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RUBELLA

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Rubella
Dari bahasa Latin ,artinyalittle red
Ditemukan pada abad ke 18 merupakan variant
dari Measles
Congenital rubella syndrome diterangkan oleh
Gregg thn 1941

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Rubella Case Definition


Acute onset of generalized maculopapular rash,
and
Temperature of>37.20C (>990F), if measured, and
Arhralgia or arthritis, or lymphadenopathy, or
conjunctivitis

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Rubella Virus
Togavirus
RNA virus
Mempunyai satu tipe antigen
Cepat inactivated oleh bahan kimia, pH yang
rendah, panas dan cahaya ultraviolet

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Epidemik Rubella di USA,


1964-1965
12.5 million rubella cases
2,000 encephalitis cases
11,250 abortions (surgical/spontaneous)
2,100 neonatal deaths
- 11,600 Deaf
- 3,580 Blind
- 1,800 Mentally retarded
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Rubella Epidemiology
Reservoir
Transmission

Manusia
Saluran Nafas
Pasien dengan sublinik

dapat

menyebarkan
Terjadinya infeksi
7 hari sebelum 5-7 hari
setelah timbulnya ruam

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Rubella Pathogenesis
Transmisi virus melalui saluran pernafasan
Replication di nasopharynx dan regional lymph
nodes
Viremia terjadi 5-7 hari setelah kontak
Placenta and fetus terinfeksi selama viremia

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Gambaran Klinis
Masa Inkubasi 14 hari (range 12-23 hari)
Masa Prodromal dengan demam yang tidak
begitu tinggi
Lymphadenopathy pada minggu ke dua
Maculopapular rash 14-17 hari setelah kontak

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Komplikasi Rubella
Arhtralgia aatau arthritis
- children
- adult female
Thrombocytopenic purpura
Encephalitis
Neuritis
Orchitis
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jarang
sampai 70%
1/3,000 cases
1/6,000 cases
jarang
jarang
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Congenital Rubella Syndrome


Infeksi bisa mengenai seluruh organ
Biasa fetal death /Lahir premature
Beratnya kelainan tergantung pada masa gestasi
terjadinya infeksi
Sampai 85% dari Janin infeksi pada
trisemester pertama

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Congenital Rubella Syndrome


Deafness
Cataract
Heart defects
Microcephaly
Mental retardation
Bone alterations
Liver and spleen damage
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Laboratory Diagnosis Rubella


Isolation of rubella virus from clinical specimen
(eg: nasopharynx, urine)
Significant rise in rubella IgG by any standard
serologic assay (eg: enzyme immunoassay)
Positive serologic test for rubella IgM antibody

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Rubella Vaccine
Composition
Live virus (RA 27/3 strain)
Efficacy
95% (Range, 90%-97%)
Duration of
Immunity
Lifelong
Schedule
>1 Dose
Should be administered with measles and mumps
as MMR

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MMR Adverse Reactions


Fever
Rash
Joint symptoms
Thrombocytopenia
Parotitis
Deafness
Encephalopathy
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5%-15%
5%
25%
<1/30,000 doses
rare
rare
<1/1,000,000 doses
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MMR Vaccine
Contraindications and Precautions
Severe allergic reaction to vaccine component or
following prior dose
Pregnancy
Immunosuppression
Moderate or severe acute illness

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TERIMA

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KASIH

16

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Rubella and CRS in the United


States
Most reported rubella in the US since the mid1990s has occurred among foreign-born Hispanic
adults
Rubella outbreaks have occurred in workplaces
where most employees are foreign-born
Majority of CRS since 1997 occurred in children
of unvaccinated women born to Hispanic women,
most born in Latin America
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Rubella Vaccine
Vaccine
GMK-3:RK53

Trade Name
Cendevax

Licensure
1969

HPV-77:DK12

Rubelogen

1969

HPV-77:DE5

Meruvax

1969

RA 27/3*

Meruvax II

1979

* Only vaccine currently licensed in US


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Rubella Vaccine
Vaccine
GMK-3:RK53

Trade Name
Cendevax

Licensure
1969

HPV-77:DK12

Rubelogen

1969

HPV-77:DE5

Meruvax

1969

RA 27/3*

Meruvax II

1979

* Only vaccine currently licensed in US


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Rubella Immunity
Birth before 1957 is not acceptable evidence of
rubella immunity for women who might become
pregnant
Only serology or documented vaccination should
be accepted

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