Rubella (German measles),PSM,COMMUNITY MEDICINE,DR NARENDRA KUMAR YADAV

1. Rubella (German measles)
DR NARENDRA KUMAR YADAV
MBBS, MD Community Medicine & Tropical Diseases

2. Rubella (German measles):
 Rubella is an acute childhood infection, caused by an
RNA togavirus.
Rubella is AKA: 3 day measles.
Only one antigenic type of the virus causes infection.
One attack results in life-long immunity; second attacks
are rare.

3. Epidemiology of Rubella (German measles):
 Rubella is worldwide in distribution.
Epidemics every 4-9 years.
(Cyclical trend)
Age group: Any age but more common in Children (3 years-10
years).
Any season but more common in late winter and spring.

4. Epidemiological determinants of Rubella (German measles):
Agent factors: Host factors: Environmental
factors:
RNA togavirus.
 SOURCE OF INFECTION:
Cases or subclinical
cases.
Age group: Any age but
more common in Children
(3 years-10 years).
Congenital rubella in
the newborn.
Any season but more
common in late winter
and spring.
Epidemics every 4-9 years.
(Cyclical trend)

5. Rubella (German measles):
 Incubation period of rubella: 2 weeks- 3 weeks (AVG: 18 days).
 Mode of transmission of rubella:
1. Respiratory (Air droplets)
2. Vertical transmission: The virus can cross the placenta and infect the
fetus in utero, leading to congenital rubella in the newborn.
 Period of communicability: 4 days----Symptoms….Rash------7days
SAR: 80%

6. Clinical features of Rubella (German measles):
1. PRODROMAL: Low-grade fever, coryza, sore throat.
2. LYMPHADENOPATHY:
The enlargement of the postauricular and posterior cervical lymph nodes
appears before the appearance of the rash.
3. RASH (Macular or Maculopapular): Appears first on the face, usually
within 24 hours of the onset of prodromal symptoms. It disappears by the
third day.
4. COMPLICATIONS: Arthralgia, Thrombocytopenic purpura, Encephalitis.

7. Cervical Lymphadenopathy:

8. Measles vs Rubella:

9. Q. Does rubella always present with rash?
 No
 25% rubella present without rash.
Incidence of rubella infection without rash: 25%

10. Diagnosis:
 Virus Isolation (Throat Swabs)
Serological Test: Hemagglutination inhibition test
ELISA Test

11. Q. Can Rubella be diagnosed at birth?
YES
At birth virus is easily detected in: Pharyngeal secretion, CSF, multiple
organs, urine and rectal swabs.
Presence of IgM antibodies shortly after birth OR IgG antibodies
persisting > 6 months: Congenital rubella in the newborn (Congenital
rubella syndrome).

12. Congenital rubella in the newborn:
M/C time of vertical transmission: First trimester
Infection in 1st trimester: MOST DISASTROUS TIME
Infection after 16 weeks of pregnancy: No major abnormalities.
Classical triad of Congenital rubella syndrome:
1. Cataract
2. Sensorineural hearing loss
3. Congenital heart defect (M/C is PDA)

13. Congenital rubella syndrome(CRS):

14. Congenital cataract:

15. Patent Ductus Arteriosus (PDA):

16. Prevention of Rubella (German measles):
1. Active immunization: Live attenuated MR vaccine
2. Isolation: Cases should be isolated
3. Proper nutrition
4. Health Education, Information and Communication

17. MMR vaccine (Active immunization):
Types: Live attenuated
Strain: EDMONSTON ZAGREB S
Age of administration: 9 months and 15 months
Route of administration: SUBCUTANEOUS (S/C)
Site of administration: R. Arm
Diluent: Distilled water/ Sterile water

18. MCQ
Q. Recommended vaccination strategy for rubella is to vaccinate which
age group on priority during rubella outbreak.
a. Women 15-49 years (non pregnant)
b. Infants
c. Women 15-39 years (Pregnant)
d. Adolescent girl 10-19 years

19. Ans: a Women 15-49 years (non pregnant)

20. Rubella vaccination strategy:
1. First Priority: Women of child bearing age(15-39 years)
2. Second Priority: Interruption transmission by vaccination all
children 1-14 years age.
3. Third Priority: Routine immunization of all children <1year (MR
vaccine)

21. MCQ
Q. Risk of the damage of fetus by maternal rubella is maximum if mother
gets infected in:
a. 6-12 weeks pregnancy
b. 20-24 weeks pregnancy
c. 24-28 weeks pregnancy
d. 32-36 weeks pregnancy

22. Ans: a (6-12 weeks pregnancy)

23. MCQ
Q. Rubella features included all, except:
a. Tender lymph nodes in the neck
b. Congenital infection with cataract
c. Incubation period < 10 days
d. Caused by RNA virus

24. Ans: c (Incubation period < 10 days)
 Incubation period of rubella: 2 weeks- 3
weeks (AVG: 18 days).

25. MCQ
Q. All of the following statements are true about Congenital Rubella except:
a. It is diagnosed when the infant has IgM antibodies at birth.
b. It is diagnosed when IgG antibodies persist for >6 months.
c. Most congenital defects are deafness, cardiac malformation,
cataract.
d. Infection after 16 weeks of gestation results in major congenital
defect.

26. Ans: d (Infection after 16 weeks of gestation results in major
congenital defect).
Infection in 1st trimester: MOST DISASTROUS TIME
Infection after 16 weeks of pregnancy: No major abnormalities.

27. Q. Why Rubella is called 3 day measles?

28. Q. Write the differences between measles and
rubella.

30. The End