Rubella, also known as German measles, is a mild viral illness caused by the rubella virus. It was first described as a distinct clinical entity in the 18th century. In 1941, an Australian ophthalmologist documented the virus's ability to cause birth defects when a pregnant woman is infected. An attenuated vaccine was developed in 1967 that provides lifelong immunity. The virus is transmitted through respiratory droplets and causes a maculopapular rash. If a pregnant woman is infected it can lead to congenital rubella syndrome in the fetus, resulting in defects like deafness, cataracts and heart disease. Diagnosis involves virus isolation or serology to detect antibodies. There is no specific treatment but the live attenuated M

1. Rubella
By : Dr. Saurabh Agrawal

2. HISTORY - RUBELLA
 Discovered in 18th century -
thought to be variant of measles
 The Teratogenic property of the
infection was documented by an
Australian ophthalmologist
Norman McAlister Gregg, in 1941
 The virus was isolated in 1962
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3. Introduction
 From Latin meaning "little red"
 An attenuated vaccine was
developed in 1967
 First described as distinct
clinical entity in German
literature
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4. EPIDEMIOLOGY
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Occurs worldwide
The virus tends to peak in countries with temperate climates
Common in children ages 5-10 years old
Human are only known reservoir.
Host -3-10 yrs
Source of infection – Respiratory secretion
Infants with CRS may shed virus for a year or more
Immunity –life long
Occurs round the year, peak in late winter and spring season
Transmission – droplet, vertical transmission
I.P – 2-3 weeks average 18 days
Rubella is world wide in distribution
Epidemics occur every 4-9 years.

5. Rubella Virus
 Togavirus
 RNA virus
 One antigenic type
 Rapidly inactivated by chemical agents, low pH,
heat and ultraviolet light
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6. AGENT FACTORS
A- Agent
 Causative agent: Rubella virus
ssRNA Virus of the
Togaviridae Family
 genus Rubivirus
 One antigenic type
 Diameter 50 – 70 nm
 Enveloped Spherical
 Virus carry hemagglutinin
 Virus multiply in the cytoplasm of infected cell.
 Highly sensitive to heat, extremes of pH & uv light.
 At 4°C, virus is relatively stable for 24 hours.6 04/04/2015

7. AGENT FACTORS cont.
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B- Source of infection
 CASES
 Subclinical
 Clinical
 Congenital from infected
pregnant women to fetus.
 There is no known carrier
state.
C- Period of
communicability
 It probably extends from
a week before symptoms
to about a week after
rash appears.
 Infectivity is greatest
when the rash is
erupting.

8. HOST FACTORS
A- Age
 Disease of childhood
3-10 yrs age group.
 Following widespread
immunization
campaigns persons
older than 15 yrs
account for 70% cases
in developed
countries.
B- Immunity
 One attack results in
life long immunity.
 Infants of immune
mothers are protected
for 4-6 months.
 In India, about 40% of
child bearing age
group women are
susceptible to rubella.
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9. Immunity - Rubella
 Antibodies appear in
serum as rash fades and
antibody titres raise
 Rapid raise in 1 – 3 weeks
 Rash in association with
detection of IgM indicates
recent infection.
 IgG antibodies persist for
life
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10. ENVIRONMENTAL
FACTORS
Disease usually
occurs in seasonal
pattern, during the
late winter & spring.
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11. Mode of Transmission
Person to person- via
respiratory route:-
 Droplet from nose & throat
 Droplet nuclei (aerosols)
 Maintain in human
population by chain
transmission.
Acquired during pregnancy- vertical
transmission:-
 Virus can enter via the Placenta & infect the
foetus in utero (Congenital Rubella Syndrome).
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12. Incubation period
Between 14-21 days
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13. Pathogenesis Continued……
Respiratory
Tract Skin
Lymph
Nodes Joints
Placenta or
Fetus
• Cough
• Minor
sore
throat
• Rashes
• Lesions
• Mild
arthralgia
• arthritis
• Placentitis
• Fetal
Damage
• Lymphadenopathy
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Rubella Virus Developed in the nasopharynx

14. Rubella Clinical Features
Incubation period 14 days (range 12-23 days)
 Low grade fever
Lymphadenopathy in
second week
Maculopapular rash 14-
17 days after exposure
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15. SIGNS AND SYMPTOMS
 RASH-
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 with no
staining or peeling of the skin.
 The skin manifestations are called
"BLUEBERRY MUFFIN
LESIONS."19 04/04/2015

16. SIGNS AND SYMPTOMS
continued….
 LYMPH NODE-
 Tender lymphadenopathy
(particularly posterior
auricular and suboccipital
lymph nodes)
 persist for up to a week.
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17. SIGNS AND SYMPTOMS
 TEMPERATURE-Fever rarely rises above 38o C (100.4 o F)
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18. Other manifestations &
complications
 May produce transient
Arthritis, particular in
women.
 Serious complications
are-
 Thrombocytopenia
Purpura
 Encephalitis
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19. Congenital Rubella Syndrome
(crs)
 Occurs during the first trimester of
pregnancy.
 Affects the development of the fetus.
 may lead to several birth defects.
 Infection may affect all organs.
 May lead to fetal death or premature
delivery.
 Severity of damage to fetus depends
gestational age.
 Infants: virus is isolated from urine
and feces.
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20. Rubella infection – At various
trimesters
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 Ist trimester 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 newborn up to 12-18 months.

21. Rubella infection & Chance of
CRS
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 0–28 days before conception - 43% chance
 0–12 weeks after conception - 51% chance
 13–26 weeks after conception - 23% chance
 Infants are not generally affected if rubella is
contracted during the third trimester

22. 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 immunologic basis
for the rash
 In 20 – 50 % cases of primary infections are
subclinical. 04/04/201530

23. Clinical Features
Rash at birth
Deafness
Cataracts
Heart defects
Microcephaly
Mental retardation
Bone alterations
Liver and spleen damage
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24. Diagnosis of Rubella in
Adults
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 Clinical Diagnosis is unreliable
 Many viral infections mimic Rubella
 Specific diagnosis of infection with-
 1 Isolation of virus
 2 Evidence of seroconversion

25. 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
Immunofluresecent
methods37 04/04/2015

26. Medical Treatment
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 Rubella is a mild self limited illness.
 No specific treatment or Antiviral treatment is indicated.
 Isolation and quarantine
 Increase fluid intake
 Encourage the patient to rest
 Good ventilation
 Encourage the patient to drink either lemon or orange juice
 Provide health teaching about Rubella (cause, immunizations)

27. Treatment for acute maternal
rubella infection
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 Acetaminophen for symptomatic relief
 IgG –
 role is controversial, CDC recommends limiting use of
immunoglobulin to women with known rubella exposure who
decline pregnancy termination.
 Glucocorticoids, platelet transfusion, and other supportive
measures for complications.
 Counseled about maternal-fetal transmission and offered
pregnancy termination, especially prior to 16 weeks
gestation.
 After 20 weeks gestation- individualized management.

28. Prevention
 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.
 Given to children 12 and 15
months and again between 3-
6 years of age
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29. Vaccination of Women of
Childbearing Age
 Ask if pregnant or likely to
become so in next 4 weeks
 Exclude those who say "yes
the vaccine has been already
taken"
 For others
 Explain theoretical risks
 Vaccinate
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30. MMR Vaccine
 The MMR vaccine is a mixture of three live
attenuated viruses, administered via injection
for immunization against measles, mumps
and rubella virus strain RA 27/3 .
 It is generally administered to children around
the age of one year, with a second dose before
starting school (i.e. age 4/5).
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31. MMR Vaccine
 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, the vaccine was licensed in 1963
and the second dose was introduced in
the mid 1990s. It is widely used.
 Contraindications= immunodeficiency
disorder, history of anaphylaxis to
neomycin, and pregnancy.
 Side effects: arthritis, arthralgia, rash,
adinopathy, or fever.
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32. MMR Adverse Reactions
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 Fever
 Rash
 Joint symptoms
 Thrombocytopenia
 Parotitis
 Deafness
 Encephalopathy

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