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  • 1. RUBELLA Dr.T.V.Rao MD
  • 2. What is Rubella
    • Rubella (German measles) is a disease caused by the rubella virus. Rubella is usually a mild illness. Most people who have had rubella or the vaccine are protected against the virus for the rest of their lives. Because of routine vaccination against rubella since 1970 , rubella is now rarely reported.
  • 3. History - Rubella
    • The Teratogenic property of the infection was documented by an Australian opthalmologist Greeg in 1941
  • 4. Rubella ( German Measles )
    • Rubella is also called as 3 day Measles or German Measles.
    • Family – Togaviridae
    • Genus - Rubivirus
    • In general belong to Togavirus group
  • 5. Rubella Virus
    • Rubella virus are
    • ss – RNA virus
    • Diameter 50 – 70 nm
    • Enveloped Spherical
    • Virus carry hemagglutinin
    • Virus multiply in the cytoplasam of infected cell.
  • 6. Prevailing Genotypes
  • 7. Culturing the Virus
    • The virus can be cultured and adopted to continuous cell lines
    • Rabbit kidney cells (RK 13 )
    • and
    • Vero cells
  • 8. Main Clinical Events
    • The clinical events occuring in the neonatal age is more important and divided into two major groups
    • 1 Post Natal Rubella
    • 2 Congenital Rubella
  • 9. How Adults acquire Infection
    • Acquired, (i.e. not congenital), rubella is transmitted via airborne droplet emission from the upper respiratory tract of active cases. The virus may also be present in the urine, feces and on the skin. There is no carrier state: the reservoir exists entirely in active human cases. The disease has an incubation period of 2 to 3 weeks.
  • 10. Systemic events of Rubella Infection
  • 11. Post natal Rubella
    • Occurs in Neonates and Childhood
    • Adult infection occurs through mucosa of the upper respiratory tract spread to cervical lymphnodes
    • Viremia devlops after 7 – 9 day
    • Lasts for 13 – 15 days
    • Leads to development of antibodies
    • The appearance of antibodies coincides the appearance of suggestive immulogic basis for the rash
    • In 20 – 50 % cases of primary infections are subclinical
  • 12. Clinical findings
    • Malaise
    • Low grade fever
    • Morbilliform rash
    • Rash starts on Face Extremities
    • Rarely lasts more than 5 days
    • No features of the rash give clues to definitive diagnosis of Rubella.
  • 13. Rubella Rashes
    • When epidemics occur with similar features it is more suggestive of Rubella epidemics
    • Other Enterovirus infections can produce similar manifestations .
  • 14. Other manifestations and complications
    • May produce transient Arthritis, in women in particular.
    • Serious complications are
    • Thrombocytopenia
    • Purpura
    • Encephalits
  • 15. Immunity - Rubella
    • Antibodies appear in serum as rash fades and antibody titers raise
    • Rapid raise in 1 – 3 weeks
    • Rash in association with detection of IgM indicates recent infection.
    • IgG antibodies persist for life
  • 16. Immunity - Protects
    • One attack of Rubella infection, protects for life
    • Immune mothers transfer antibodies to off springs who are in turn are protected for 4 – 6 months.
  • 17. Diagnosis of Rubella in Adults
    • Clinical Diagnosis is unreliable
    • Many viral infections mimic Rubella
    • Specif diagnosis of infection with
    • 1 Isolation of virus
    • 2 Evidence of seroconversion
  • 18. Isolation and Identification of virus
    • Nasopharyngeal or throat swabs taken 6 days prior or after appearance of rash is a good source of Rubella virus
    • Using cell cultured in shell vial antigens can be detected by Immunofluresecentetmehods
  • 19. Serology In Rubella
    • Hemagglutination inhibition test for Rubella is of Diagnostic significance
    • ELISA tests are greater importance
    • A raise in Antibody titers must be demonostrated between two serum samples taken at least 10 days apart.
    • Or Detection of Rubella specific IgM must be detected in a single specimen.
  • 20. Epidemiology
    • Rubella is world wide in distribution
    • Occurs round the year,
    • Epidemics occur every 20 – 25 years
    • Infection is transmitted by respiratory route
    • The use of Rubella vaccine has now eliminated both epidemic and endemic Rubella in USA and several developed countries
  • 21. Treatment and Prevention
    • Rubella is a mild self limited illness.
    • No specific treatment or Antiviral treatment is indicated.
    • However Laboratory proved and clinically missed Rubella in the Ist 3-4 months of pregnancy is associated with fetal infections.
  • 22. Congenital Rubella Syndrome
    • Maternal viremia with Rubella infection during pregnancy may result in infection of placenta and fetus.
    • The growth rate of fetal cells are reduced.
    • Results in fewer number of cells after the birth.
    • Lead to deranged and hypo plastic organ development.
    • Results in structural damage and abnormalities
  • 23. Rubella infection – At various trimesters
    • I st trimester infections lead to abnormalities in 85 % of cases. and greater damage to organs
    • 2 nd trimester infections lead to defects in 16 %
    • > 20 weeks of pregnancy fetal defects are uncommon
    • However Rubella infection can also lead to fetal deaths, and spontaneous abortion.
    • The intrauterine infections lead to viral excretion in various secretion in newborn upto 12-18 months.
  • 24. Clinical Findings ( Congenital Rubella Syndrome )
    • May be transient effects in infants.
    • Permanent manifestations may be apparent at birth, become recognized during the first year.
    • Developmental abnormalities appear during childhood and adolescents.
  • 25. Classical Triad of Rubella
    • Classical Triad
    • Cataract
    • Cardiac abnormalities
    • Deafness
    • Other manifestations
    • Growth retardation
    • Rash
    • Hepatosplenomegaly
    • Jaundice
    • Meingoencephalitis
    • CNS defects lead to moderate to profound mental retardation
  • 26. Other Neurological manifestions
    • Problems in balance
    • Motor skills in preschool children altered.
    • A rare complication of Pan encephalitis can occur in second decade with Congenital rubella syndrome may progress to death.
  • 27. Diagnosis of Congenital Rubella Syndrome
    • Demonstration of Rubella antibodies of IgM in a new born is diagnostic value. As IgM group donot cross the placenta and they are produce in the infected fetus,
  • 28. Treatment, Prevention, Control
    • No specific treatment is available
    • CRS can be prevented by effective immunization of the young children and teenage girls, remain the best option to prevent Congenital Rubella Syndrome.
    • The component of Rubella in MMR vaccine protects the vaccinated
  • 29. MMR Vaccine
    • The MMR vaccine is a mixture of three live attenuated viruses , administered via injection for immunization against measles , mumps and rubella . It is generally administered to children around the age of one year, with a second dose before starting school (i.e. age 4/5). The second dose is not a booster ; it is a dose to produce immunity in the small number of persons (2-5%) who fail to develop measles immunity after the first dose In the United States, the vaccine was licensed in 1963 and the second dose was introduced in the mid 1990s. It is widely used in all National, Universal Immunization programmes
  • 30. Created for Awareness on Rubella for Medical and Paramedical students Dr.T.V.Rao MD Email [email_address]