RUBELLA Dr.T.V.Rao MD
History - RubellaThe Teratogenicproperty of theinfection wasdocumented byan AustralianophthalmologistNorman McAlisterGregg...
Introduction• Rubella, commonly known as German  measles, is a disease caused by Rubella virus.  The name is derived from ...
What is Rubella Rubella (German measles) is a disease caused by the rubella virus. Rubella is usually a mild illness. Mos...
Rubella        ( German Measles ) Rubella is also called  as 3 day Measles or  German Measles. Family – Togaviridae Gen...
Rubella Virus        Rubella virus are        ss – RNA virus        Diameter 50 – 70 nm        Enveloped Spherical       ...
Prevailing Genotypes        Dr.T.V.Rao MD   7
Cause and Transmission• The disease is caused by Rubella virus, a toga  virus that is enveloped and has a single-  strande...
Acquired Rubella• Acquired rubella is  transmitted via  airborne droplet  emission from the  upper respiratory  tract of a...
Signs and Symptoms• After an incubation period of 14-21 days,  the primary symptom of rubella virus  infection is the appe...
Main Clinical EventsThe clinical events occurring in the neonatal age is more important and divided into two major groups...
Features of Rubella Infection• The rash disappears after a few days with no  staining or peeling of the skin.• Other sympt...
How Adults acquire Infection Acquired, (i.e. not congenital), rubella is transmitted via airborne droplet emission from t...
Clinical findings Malaise Low grade fever Morbilliform rash Rash starts on Face  Extremities Rarely lasts more than 5...
Systemic events of Rubella        Infection           Dr.T.V.Rao MD     15
Rubella during Pregnancy                  • "Rubella infection in                          pregnant women                 ...
Post natal Rubella   Occurs in Neonates and    Childhood   Adult infection occurs through    mucosa of the upper respira...
Congenital Manifestations          Dr.T.V.Rao MD     18
An Infant Presenting with  Congenital Cataract          Dr.T.V.Rao MD     19
Rubella Rashes When   epidemics  occur with similar  features it is more  suggestive of  Rubella epidemics Other Enterov...
Other manifestations and         complications May produce transient  Arthritis, in women in  particular. Serious compli...
Dr.T.V.Rao MD   22
Immunity - Rubella        Antibodies  appear in         serum as rash fades and         antibody titers raise        Rap...
Immunity - Protects One  attack of  Rubella infection,  protects for life Immune mothers  transfer antibodies  to off sp...
Culturing the Virus   The virus can be    cultured and adopted to    continuous cell lines       Rabbit kidney cells     ...
Diagnosis of Rubella in          AdultsClinicalDiagnosis is unreliableMany viral infections mimic RubellaSpecific diagn...
Isolation and Identification of virus Nasopharyngeal or  throat swabs taken 6  days prior or after  appearance of rash is...
Serology In Rubella             Hemagglutination inhibition              test for Rubella is of              Diagnostic s...
Epidemiology Rubella is world wide in distribution Occurs round the year, Epidemics occur every 20 – 25 years Infectio...
Treatment and PreventionRubella   is a mild self limited illness.No specific treatment or Antiviral treatment is indicat...
Congenital Rubella• Since the virus can cross the placenta, it  can cause Congenital Rubella Syndrome  in the newly born.•...
Congenital Rubella Syndrome Maternal  Viremia with Rubella infection  during pregnancy may result in infection of  placen...
Rubella infection – At various                 trimesters Isttrimester infections lead to abnormalities in 85  % of cases...
Clinical Findings  ( Congenital Rubella Syndrome )May  be transient effects in infants.Permanent manifestations may be a...
Rubella Epidemic• The largest rubella epidemic in the United  States occurred in 1964-1965, and resulted in  the birth of ...
Classical Triad of Rubella Classical Triad Cataract Cardiac abnormalities DeafnessOther manifestationsGrowth retardatio...
Other Neurological manifestations Problems  in balance Motor skills in  preschool children  altered. A rare complicatio...
Diagnosis of    Congenital Rubella Syndrome Demonstration  of Rubella antibodies of IgM in a new born is diagnostic value...
Prevention and Treatment• Rubella vaccine is given to children at 15  months of age as a part of the MMR  (measles-mumps-r...
Treatment, Prevention, Control   No specific treatment is    available   CRS can be prevented by    effective immunizati...
MMR Vaccine   The MMR vaccine is a mixture of three live    attenuated viruses, administered via injection for    immuniz...
• Programme Created by Dr.T.V.Rao MD for  Medical and Paramedical Students in the            Developing World             ...
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Rubella

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Rubella

  1. 1. RUBELLA Dr.T.V.Rao MD
  2. 2. History - RubellaThe Teratogenicproperty of theinfection wasdocumented byan AustralianophthalmologistNorman McAlisterGregg, in 1941 Dr.T.V.Rao MD 2
  3. 3. Introduction• Rubella, commonly known as German measles, is a disease caused by Rubella virus. The name is derived from the Latin, meaning little red.• Rubella is also known as German measles because the disease was first described by German physicians, Friedrich Hoffmann, in the mid-eighteenth century. Dr.T.V.Rao MD 3
  4. 4. 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. Dr.T.V.Rao MD 4
  5. 5. Rubella ( German Measles ) Rubella is also called as 3 day Measles or German Measles. Family – Togaviridae Genus - Rubivirus In general belong to Togavirus group
  6. 6. Rubella Virus  Rubella virus are ss – RNA virus Diameter 50 – 70 nm Enveloped Spherical Virus carry hem agglutinin Virus multiply in the cytoplasm of infected cell.
  7. 7. Prevailing Genotypes Dr.T.V.Rao MD 7
  8. 8. Cause and Transmission• The disease is caused by Rubella virus, a toga virus that is enveloped and has a single- stranded RNA genome, 60-70nm diameter.• The virus is transmitted by the respiratory route and replicates in the nasopharynx and lymph nodes.• The virus is found in the blood 5 to 7 days after infection and spreads throughout the body. Dr.T.V.Rao MD 8
  9. 9. Acquired Rubella• Acquired 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. Dr.T.V.Rao MD 9
  10. 10. Signs and Symptoms• After an incubation period of 14-21 days, the primary symptom of rubella virus infection is the appearance of a rash (exanthema) on the face which spreads to the trunk and limbs and usually fades after three days.• The skin manifestations are called "blueberry muffin lesions." Dr.T.V.Rao MD 10
  11. 11. Main Clinical EventsThe clinical events occurring in the neonatal age is more important and divided into two major groups 1 Post Natal Rubella 2 Congenital Rubella Dr.T.V.Rao MD 11
  12. 12. Features of Rubella Infection• The rash disappears after a few days with no staining or peeling of the skin.• Other symptoms include low grade fever, swollen glands (post cervical lymphadenopathy), joint pains, headache, conjunctivitis.• The swollen glands or lymph nodes can persist for up to a week and the fever rarely rises above 38 oC (100.4 oF). Dr.T.V.Rao MD 12
  13. 13. 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. Dr.T.V.Rao MD 13
  14. 14. 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.
  15. 15. Systemic events of Rubella Infection Dr.T.V.Rao MD 15
  16. 16. Rubella during Pregnancy • "Rubella infection in pregnant women during the first three months of pregnancy may result in the baby being born with birth defects or congenital rubella syndrome Dr.T.V.Rao MD 16
  17. 17. Post natal Rubella Occurs in Neonates and Childhood Adult infection occurs through mucosa of the upper respiratory tract spread to cervical lymph nodes Viremia develops 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
  18. 18. Congenital Manifestations Dr.T.V.Rao MD 18
  19. 19. An Infant Presenting with Congenital Cataract Dr.T.V.Rao MD 19
  20. 20. Rubella Rashes When epidemics occur with similar features it is more suggestive of Rubella epidemics Other Enterovirus infections can produce similar manifestations.
  21. 21. Other manifestations and complications May produce transient Arthritis, in women in particular. Serious complications are Thrombocytopenia Purpura Encephalitis
  22. 22. Dr.T.V.Rao MD 22
  23. 23. 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
  24. 24. 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.
  25. 25. Culturing the Virus The virus can be cultured and adopted to continuous cell lines Rabbit kidney cells (RK 13 ) and Vero cells
  26. 26. Diagnosis of Rubella in AdultsClinicalDiagnosis is unreliableMany viral infections mimic RubellaSpecific diagnosis of infection with 1 Isolation of virus 2 Evidence of seroconversion Dr.T.V.Rao MD 26
  27. 27. 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 Immunofluresecentet methods
  28. 28. Serology In Rubella  Hemagglutination inhibition test for Rubella is of Diagnostic significance  ELISA tests are greater importance  A raise in Antibody titers must be demonstrated between two serum samples taken at least 10 days apart.  Or Detection of Rubella specific IgM must be detected in a single specimen.
  29. 29. 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 Dr.T.V.Rao MD 29
  30. 30. 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 fatal infections. Dr.T.V.Rao MD 30
  31. 31. Congenital Rubella• Since the virus can cross the placenta, it can cause Congenital Rubella Syndrome in the newly born.• Congenital infection may be mild and asymptomatic or severe, causing cataracts, glaucoma, deafness, heart abnormalities, mental retardation or death. Dr.T.V.Rao MD 31
  32. 32. Congenital Rubella Syndrome Maternal Viremia with Rubella infection during pregnancy may result in infection of placenta and fetes. 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 Dr.T.V.Rao MD 32
  33. 33. Rubella infection – At various trimesters Isttrimester infections lead to abnormalities in 85 % of cases. and greater damage to organs 2nd 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 new-born upto 12-18 months. Dr.T.V.Rao MD 33
  34. 34. 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. Dr.T.V.Rao MD 34
  35. 35. Rubella Epidemic• The largest rubella epidemic in the United States occurred in 1964-1965, and resulted in the birth of an estimated 30,000 infants with congenital rubella syndrome. As many as 85% of pregnant women with clinical rubella delivered babies with congenital rubella. The highest percentage of congenital rubella occurred when the pregnant mothers had rubella during the first trimester Dr.T.V.Rao MD 35
  36. 36. Classical Triad of Rubella Classical Triad Cataract Cardiac abnormalities DeafnessOther manifestationsGrowth retardationRashHepatosplenomegalyJaundiceMeningoencephalitisCNS defects lead to moderate to profound mental retardation
  37. 37. Other Neurological manifestations 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.
  38. 38. Diagnosis of Congenital Rubella Syndrome Demonstration of Rubella antibodies of IgM in a new born is diagnostic value. As IgM group do not cross the placenta and they are produce in the infected fetus,
  39. 39. Prevention and Treatment• Rubella vaccine is given to children at 15 months of age as a part of the MMR (measles-mumps-rubella) immunization.• The vaccine is live and attenuated and confers lifelong immunity.• There is no specific treatment for Rubella; management is a matter of responding to symptoms to diminish discomfort. Dr.T.V.Rao MD 39
  40. 40. 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
  41. 41. 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 Dr.T.V.Rao MD 41
  42. 42. • Programme Created by Dr.T.V.Rao MD for Medical and Paramedical Students in the Developing World • Email • doctortvrao@gmail.com Dr.T.V.Rao MD 42
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