RUBELLA ( GERMAN MEASLES OR THREE DAYS MEASLSES)

ABDIRAHMAN

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 life.

•Because of routine vaccination against rubella since 1970 ,

rubella is now rarely reported.

HISTORY

•The name rubella is derived from Latin,

meaning “little red.” Rubella was Discovered in

18th century, initially considered to be a variant

of measles or scarlet fever and was called

“Third disease”. It was not until 1814 that it was

first described as a separate disease in the

German medical literature. And hence named

“German measles”.

•Another name for rubella is the “Three days

measles”

HISTORY

• Infection in early pregnancy

leads to fetal death or

abnormalities.

•The Teratogenic property of

the infection was

documented by an

Australian ophthalmologist

Norman Gregg in 1941.

RUBELLA VIRUS

•Classified as Togavirus

•RNA virus

• Inactivated by lipid

solvents, trypsin,

formalin, ultraviolet

light, low pH, heat, and

amantadine

EPIDEMIOLOGY

• Reservoir

• human

• Transmission

• respiratory (Subclinical cases may transmit)

• Temporal pattern

• peak in late winter and spring

• Communicability

• 7 days before 5 to 7 days after rash onset

• Infants with CRS may shed virus for up to a year

• common in children ages 5-10 years old

PATHOGENESIS

Rubella Virus through respiratory system

Developed in the nasopharynx and regional lymph nodes

Respiratory Tract Skin

Lymph Nodes Joints

Placenta or Fetus

• Cough• Minor

sore throat

• Rashes• Lesions

• Lymphadenopathy

• Mild arthralgia

• arthritis

• Placentitis• Fetal Damage

Viremia

CLINICAL SYMPTOMS AND SIGNS

• Incubation period 14 days (range 12 to 23 days)

• Prodrome is rare in children

• Prodrome of low-grade fever in adults

•Maculopapular rash 14 to 17 days after exposure

• Lymphadenopathy occurs before rash and lasts for

several weeks

RUBELLA RASHES

LYMPHADENOPATHY

COMPLICATIONS

•May produce transient

Arthritis.

• Serious but rare

complications are-

Thrombocytopenia

Purpura

Encephalitis

Neuritis

Orchitis

CONGENITAL RUBELLA SYNDROME (CRS)

• Infection may affect all organs

• May lead to fetal death or premature delivery

• Severity of damage to fetus depends on gestational age

• Up to 85% of infants affected if infected during first trimester

• Deafness

• Eye defects

• Cardiac defects

• Microcephaly

• Mental retardation

• Bone alterations

• Liver and spleen damage

Congenital rubella syndrome (CRS) can occur in a developing fetus of a pregnant woman who has contracted rubella, usually in the first trimester.

CLASSICAL TRIAD OF CONGENITAL RUBELLA

•Cataract

•Cardiac abnormalities

•Deafness

Cataract

LABORATORY DIAGNOSIS

• Isolation of rubella virus from

clinical specimen (e.g.,

nasopharynx, urine)

• Serologic tests available vary

among laboratories

• Positive serologic test for rubella

IgM antibody

• Significant rise in rubella IgG by

any standard serologic assay

(e.g., enzyme immunoassay)

EPIDEMIOLOGICAL DETERMINANTS OF THE DISEASE

•Agent factors

•Host factors

•Environment factors

A - AGENT FACTOR

1. Agent should be available

2. Source of infection

• Case

subclinical

Clinical

• Congenital .from infected

pregnant women to fetus

(vertical transmission)

There is no know carrier state

3. Period of communicability

• It probably extends from a week

before symptoms to about a

week after rash appears.

• Infectivity is greatest when the

rash is erupting.

B - HOST FACTORS

1. Age

Disease of childhood 3-10 yrs.

age group.

2. Immunity

One attack results in life long

immunity.

Infants of immune mothers are

protected for 4-6 months.

C - ENVIRONMENTAL FACTORS

•Disease usually occurs

in seasonal pattern,

during the late winter

& spring.

•Epidemics every 4-9

years.

TREATMENT AND PROGNOSIS

• Rubella is typically a mild disease and no specific

treatment has been found.

• Rubella infection of children and adults is usually

mild, self-limiting and often asymptomatic. The

prognosis in children born with CRS is poor and

depends on the extent of damage.

NURSING INTERVENTION

• Isolation and quarantine

• Increase fluid intake

• Encourage the patient to rest

•Good ventilation

• Encourage the patient to drink either lemon or orange

juice

• Provide health teaching about rubella

PREVENTION

• Rubella is most commonly

prevented by an efficient

lifelong rubella vaccine.

• The widespread use of the

vaccine prevents outbreaks and

the occurrence of birth defects

due to CRS.

• The vaccine is highly

recommended for women in

child bearing age, due to the

prevention against CRS.

RUBELLA VACCINE • The first rubella vaccines were licensed

in 1969.

• Composition

• live virus (RA 27/3 strain)

• Efficacy

• 95% or more

• Duration of Immunity

• lifelong

• Schedule

• at least 1 dose

Should be administered with measles and mumps as MMR or with measles, mumps and varicella as MMRV

RUBELLA VACCINE INDICATION

• All infants 12 months of age and

older

• Susceptible adolescents and

adults without documented

evidence of rubella immunity

• Emphasis on nonpregnant women

of childbearing age.

• Emphasis on males and females in

college, places of employment,

and health care settings

RUBELLA VACCINE CONTRAINDICATION AND PRECAUTIONS • History of anaphylactic reactions to neomycin

• History of severe allergic reaction to any component of the

vaccine

• Pregnancy

• Immunosuppression

• Moderate or severe acute illness

• Recent blood product

• Personal or family (i.e. sibling or parent) history of seizures of

any etiology (MMRV only)

VACCINE ADVERSE REACTIONS

• Fever

• Lymphadenopathy

•Arthralgia — associated with rubella component

•Arthritis- associated with rubella component

• Pain, paresthesia — begins 1-3 weeks after

vaccination, persist for 1 day to three weeks, and

rarely recurs

RUBELLA OUT-BREAK

MANAGEMENT OF RUBELLA OUTBREAK

•What does outbreak means?

a sudden rise in the incidence of a disease

rubella outbreaks are defined as:

2 or more laboratory-confirmed cases which are

temporally related (with dates of rash onset occurring

between 12 and 46 days apart) and epidemiologically or

virologically linked, or both.

CONTINUE………..

•The steps described below are recommended

for the management of suspected rubella

outbreaks,

Investigation

Confirmation and

Response.

OUTBREAK INVESTIGATION

• Outbreak investigation and response should be initiated as soon as

the outbreak is suspected.

• Demographic information can help to assess the required significant

human and financial resources.

• an outbreak response coordinating team or working group

consisting of stakeholders (public health officials, clinicians, local

government and community representatives, etc.) should be

established to enhance capacity to respond and ensure timely flow of

information.

• Rubella surveillance systems should be capable of detecting and

investigating any suspected case of rubella.

CONFIRMATION

• all suspected rubella outbreaks, particularly

in settings with an elimination goal, should

be confirmed by laboratory.

• Intensive surveillance is needed, if the

suspected cases where confirmed as

positive.

RESPOND • Case management

Isolate patients and use nursing treatments to prevent further

complications and disease transmission.

• Case investigation

Investigate any suspected cases who made contact with the confirmed

case during their infectious period

• Contact management

Persons who have been in contact with cases should be identified and

followed up.

CONTINUE………

• Immunization activities should be

started with the high risk population.

•Advocacy and communication to ensure

effective community involvement and

public awareness.