, headache, conjunctivitis, rash
−
 
 
−
 
 
−
Rubella, which literally means “little red” in German, is otherwise known as German measles or “three ay measles”. Earlier, it was regarded as a variant of measles.
 
−
 
 
−
It is a contagious respiratory, viral illness that causes mild symptoms, in the case of children and adults. But its effects are far more serious and damaging on fetuses, especially if the infection is contracted in the first trimester of pregnancy.
 
−
 
 
−
The infection first starts in the upper respiratory tract; then spreads to the epithelium, lymph nodes and other tissues. After an incubation period of approximately 2 weeks rashes appear.
 
−
 
 
−
 
 
−
==Causes==
 
−
 
 
−
Rubella is caused by a virus called a Rubivirus, which can only survive on human beings. It can be spread from a pregnant mother to the unborn child, or from secretions from another infected person. It is most prevalent in late winter and early spring, spreading through the air or by close contact.
 
−
 
 
−
Congenital rubella syndrome occurs in 25% or more of infants born to women who acquired rubella during the first trimester of pregnancy. Birth defects are rare if the infection occurs after the 20th week of pregnancy.
 
−
 
 
−
Virus from congenital infections persists after birth. Those with congenital infections can infect others after birth for a year or more. The virus can be present in naso-pharyngeal secretions, urine and feces.
 
−
 
 
−
Since patients are contagious beginning 7 days before the onset of the rash to 14 days after the rash has appeared, they may be infectious before they even realize they have the disease.
 
  
 +
Adults and children:
 +
*swollen [[gland]]s or lymph nodes (may persist for up to a week)
 +
*[[fever]] (rarely rises above 38 degrees Celsius [100.4 degrees Fahrenheit])
 +
*rash (Appears on the face and then spreads to the trunk and limbs. It appears as pink dots under the skin. It appears on the first or third day of the illness but it disappears after a few days with no staining or peeling of the skin)
 +
*[[Forchheimer's sign]] occurs in 20% of cases, and is characterized by small, red [[papule]]s on the area of the [[soft palate]]
 +
*flaking, dry skin
  
 +
*nerves become weak or numb (very rare)
  
 
==Risks==
 
==Risks==
 +
Rubella can affect anyone of any age and is generally a mild disease. However, rubella can cause [[congenital rubella syndrome]] in the fetus of an infected pregnant woman. Usually occurs between 14 - 21 weeks of pregnancy.
  
−
Progressive rubella panencephalitis is an extremely rare slow virus disease. It usually develops in the teens with death within 8 years. Most often it is stems from congenital rubella or associated with childhood rubella.
+
==Prevention and treatment==
−
 
+
Symptoms are usually treated with [[paracetamol]] until the disease has run its course. There is no treatment available for congenital rubella.  
−
The risk to a fetus is highest in the first few weeks of pregnancy and then declines in terms of both frequency and severity, although there is still some risk in the second trimester. The virus infects the placenta and then spreads to the fetus. A miscarriage or stillbirth may even occur.
 
−
 
 
−
Congenital rubella syndrome can have devastating effects:
 
−
 
 
−
*Hearing loss.
 
−
*Heart defects such as ductus arteriosis
 
−
*Neurologic problems such as psychomotor retardation, mental retardation and microcephaly
 
−
*Ophthalmic problems such as cataract, glaucoma, retinopathy, microphthalmia
 
−
 
 
−
A host of other problems like bone lesions and pneumonitis can also occur. Patients with congenital rubella syndrome may develop additional complications including diabetes mellitus (up to 20%), thyroid dysfunction, growth hormone deficiency and ocular complications.
 
−
 
 
−
 
 
−
==Signs & Symptoms==
 
−
 
 
−
Young children generally have few symptoms, but adolescents and adults may experience fever, sore throat, headache, uneasiness and a runny nose before the rash appears. A person can transmit the disease from 1 week before the onset of the rash, until 1-2 weeks after the rash disappears.
 
−
 
 
−
Children develop signs of rubella 14 to 21 days after coming in contact with the infection. It is important to know that a child is most contagious when the rash is erupting.
 
−
 
 
−
Childhood rubella can be identified when the child develops the following pattern:
 
−
 
 
−
 
 
−
 
 
−
*Uneasiness, low fever and diarrhea, which may last up to five days.
 
−
 
 
−
*The rash then appears as a pink rash with areas of small, raised lesions.
 
−
 
 
−
*The rash first appears on the face, then spreads downward to the hands and feet. As the rash spreads to the arms and legs, the rash on the face fades.
 
−
 
 
−
*The rash disappears by the fifth day. And sometimes even by the third day.
 
−
 
 
−
*The lymph nodes, particularly those behind the ears, may become enlarged and tender.
 
−
 
 
−
*Older children and adolescents may develop some soreness and inflammation in their joints.
 
−
 
 
−
 
 
−
 
 
−
==Diagnosis==
 
−
 
 
−
The symptoms of rubella may be very similar to other skin conditions. For an accurate diagnosis, a rubella serology (blood test) and a viral culture with nasal/ throat swab must be conducted, apart from physical examination.
 
−
 
 
−
Examining the patient’s medical history is also vital in diagnosing the disease. Since rashes are not always present, there are chances for the infection to go unrecognized.
 
−
 
 
−
 
 
−
 
 
−
==Prevention==
 
−
 
 
−
The good news is that vaccination can prevent Rubella, for a lifetime.
 
−
 
 
−
The MMR vaccine, which is one of the recommended childhood immunizations, is a "3-in-1" vaccine. This combined vaccine protects against measles, mumps, and rubella – all of which are potentially serious diseases for infants.
 
−
 
 
−
Proof of MMR vaccination is usually required for school/ kindergarten entry.
 
−
 
 
−
The MMR schedule:
 
−
 
 
−
*The first shot is recommended at 12-15 months.
 
−
*The second one is recommended prior to school entry at 4-6 years, but can be given at any time thereafter.
 
−
 
 
−
 
 
−
Precautions should also be taken to prevent the spread of rubella:
 
−
 
 
−
*Children should not attend school for seven days after the onset of the rash.
 
−
 
 
−
*Children who are born with rubella are considered contagious for the first year of life.
 
−
 
 
−
*Making sure that all of your child's contacts have been properly immunized.
 
−
 
 
−
*Women of childbearing age who are unsure of their immunity to rubella should be tested before attempting to start a family. If immunity is not present, immunization can be given if conception can be prevented for 28 days after the vaccination. Vaccination should not be given at any time during pregnancy or to a person with an immune system altered by cancer, corticosteroid therapy, or radiation treatment. Although great care is taken not to give vaccine to an already pregnant woman, in the rare instances where that has occurred, no abnormalities have been detected in the infants.
 
−
 
 
−
Most people who receive the MMR will have no associated problems. Others may have minor problems, such as soreness and redness at the injection site or fevers.
 
−
 
 
−
It would be advisable for those born after 1956 to receive MMR if they are uncertain of their immunization status or if they have only had one MMR prior to school entry. Those born during or prior to 1956 are presumed to be immune. Many people within that age group had the actual diseases during childhood.
 
−
 
 
−
 
 
−
 
 
−
==Treatment==
 
−
 
 
−
The truth is that there is no treatment for this disease. Treatment only aims to prevent the disease or decrease the severity of the symptoms.
 
−
 
 
−
Acetaminophen is usually given to reduce fever. Increased fluid intake and plenty of rest is also recommended.
 
  
−
The treatment for congenital rubella syndrome depends on several factors:
+
Fewer cases of rubella have occurred ever since a [[vaccine]] became available in [[1969]], although decreased uptake of the [[MMR vaccine]] (e.g. in the UK) is expected to lead to a rise in incidence. In most Western countries, the vast majority of people are vaccinated against rubella as children at 12 to 15 months of age. A second dose is required before age 11. The vaccine may give lifelong protection against rubella. A side-effect of the vaccine can be transient [[arthritis]].
  
−
*The child's age, overall health, and medical history
+
The [[Immunization (medicine)|immunization]] program has been quite successful with [[Cuba]] declaring the disease eradicated in the [[1990s]] and the [[United States]] eradicating it in [[2005]]/<ref>{{cite news
−
*The extent of the disease
+
| first = Karen
−
*The child's tolerance for specific medications, procedures, or therapies
+
| last = Pallarito
 +
| title = Rubella No Longer a Threat in the U.S.
 +
| url = http://www.forbes.com/lifestyle/health/feeds/hscout/2005/03/21/hscout524659.html
 +
| work= Forbes.com
 +
| date = [[2005-03-21]]
 +
| accessdate = 2007-06-13
 +
}}</ref> Every minister of health in [[the Americas]] plans to eliminate the disease by [[2010]].
  
 +
==History==
  
 +
[[Friedrich Hoffmann]] made a clinical description of rubella in 1740.<ref name=Ackerknecht1982>{{cite book |author=Ackerknecht, Erwin Heinz |title=A short history of medicine |publisher=Johns Hopkins University Press |location=Baltimore |year=1982 |pages=129 |isbn=0-8018-2726-4}}</ref> Later descriptions by de Bergen in 1752 and Orlow in 1758 supported the belief that this was a derivative of measles. In 1814, George de Maton first suggested that it be considered a disease distinct from both measles and scarlet fever. All these physicians were German, and the disease was known medically as Rötheln (from the German name ''Röteln''), hence the common name of "German measles".<ref name=Ackerknecht1982/><ref name=Lee2000>{{cite journal |author=Lee JY, Bowden DS |title=Rubella virus replication and links to teratogenicity |journal=Clin. Microbiol. Rev. |volume=13 |issue=4 |pages=571-87 |year=2000 |pmid=11023958 |url=http://cmr.asm.org/cgi/content/full/13/4/571}}</ref><ref name=patientPlus>{{cite web
 +
| date = [[2006-05-08]]
 +
| url = http://www.patient.co.uk/showdoc/40024614/
 +
| title = Rubella
 +
| publisher = PatientPlus
 +
| accessdate = 2007-07-03
 +
}}</ref><ref name=cdc>{{cite book
 +
| author = Atkinson W, Hamborsky J, McIntyre L, Wolfe S, eds.
 +
| year = [[2007]]
 +
| url = http://www.cdc.gov/vaccines/pubs/pinkbook/pink-chapters.htm
 +
| title = Epidemiology and Prevention of Vaccine-Preventable Diseases. 10th ed.
 +
| chapter = Chapter 12. Rubella
 +
| chapterURL = http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/rubella.pdf
 +
| publisher = Centers for Disease Control and Prevention
 +
| accessdate = 2007-07-03
 +
}}</ref><ref name=MoHNZ>{{cite book
 +
| year = 2006
 +
| month = April
 +
| title = Immunisation Handbook 2006
 +
| publisher = Ministry of Health, Wellington, NZ.
 +
| url = http://www.moh.govt.nz/moh.nsf/indexmh/immunisation-handbook-2006
 +
| chapter = Chapter 11 - Rubella
 +
| chapterURL = http://www.moh.govt.nz/moh.nsf/pagesmh/4617/$File/2006-11rubella.pdf
 +
| isbn=0-478-29926-5
 +
| accessdate = 2007-07-03
 +
}}</ref><ref name=EPI>{{cite web
 +
| year = 1998
 +
| month = August
 +
| url = http://www.ops-oms.org/english/ad/fch/im/nlrubella_PublicHealthBurdenRubellaCRS_Aug1998.pdf
 +
| title = EPI Newsletter Volume XX, Number 4
 +
| publisher = Pan American Health Organization
 +
| accessdate = 2007-07-03
 +
}}</ref>
  
−
==References==
+
English Royal Artillery surgeon, Henry Veale, observed an outbreak in India. He coined the euphonious name "rubella" (from the Latin, meaning "little red") in 1866.<ref name=MoHNZ/> It was formally recognized as an individual entity in 1881, at the International Congress of Medicine in London.<ref name=EPI/> In 1914, Alfred Fabian Hess theorised that rubella was caused by a virus, based on work with monkeys.<ref name=whonamedit>{{cite journal
 +
| first = Alfred Fabian
 +
| last = Hess
 +
| year = 1914
 +
| title = German measles (rubella): an experimental study
 +
| journal = The Archives of Internal Medicine
 +
| location = Chicago
 +
| volume = 13
 +
| pages = 913-916
 +
}} as cited by {{cite web
 +
| first = Ole Daniel
 +
| last = Enersen
 +
| url = http://www.whonamedit.com/doctor.cfm/2283.html
 +
| title = Alfred Fabian Hess
 +
| publisher = WhoNamedIt
 +
| accessdate = 2007-07-03
 +
}}</ref> In 1938, Hiro and Tosaka confirmed this by passing the disease to children using filtered nasal washings from acute cases.<ref name=cdc/>
  
−
Retrieved from:
+
In 1940, there was a widespread epidemic of rubella in Australia. Subsequently, opthalmologist Norman McAllister Gregg found 78 cases of congenital cataracts in infants and 68 of them were born to mothers who had caught rubella in early pregnancy.<ref name=Lee2000/><ref name=cdc/> Gregg published an account, ''Congenital Cataract Following German Measles in the Mother'', in 1941. He described a variety of problems now know as [[congenital rubella syndrome]]  (CRS) and noticed that the earlier the mother was infected, the worse the damage was.<ref name=EPI/> The virus was isolated in tissue culture in 1962 by two separate groups led by physicians Parkman and Weller.<ref name=MoHNZ/><ref name=Lee2000/>
  
−
“http://www.nlm.nih.gov”
+
There was a pandemic of rubella between 1962 and 1965, starting in Europe and spreading to the United States.<ref name=MoHNZ/> In the years 1964-65, the United States had an estimated 12.5 million rubella cases. This led to 11,000 miscarriages or therapeutic abortions and 20,000 cases of congenital rubella syndrome. Of these, 2,100 died as neonates, 12,000 were deaf, 3,580 were blind and 1,800 were mentally retarded. In New York alone, CRS affected 1% of all births.<ref name=EPI/>
−
“http://www.cdc.gov”
 
−
“http://www.in.gov”
 
−
“http://www.healthsystem.virginia.edu”
 
−
“http://pathmicro.med.sc.edu”
 
  
 +
In 1969 a live attenuated virus vaccine was licensed.<ref name=cdc/> In the early 1970s, a triple vaccine containing attenuated measles, mumps and rubella ([[MMR vaccine|MMR]]) viruses was introduced.<ref name=MoHNZ/>
  
 +
==Rubella in popular culture==
 +
*[[Agatha Christie]]'s ''[[The Mirror Crack'd from Side to Side]]'' features a plot, possibly based on [[Gene Tierney|real life]], in which a girl is shut in quarantine for a minor illness but climbs out of the window to meet a celebrity ([[Gene Tierney]]). The celebrity (Tierney) is pregnant and unknowingly catches rubella resulting in a child with [[congenital rubella syndrome]]. However, as this is the fan's favourite anecdote, when she meets the celebrity (Tierney) years later she tells her the story and the celebrity realises that her baby's syndrome was caused by this fan.
  
 +
== References ==
 +
{{commons|Rubella}}
 +
<!--<nowiki>
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  See http://en.wikipedia.org/wiki/Wikipedia:Footnotes for an explanation of how
 +
  to generate footnotes using the <ref> and </ref> tags, and the template below
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</nowiki>—>
 +
{{Reflist}}
  
−
{{Exanthema}}
+
==External links==
 +
* [http://www.virology-online.com/viruses/Rubella.htm Rubella] at Wong's Virology.
 +
* [http://www.immunize.org/rubella/index.htm Immunization Action Coalition: Rubella]
 
[[Category:Life sciences]]
 
[[Category:Life sciences]]
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{{credit|133330418}}
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{{credit|Rubella|156602583}}

Revision as of 02:14, 9 September 2007

Rubella
Classification and external resources
ICD-10 B06
ICD-9 056
DiseasesDB 11719
MedlinePlus 001574
eMedicine emerg/388  peds/2025 derm/259
Rubella virus
Rubella virus TEM B82-0203 lores.jpg
Virus classification
Group: Group IV ((+)ssRNA)
Family: Togaviridae
Genus: Rubivirus
Species: Rubella virus

Rubella, commonly known as German measles, is a disease caused by the rubella virus. It is often mild and an attack can pass unnoticed. However, this can make the virus difficult to diagnose. The virus usually enters the body through the nose or throat. The disease can last 1-5 days. Children recover more quickly than adults. Like most viruses living along the respiratory tract, it is passed from person to person by tiny droplets in the air that are breathed out. Rubella can pose a serious risk as it can also be transmitted from a mother to her developing baby through the bloodstream via the placenta. If the mother is infected within the first 20 weeks of pregnancy, the child may be born with congenital rubella syndrome, which includes a range of birth defects. The virus has an incubation period of 2 to 3 weeks during which it becomes established.

Symptoms

File:Rubella.JPG
Rubella rash on the abdomen

Symptoms of rubella include:

Children: Low grade fever, swollen glands, joint pain, headache, conjunctivitis, rash

Adults and children:

  • swollen glands or lymph nodes (may persist for up to a week)
  • fever (rarely rises above 38 degrees Celsius [100.4 degrees Fahrenheit])
  • rash (Appears on the face and then spreads to the trunk and limbs. It appears as pink dots under the skin. It appears on the first or third day of the illness but it disappears after a few days with no staining or peeling of the skin)
  • Forchheimer's sign occurs in 20% of cases, and is characterized by small, red papules on the area of the soft palate
  • flaking, dry skin
  • nerves become weak or numb (very rare)

Risks

Rubella can affect anyone of any age and is generally a mild disease. However, rubella can cause congenital rubella syndrome in the fetus of an infected pregnant woman. Usually occurs between 14 - 21 weeks of pregnancy.

Prevention and treatment

Symptoms are usually treated with paracetamol until the disease has run its course. There is no treatment available for congenital rubella.

Fewer cases of rubella have occurred ever since a vaccine became available in 1969, although decreased uptake of the MMR vaccine (e.g. in the UK) is expected to lead to a rise in incidence. In most Western countries, the vast majority of people are vaccinated against rubella as children at 12 to 15 months of age. A second dose is required before age 11. The vaccine may give lifelong protection against rubella. A side-effect of the vaccine can be transient arthritis.

The immunization program has been quite successful with Cuba declaring the disease eradicated in the 1990s and the United States eradicating it in 2005/[1] Every minister of health in the Americas plans to eliminate the disease by 2010.

History

Friedrich Hoffmann made a clinical description of rubella in 1740.[2] Later descriptions by de Bergen in 1752 and Orlow in 1758 supported the belief that this was a derivative of measles. In 1814, George de Maton first suggested that it be considered a disease distinct from both measles and scarlet fever. All these physicians were German, and the disease was known medically as Rötheln (from the German name Röteln), hence the common name of "German measles".[2][3][4][5][6][7]

English Royal Artillery surgeon, Henry Veale, observed an outbreak in India. He coined the euphonious name "rubella" (from the Latin, meaning "little red") in 1866.[6] It was formally recognized as an individual entity in 1881, at the International Congress of Medicine in London.[7] In 1914, Alfred Fabian Hess theorised that rubella was caused by a virus, based on work with monkeys.[8] In 1938, Hiro and Tosaka confirmed this by passing the disease to children using filtered nasal washings from acute cases.[5]

In 1940, there was a widespread epidemic of rubella in Australia. Subsequently, opthalmologist Norman McAllister Gregg found 78 cases of congenital cataracts in infants and 68 of them were born to mothers who had caught rubella in early pregnancy.[3][5] Gregg published an account, Congenital Cataract Following German Measles in the Mother, in 1941. He described a variety of problems now know as congenital rubella syndrome (CRS) and noticed that the earlier the mother was infected, the worse the damage was.[7] The virus was isolated in tissue culture in 1962 by two separate groups led by physicians Parkman and Weller.[6][3]

There was a pandemic of rubella between 1962 and 1965, starting in Europe and spreading to the United States.[6] In the years 1964-65, the United States had an estimated 12.5 million rubella cases. This led to 11,000 miscarriages or therapeutic abortions and 20,000 cases of congenital rubella syndrome. Of these, 2,100 died as neonates, 12,000 were deaf, 3,580 were blind and 1,800 were mentally retarded. In New York alone, CRS affected 1% of all births.[7]

In 1969 a live attenuated virus vaccine was licensed.[5] In the early 1970s, a triple vaccine containing attenuated measles, mumps and rubella (MMR) viruses was introduced.[6]

Rubella in popular culture

  • Agatha Christie's The Mirror Crack'd from Side to Side features a plot, possibly based on real life, in which a girl is shut in quarantine for a minor illness but climbs out of the window to meet a celebrity (Gene Tierney). The celebrity (Tierney) is pregnant and unknowingly catches rubella resulting in a child with congenital rubella syndrome. However, as this is the fan's favourite anecdote, when she meets the celebrity (Tierney) years later she tells her the story and the celebrity realises that her baby's syndrome was caused by this fan.

References
ISBN links support NWE through referral fees

Commons
Wikimedia Commons has media related to::
  1. ↑ Pallarito, Karen, "Rubella No Longer a Threat in the U.S.", Forbes.com, 2005-03-21. Retrieved 2007-06-13.
  2. ↑ 2.0 2.1 Ackerknecht, Erwin Heinz (1982). A short history of medicine. Baltimore: Johns Hopkins University Press, 129. ISBN 0-8018-2726-4. 
  3. ↑ 3.0 3.1 3.2 Lee JY, Bowden DS (2000). Rubella virus replication and links to teratogenicity. Clin. Microbiol. Rev. 13 (4): 571-87.
  4. ↑ Rubella. PatientPlus (2006-05-08). Retrieved 2007-07-03.
  5. ↑ 5.0 5.1 5.2 5.3 Atkinson W, Hamborsky J, McIntyre L, Wolfe S, eds. (2007). "Chapter 12. Rubella", Epidemiology and Prevention of Vaccine-Preventable Diseases. 10th ed.. Centers for Disease Control and Prevention. Retrieved 2007-07-03. 
  6. ↑ 6.0 6.1 6.2 6.3 6.4 (April 2006) "Chapter 11 - Rubella", Immunisation Handbook 2006. Ministry of Health, Wellington, NZ.. ISBN 0-478-29926-5. Retrieved 2007-07-03. 
  7. ↑ 7.0 7.1 7.2 7.3 EPI Newsletter Volume XX, Number 4. Pan American Health Organization (August 1998). Retrieved 2007-07-03.
  8. ↑ Hess, Alfred Fabian (1914). German measles (rubella): an experimental study. The Archives of Internal Medicine 13: 913-916. as cited by Enersen, Ole Daniel. Alfred Fabian Hess. WhoNamedIt. Retrieved 2007-07-03.

External links

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