Rubella overview
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Synonyms: German measles; 3 day measles
Overview
Rubella is a common childhood infection usually with minimal systemic upset although transient arthropathy may occur in adults. Serious complications are very rare. If it were not for the effects of transplacental infection on the developing foetus, rubella is a relatively trivial infection.
Historical Perspective
Pathophysiology
The pathophysiology of rubella is not completely understood. Viral replication in the respiratory epithelium occurs following transmission of the virus via contact with droplet secretions from an infected person. Viremia subsequently ensues, with the onset of the rubella rash occurring at the peak of viremia.
Causes
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 fetus where it stops cells from developing or destroys them.[2]
Differentiating Rubella from other Diseases
Rubella infection must be differentiated from diseases presenting with features of skin rash, fever and lymphadenopathy such as measles, coxackie virus infection and infectious mononucleosis.
Epidemiology and Demographics
In the United States, endemic rubella virus transmission has been eliminated since 2001. From 2004 to 2013, 10 cases of rubella infection was diagnosed in the immigrants.
Risk Factors
The risk factors predisposing for rubella infection include: contact with infected patient and not receiving immunization according to the standard schedule.
Screening
There are no standard screening test recommended for rubella infection, however pregnant women with suspected rubella infection must be investigated to confirm the diagnosis to prevent fetal anomalies
Natural History and Complications
Rubella is transmitted by direct contact and presents with a fever, rash and lymphadenopathy. It is usually a self limiting infection and resolves without any complications. Few patients might develop complications such as arthritis which needs symptomatic treatment. The prognosis is good in adults with complete resolution of symptoms in a week.
Diagnosis
History and Symptoms
Patients with rubella infection present with a fever, skin rash and cervical lymphadenopathy. Malaise and anorexia precede the development of fever and rash.
Physical Examination
Rubella infection in adults presents with low grade fever and a maculopapular rash starting on the face and spreads caudally. Cervical lymphadenopathy is present in majority of the patients.
Laboratory Diagnosis
All patients with suspected rubella infection must be investigated further to confirm the diagnosis. Serological tests to look for the presence of rubella specific IgG antibodies and IgG avidity and RT-PCR should be done to confirm the diagnosis.
Treatment
Medical Therapy
There is no specific antiviral therapy for rubella infection. Symptomatic therapy and reporting the infection to local disease control agencies is recommended.
Surgical Therapy
Surgical intervention is not recommended for the management of rubella infection.
Prevention
Primary 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, are effective in the prevention of adult disease
Secondary Prevention
All the patients with confirmed rubella infection must be vaccinated. Pregnant women should be vaccinated after delivery of the baby.
Cost-Effectiveness of Therapy
When considering the financial costs of a certain disease, many different factors have to be taken into account. If there is a disease without a vaccination program, some of the costs ensued are expenditures made for treatment of acute illness, lost money from missing work, complications and chronic sequelae, and lost savings due to retardation or even death.[3]
On the other hand, diseases such as rubella, have vaccination programs in place, and a vaccination program has different costs associated with it. There are certain expenditures to make the vaccine itself as well as its administration, treatment of complications associated with the vaccine, and the cost of implementing the vaccine program.[3]
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.
- ↑ 3.0 3.1 White CC, Koplan JP, Orenstein WA (1985). "Benefits, risks and costs of immunization for measles, mumps and rubella". American Journal of Public Health. 75 (7): 739–44. PMC 1646302. PMID 3923849. Unknown parameter
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