Rubella
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| Rubella | |
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| ICD-10 | B06 |
| ICD-9 | 056 |
| DiseasesDB | 11719 |
| MedlinePlus | 001574 |
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Rubella Microchapters |
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Rubella On the Web |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Historical Perspective
Pathophysiology
Epidemiology & Demographics
Risk Factors
Screening
Causes
Differentiating Rubella
Complications & Prognosis
Diagnosis
History and Symptoms | Physical Examination | Laboratory tests | Electrocardiogram | X Rays | CT | MRI Echocardiography or Ultrasound | Other images | Alternative diagnostics
Treatment
Medical therapy | Surgical options | Primary prevention | Secondary prevention | Financial costs | Future therapies
Cause
The disease is caused by Rubella virus, a togavirus that is enveloped and has a single-stranded RNA genome.[1] The virus is transmitted by the respiratory route and replicates in the nasopharynx and lymph nodes. The virus is found in the blood 5 to 7 days after infection and spreads throughout the body. It is capable of crossing the placenta and infecting the foetus where it stops cells from developing or destroys them.[2]
Diagnosis of acquired rubella
Rubella virus specific IgM antibodies are present in people recently infected by Rubella virus but these antibodies can persist for over a year and a positive test result needs to be interpreted with caution.[3] The presence of these antibodies along with, or a short time after, the characteristic rash confirms the diagnosis.[4]
Prevention
Rubella infections are prevented by active immunization programs using live, disabled virus vaccines. Two live attenuated virus vaccines, RA 27/3 and Cendehill strains, were effective in the prevention of adult disease. However their use in prepubertile females did not produce a significant fall in the overall incidence rate of CRS in the UK. Reductions were only achieved by immunisation of all children.
The vaccine is now given as part of the MMR vaccine. The WHO recommends the first dose is given at 12 to 18 months of age with a second dose at 36 months. Pregnant women are usually tested for immunity to rubella early on. Women found to be susceptible are not vaccinated until after the baby is born because the vaccine contains live virus.[5]
The immunization program has been quite successful with Cuba declaring the disease eliminated in the 1990s. In 2004 the Centers for Disease Control and Prevention announced that both the congenital and acquired forms of rubella had been eliminated from the United States.[6][7]
Treatment
Symptoms are usually treated with paracetamol until the disease has run its course. Treatment of newly born babies is focused on management of the complications. Congenital heart defects and cataracts can be corrected by surgery.[8] Management for ocular CRS is similar to that for age-related macular degeneration, including counseling, regular monitoring, and the provision of low vision devices, if required.[9]
Prognosis
Rubella infection of children and adults is usually mild, self-limiting and often asymptomatic. The prognosis in children born with CRS is poor.[10]
Epidemiology
Rubella is a disease that occurs worldwide. The virus tends to peak during the spring in countries with temperate climates. Before the vaccine to rubella was introduced in 1969, widespread outbreaks usually occurred every 6-9 years in the United States and 3-5 years in Europe, mostly affecting children in the 5-9 year old age group.[11] Since the introduction of vaccine, occurrences have become rare in those countries with high uptake rates. However, in the UK there remains a large population of men susceptible to rubella who have not been vaccinated. Outbreaks of rubella occurred amongst many young men in the UK in 1993 and in 1996 the infection was transmitted to pregnant women, many of whom were immigrants and were susceptible. Outbreaks still arise, usually in developing countries where the vaccine is not as accessible.[12]
During the epidemic in the US between 1962-1965, Rubella virus infections during pregnancy were estimated to have caused 30,000 still births and 20,000 children to be born impaired or disabled as a result of CRS.[13][14] Universal immunisation producing a high level of herd immunity is important in the control of epidemics of rubella.[15]
History
Rubella was first described in the mid-eighteenth century. Friedrich Hoffmann made the first clinical description of rubella in 1740,[16] which was confirmed by de Bergen in 1752 and Orlow in 1758.[17]
In 1814, George de Maton first suggested that it be considered a disease distinct from both measles and scarlet fever. All these physicians were German, and the disease was known as Rötheln (from the German name Röteln), hence the common name of "German measles". [18] Henry Veale, an English Royal Artillery surgeon, described an outbreak in India. He coined the name "rubella" (from the Latin, meaning "little red") in 1866.[16][19][20][21]
It was formally recognised as an individual entity in 1881, at the International Congress of Medicine in London.[22] In 1914, Alfred Fabian Hess theorised that rubella was caused by a virus, based on work with monkeys.[23] In 1938, Hiro and Tosaka confirmed this by passing the disease to children using filtered nasal washings from acute cases.[20]
In 1940, there was a widespread epidemic of rubella in Australia. Subsequently, ophthalmologist Norman McAllister Gregg found 78 cases of congenital cataracts in infants and 68 of them were born to mothers who had caught rubella in early pregnancy.[19][20] Gregg published an account, Congenital Cataract Following German Measles in the Mother, in 1941. He described a variety of problems now know as congenital rubella syndrome (CRS) and noticed that the earlier the mother was infected, the worse the damage was. The virus was isolated in tissue culture in 1962 by two separate groups led by physicians Parkman and Weller.[21][19]
There was a pandemic of rubella between 1962 and 1965, starting in Europe and spreading to the United States.[21] In the years 1964-65, the United States had an estimated 12.5 million rubella cases. This led to 11,000 miscarriages or therapeutic abortions and 20,000 cases of congenital rubella syndrome. Of these, 2,100 died as neonates, 12,000 were deaf, 3,580 were blind and 1,800 were mentally retarded. In New York alone, CRS affected 1% of all births [24]
In 1969 a live attenuated virus vaccine was licensed.[20] In the early 1970s, a triple vaccine containing attenuated measles, mumps and rubella (MMR) viruses was introduced.[21]
See also
References
- ↑ Frey TK (1994). "Molecular biology of rubella virus". Adv. Virus Res. 44: 69–160. PMID 7817880.
- ↑ Edlich RF, Winters KL, Long WB, Gubler KD (2005). "Rubella and congenital rubella (German measles)". J Long Term Eff Med Implants. 15 (3): 319–28. PMID 16022642.
- ↑ Best JM (2007). "Rubella". Semin Fetal Neonatal Med. 12 (3): 182–92. doi:10.1016/j.siny.2007.01.017. PMID 17337363.
- ↑ Stegmann BJ, Carey JC (2002). "TORCH Infections. Toxoplasmosis, Other (syphilis, varicella-zoster, parvovirus B19), Rubella, Cytomegalovirus (CMV), and Herpes infections". Curr Womens Health Rep. 2 (4): 253–8. PMID 12150751.
- ↑ Watson JC, Hadler SC, Dykewicz CA, Reef S, Phillips L (1998). "Measles, mumps, and rubella--vaccine use and strategies for elimination of measles, rubella, and congenital rubella syndrome and control of mumps: recommendations of the Advisory Committee on Immunization Practices (ACIP)". MMWR Recomm Rep. 47 (RR-8): 1–57. PMID 9639369.
- ↑ Dayan GH, Castillo-Solórzano C, Nava M; et al. (2006). "Efforts at rubella elimination in the United States: the impact of hemispheric rubella control". Clin. Infect. Dis. 43 Suppl 3: S158–63. doi:10.1086/505949. PMID 16998776.
- ↑ "Elimination of rubella and congenital rubella syndrome--United States, 1969-2004". MMWR Morb. Mortal. Wkly. Rep. 54 (11): 279–82. 2005. PMID 15788995.
- ↑ Khandekar R, Sudhan A, Jain BK, Shrivastav K, Sachan R (2007). "Pediatric cataract and surgery outcomes in Central India: a hospital based study". Indian J Med Sci. 61 (1): 15–22. PMID 17197734.
- ↑ Weisinger HS, Pesudovs K (2002). "Optical complications in congenital rubella syndrome". Optometry. 73 (7): 418–24. PMID 12365660.
- ↑ Freij BJ, South MA, Sever JL (1988). "Maternal rubella and the congenital rubella syndrome". Clin Perinatol. 15 (2): 247–57. PMID 3288422.
- ↑ Reef SE, Frey TK, Theall K; et al. (2002). "The changing epidemiology of rubella in the 1990s: on the verge of elimination and new challenges for control and prevention". JAMA. 287 (4): 464–72. PMID 11798368.
- ↑ Reef S (2006). "Rubella mass campaigns". Curr. Top. Microbiol. Immunol. 304: 221–9. PMID 16989272.
- ↑ Plotkin SA (2001). "Rubella eradication". Vaccine. 19 (25–26): 3311–9. PMID 11348695.
- ↑ Cooper,L.Z. Congenital Rubella in the United States. 1975 In: Krugman,S Gershon,A (eds), Symposium on Infections Of the Fetus and Newborn Infant. New York, Alan R. Liss Inc.,p.1.
- ↑ Danovaro-Holliday MC, LeBaron CW, Allensworth C; et al. (2000). "A large rubella outbreak with spread from the workplace to the community". JAMA. 284 (21): 2733–9. PMID 11105178.
- ↑ 16.0 16.1 Ackerknecht, Erwin Heinz (1982). A short history of medicine. Baltimore: Johns Hopkins University Press. p. 129. ISBN 0-8018-2726-4.
- ↑ Wesselhoeft C (1949). "Rubella and congenital deformities". N. Engl. J. Med. 240 (7): 258–61. PMID 18109609.
- ↑ Best, J.M., Cooray, S., Banatvala J.E. Rubella in Topley and Wilson's Microbiology and Microbial Infections, Vol. 2, Virology, Chapter 45, p.960-92, ISBN 0 340 88562 9, 2005
- ↑ 19.0 19.1 19.2 Lee JY, Bowden DS (2000). "Rubella virus replication and links to teratogenicity". Clin. Microbiol. Rev. 13 (4): 571–87. PMID 11023958.
- ↑ 20.0 20.1 20.2 20.3 Atkinson W, Hamborsky J, McIntyre L, Wolfe S, eds. (2007). "Chapter 12. Rubella". Epidemiology and Prevention of Vaccine-Preventable Diseases. 10th ed. Centers for Disease Control and Prevention. Retrieved 2007-07-03. Unknown parameter
|chapterURL=ignored (|chapterurl=suggested) (help) - ↑ 21.0 21.1 21.2 21.3 "Chapter 11 - Rubella". Immunisation Handbook 2006. Ministry of Health, Wellington, NZ. 2006. ISBN 0-478-29926-5. Retrieved 2007-07-03. Unknown parameter
|month=ignored (help); Unknown parameter|chapterURL=ignored (|chapterurl=suggested) (help) - ↑ Smith, J. L. Contributions to the study of Rötheln. Trans. Int. Med. Congr. Phil. 4,14. 1881
- ↑ Hess, Alfred Fabian (1914). "German measles (rubella): an experimental study". The Archives of Internal Medicine. Chicago. 13: 913–916. as cited by Enersen, Ole Daniel. "Alfred Fabian Hess". WhoNamedIt. Retrieved 2007-07-03.
- ↑ J.B. Hanshaw, J.A. Dudgeon, and W.C. Marshall. Viral diseases of the fetus and newborn. W.B. Saunders Co., Philadelphia, 1985
External links
- Rubella at Wong's Virology.
- Immunization Action Coalition: Rubella
- Template:DermNet
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