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RUBELLA

Dr.T.V.Rao MD
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.
History - Rubella

The Teratogenic property of the


infection was documented by an
Australian opthalmologist Greeg in
1941
Rubella
( German Measles )
 Rubella is also
called as 3 day
Measles or German
Measles.
 Family – Togaviridae

 Genus - Rubivirus

 In general belong
to Togavirus group
Rubella Virus

 Rubella virus are


ss – RNA virus
Diameter 50 – 70 nm
Enveloped Spherical
Virus carry
hemagglutinin
Virus multiply in the
cytoplasam of infected
cell.
Prevailing Genotypes
Cu ltur ing t he V irus

 The virus can be


cultured and
adopted to
continuous cell
lines
Rabbit kidney cells
(RK 13 )
and
Vero cells
Mai n Cl ini ca l E ve nts

 The clinical events occuring in the


neonatal age is more important and
divided into two major groups
1 Post Natal Rubella
2 Congenital Rubella
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.
System ic events o f
Rub ella In fecti on
Po st n at al R ube lla
 Occurs in Neonates and
Childhood
 Adult infection occurs
through mucosa of the
upper respiratory tract
spread to cervical
lymphnodes
 Viremia devlops 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
Cl inical fi nd ings
 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.
Rubella Rashes
 When epidemics
occur with
similar features
it is more
suggestive of
Rubella
epidemics
 Other
Enterovirus
infections can
produce similar
manifestations.
Other manifestations and
complications

 May produce
transient Arthritis,
in women in
particular.
 Serious
complications are
Thrombocytopenia
Purpura
Encephalits
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
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.
Di agnos is of Rubel la in
Adul ts
 ClinicalDiagnosis is unreliable
 Many viral infections mimic Rubella

 Specif diagnosis of infection with

1 Isolation of virus
2 Evidence of seroconversion
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
mehods
Se ro logy In R ub ella
 Hemagglutination
inhibition test for
Rubella is of
Diagnostic significance
 ELISA tests are
greater importance
 A raise in Antibody
titers must be
demonostrated
between two serum
samples taken at least
10 days apart.
 Or Detection of Rubella
specific IgM must be
detected in a single
specimen.
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
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 fetal infections.
Congenital Rubella Syndrome
 Maternal viremia with Rubella infection
during pregnancy may result in infection of
placenta and fetus.
 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
Ru bel la i nfec tion – At va ri ous
tri mes ter s
 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 upto 12-18
months.
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.
Classical Triad of Rubella
Classical Triad
 Cataract
 Cardiac
abnormalities
 Deafness
Other manifestations
Growth retardation
Rash
Hepatosplenomegaly
Jaundice
Meingoencephalitis
CNS defects lead to
moderate to profound
mental retardation
Other Neurological manifestions
 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.
Diagnosis of
Congenital Rubella Syndrome

 Demonstration of
Rubella antibodies
of IgM in a new
born is diagnostic
value. As IgM
group donot cross
the placenta and
they are produce in
the infected fetus,
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
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
Created for Awareness
on Rubella for Medical
and Paramedical
students
Dr.T.V.Rao MD
Email
doctortvrao@gmail.com