Rubella, also known as German measles, is a viral illness that was first recognized as a distinct disease in 1881. It is caused by the rubella virus, which is transmitted via respiratory droplets. While rubella infection poses little risk to adults, contracting the virus during pregnancy can lead to congenital rubella syndrome in the fetus, causing health issues such as deafness, heart defects, and cataracts. Since the 1960s, effective vaccines have been developed to prevent rubella infection and the risk it poses during pregnancy through universal childhood vaccination programs and antenatal screening of pregnant women.

1. Rubella
History
1881 Rubella accepted as a distinct disease
1941 Associated with congenital disease
1961 Rubella virus first isolated
1967 Serological tests available
1969 Rubella vaccines available

2. Rubella Virus
• RNA enveloped virus
• Member of the togavirus family
• Spreads by respiratory droplets
• In the pre-vaccination era, 80% of women
were already infected by childbearing age

3. Clinical Features
• Rubella: Latin “little red”
• Maculopapular rash
• Lymphadenopathy
• Fever
• Arthropathy (up to 60% of cases)

4. Rash of Rubella

5. Risks of Rubella Infection During
Pregnancy
Preconception Minimal risk
0-12 weeks 100% risk of fetus being congenitally infected
resulting in major congenital abnormalities.
Spontaneous abortion occurs in 20% of cases.
13-16 weeks Deafness and retinopathy 15%
After 16 weeks Normal development, slight risk of deafness
and retinopathy

6. Congenital Rubella Syndrome
Classical triad consists
of:
• Cataracts
• Heart defects
• Sensorineural
deafness.

7. Transient
• Low birth weight, hepatosplenomegaly,
thrombocytopenic purpura, meningoencephalitis,
hepatitis, haemolytic anemia, pneumonia,
lymphadenopathy
Permanent
• Sensorineural deafness, Heart defects, Eye defects
(retinopathy, cataract, microopthalmia, glaucoma),
diabetes mellitis
Developmental
• Sensorineural deafness, Mental retardation
Congenital Rubella Syndrome

8. Outcome
• 1/3 rd will lead normal independent lives
• 1/3 rd will live with parents
• 1/3rd will be institutionalised
 The only effective way to prevent CRS is
to terminate the pregnancy

9. Laboratory Diagnosis
Diagnosis of acute infection
• Presence of rubella-specific IgM
• Rising titres of antibody (mainly IgG)

10. Typical Serological Events following
acute rubella infection
Note that in reinfection, IgM is usually absent or only present transiently at a low level

11. Prevention
Antenatal screening
• Screening of all pregnant women attending antenatal
clinics for immune status against rubella.
• Non-immune women are vaccinated in the immediate
post partum period.

12. Prevention
• Since 1968, a highly effective live attenuated
vaccine has been available with 95% efficacy
• Universal vaccination is now offered to all
infants as part of the MMR regimen in the
USA, UK and a number of other countries.
• Vaccination of schoolgirls before they reach
childbearing age.