Rubella

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Rubella
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ICD-10 B06
ICD-O: {{{ICDO}}}
ICD-9 056
OMIM {{{OMIM}}}
MedlinePlus {{{MedlinePlus}}}
eMedicine emerg/388
DiseasesDB {{{DiseasesDB}}}
Rubella virus
Rubella virus TEM B82-0203 lores.jpg
Virus classification
Group: Group IV ((+)ssRNA)
Family: Togaviridae
Genus: Rubivirus
Species: Rubella virus


RUBELLA

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.


Risks

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.

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:

  • The child's age, overall health, and medical history
  • The extent of the disease
  • The child's tolerance for specific medications, procedures, or therapies


References
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Retrieved from:

http://www.nlm.nih.gov”http://www.cdc.gov”http://www.in.gov”http://www.healthsystem.virginia.edu”http://pathmicro.med.sc.edu”




Exanthema edit
Measles (1st disease) - Scarlet fever (2nd disease) - Rubella (3rd disease)
Duke's disease (4th disease) - Slap cheek (5th disease) - Roseola (6th disease)

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