Download - Rubella
RUBELLARUBELLADr.T.V.Rao MDDr.T.V.Rao MD
What is RubellaWhat is Rubella
Rubella (German measles) is a disease Rubella (German measles) is a disease caused by the rubella virus. Rubella is caused by the rubella virus. Rubella is usually a mild illness. Most people who usually a mild illness. Most people who have had rubella or the vaccine are have had rubella or the vaccine are protected against the virus for the rest of protected against the virus for the rest of their lives. Because of routine vaccination their lives. Because of routine vaccination against rubella since 1970 , rubella is now against rubella since 1970 , rubella is now rarely reported.rarely reported.
History - RubellaHistory - Rubella
The Teratogenic property of the The Teratogenic property of the infection was documented by an infection was documented by an
Australian opthalmologist Greeg in Australian opthalmologist Greeg in 19411941
RubellaRubella( German Measles )( German Measles )
Rubella is also Rubella is also called as 3 day called as 3 day Measles or German Measles or German Measles.Measles.
Family – Family – TogaviridaeTogaviridae
Genus - Genus - RubivirusRubivirus In general belong In general belong
to Togavirus groupto Togavirus group
Rubella VirusRubella Virus
Rubella virus areRubella virus are
ss – RNA virusss – RNA virus
Diameter 50 – 70 nmDiameter 50 – 70 nm
Enveloped SphericalEnveloped Spherical
Virus carry Virus carry hemagglutinin hemagglutinin
Virus multiply in the Virus multiply in the cytoplasam of infected cytoplasam of infected cell.cell.
Prevailing GenotypesPrevailing Genotypes
Culturing the VirusCulturing the Virus
The virus can be The virus can be cultured and cultured and adopted to adopted to continuous cell continuous cell lineslines Rabbit kidney Rabbit kidney
cells (RK 13 )cells (RK 13 ) and and
Vero cellsVero cells
Main Clinical EventsMain Clinical Events
The clinical events occuring in the The clinical events occuring in the neonatal age is more important and neonatal age is more important and divided into two major groupsdivided into two major groups
1 Post Natal Rubella1 Post Natal Rubella
2 Congenital Rubella2 Congenital Rubella
How Adults acquire InfectionHow Adults acquire Infection
Acquired, (i.e. not congenital), Acquired, (i.e. not congenital), rubella is transmitted via airborne rubella is transmitted via airborne droplet emission from the upper droplet emission from the upper respiratory tract of active cases. The respiratory tract of active cases. The virus may also be present in the virus may also be present in the urine, feces and on the skin. There is urine, feces and on the skin. There is no carrier state: the reservoir exists no carrier state: the reservoir exists entirely in active human cases. The entirely in active human cases. The disease has an disease has an incubation periodincubation period of 2 of 2 to 3 weeks. to 3 weeks.
Systemic events of Rubella Systemic events of Rubella InfectionInfection
Post natal RubellaPost natal Rubella Occurs in Neonates and Occurs in Neonates and
ChildhoodChildhood Adult infection occurs Adult infection occurs
through mucosa of the upper through mucosa of the upper respiratory tract spread to respiratory tract spread to cervical lymphnodescervical lymphnodes
Viremia devlops after 7 – 9 Viremia devlops after 7 – 9 dayday
Lasts for 13 – 15 daysLasts for 13 – 15 days Leads to development of Leads to development of
antibodiesantibodies The appearance of The appearance of
antibodies coincides the antibodies coincides the appearance of suggestive appearance of suggestive immulogic basis for the rashimmulogic basis for the rash
In 20 – 50 % cases of In 20 – 50 % cases of primary infections are primary infections are subclinicalsubclinical
Clinical findingsClinical findings
MalaiseMalaise Low grade feverLow grade fever Morbilliform rashMorbilliform rash Rash starts on Face Rash starts on Face
Extremities Extremities Rarely lasts more Rarely lasts more
than 5 daysthan 5 days No features of the No features of the
rash give clues to rash give clues to definitive diagnosis definitive diagnosis of Rubella.of Rubella.
Rubella RashesRubella Rashes When epidemics When epidemics
occur with similar occur with similar features it is features it is more suggestive more suggestive of Rubella of Rubella epidemicsepidemics
Other Enterovirus Other Enterovirus infections can infections can produce similar produce similar manifestationsmanifestations..
Other manifestations and Other manifestations and complicationscomplications
May produce May produce transient Arthritis, transient Arthritis, in women in in women in particular.particular.
Serious Serious complications complications areare
ThrombocytopeniaThrombocytopenia
PurpuraPurpura
EncephalitsEncephalits
Immunity - RubellaImmunity - Rubella Antibodies appear in Antibodies appear in
serum as rash fades serum as rash fades and antibody titers and antibody titers raiseraise
Rapid raise in 1 – 3 Rapid raise in 1 – 3 weeksweeks
Rash in association Rash in association with detection of IgM with detection of IgM indicates recent indicates recent infection.infection.
IgG antibodies persist IgG antibodies persist for lifefor life
Immunity - ProtectsImmunity - Protects
One attack of One attack of Rubella infection, Rubella infection, protects for lifeprotects for life
Immune mothers Immune mothers transfer antibodies transfer antibodies to off springs who to off springs who are in turn are are in turn are protected for 4 – 6 protected for 4 – 6 months.months.
Diagnosis of Rubella in Diagnosis of Rubella in AdultsAdults
Clinical Diagnosis is unreliableClinical Diagnosis is unreliable Many viral infections mimic RubellaMany viral infections mimic Rubella Specif diagnosis of infection withSpecif diagnosis of infection with
1 Isolation of virus1 Isolation of virus
2 Evidence of seroconversion2 Evidence of seroconversion
Isolation and Identification of Isolation and Identification of virusvirus
Nasopharyngeal or Nasopharyngeal or throat swabs taken 6 throat swabs taken 6 days prior or after days prior or after appearance of rash is appearance of rash is a good source of a good source of Rubella virusRubella virus
Using cell cultured in Using cell cultured in shell vial antigens can shell vial antigens can be detected by be detected by ImmunofluresecentetImmunofluresecentetmehodsmehods
Serology In RubellaSerology In Rubella Hemagglutination Hemagglutination
inhibition test for inhibition test for Rubella is of Diagnostic Rubella is of Diagnostic significancesignificance
ELISA tests are greater ELISA tests are greater importanceimportance
A raise in Antibody titers A raise in Antibody titers must be demonostrated must be demonostrated between two serum between two serum samples taken at least samples taken at least 10 days apart.10 days apart.
Or Detection of Rubella Or Detection of Rubella specific IgM must be specific IgM must be detected in a single detected in a single specimen.specimen.
EpidemiologyEpidemiology
Rubella is world wide in distributionRubella is world wide in distribution Occurs round the year,Occurs round the year, Epidemics occur every 20 – 25 yearsEpidemics occur every 20 – 25 years Infection is transmitted by respiratory Infection is transmitted by respiratory
routeroute The use of Rubella vaccine has now The use of Rubella vaccine has now
eliminated both epidemic and endemic eliminated both epidemic and endemic Rubella in USA and several developed Rubella in USA and several developed countriescountries
Treatment and PreventionTreatment and Prevention
Rubella is a mild self limited illness.Rubella is a mild self limited illness. No specific treatment or Antiviral No specific treatment or Antiviral
treatment is indicated.treatment is indicated. However Laboratory proved and However Laboratory proved and
clinically missed Rubella in the Ist 3-4 clinically missed Rubella in the Ist 3-4 months of pregnancy is associated months of pregnancy is associated with fetal infections.with fetal infections.
Congenital Rubella SyndromeCongenital Rubella Syndrome
Maternal viremia with Rubella infection Maternal viremia with Rubella infection during pregnancy may result in infection during pregnancy may result in infection of placenta and fetus.of placenta and fetus.
The growth rate of fetal cells are reduced.The growth rate of fetal cells are reduced. Results in fewer number of cells after the Results in fewer number of cells after the
birth.birth. Lead to deranged and hypo plastic organ Lead to deranged and hypo plastic organ
development.development. Results in structural damage and Results in structural damage and
abnormalitiesabnormalities
Rubella infection – At Rubella infection – At various trimestersvarious trimesters
IIstst trimester infections lead to abnormalities in 85 trimester infections lead to abnormalities in 85 % of cases. and greater damage to organs% of cases. and greater damage to organs
22ndnd trimester infections lead to defects in 16 % trimester infections lead to defects in 16 % > 20 weeks of pregnancy fetal defects are > 20 weeks of pregnancy fetal defects are
uncommonuncommon However Rubella infection can also lead to fetal However Rubella infection can also lead to fetal
deaths, and spontaneous abortion.deaths, and spontaneous abortion. The intrauterine infections lead to viral excretion The intrauterine infections lead to viral excretion
in various secretion in newborn upto 12-18 in various secretion in newborn upto 12-18 months.months.
Clinical FindingsClinical Findings( Congenital Rubella Syndrome )( Congenital Rubella Syndrome )
May be transient effects in infants.May be transient effects in infants. Permanent manifestations may be Permanent manifestations may be
apparent at birth, become apparent at birth, become recognized during the first year.recognized during the first year.
Developmental abnormalities appear Developmental abnormalities appear during childhood and adolescents.during childhood and adolescents.
Classical Triad of RubellaClassical Triad of Rubella
Classical TriadClassical Triad CataractCataract Cardiac Cardiac
abnormalitiesabnormalities DeafnessDeafness
Other manifestationsOther manifestations Growth retardationGrowth retardation
RashRash HepatosplenomegalyHepatosplenomegaly
JaundiceJaundice MeingoencephalitisMeingoencephalitis CNS defects lead to CNS defects lead to moderate to profound moderate to profound
mental retardationmental retardation
Other Neurological manifestionsOther Neurological manifestions
Problems in balanceProblems in balance Motor skills in Motor skills in
preschool children preschool children altered.altered.
A rare complication of A rare complication of Pan encephalitis can Pan encephalitis can occur in second occur in second decade with decade with Congenital rubella Congenital rubella syndrome may syndrome may progress to death.progress to death.
Diagnosis ofDiagnosis ofCongenital Rubella SyndromeCongenital Rubella Syndrome
Demonstration of Demonstration of Rubella antibodies Rubella antibodies of IgM in a new of IgM in a new born is diagnostic born is diagnostic value. As IgM value. As IgM group donot cross group donot cross the placenta and the placenta and they are produce in they are produce in the infected fetus,the infected fetus,
Treatment, Prevention, Treatment, Prevention, ControlControl
No specific treatment is No specific treatment is availableavailable
CRS can be prevented CRS can be prevented by effective by effective immunization of the immunization of the young children and young children and teenage girls, remain teenage girls, remain the best option to the best option to prevent Congenital prevent Congenital Rubella Syndrome.Rubella Syndrome.
The component of The component of Rubella in MMR vaccine Rubella in MMR vaccine protects the vaccinatedprotects the vaccinated
MMR VaccineMMR Vaccine The The MMR vaccineMMR vaccine is a mixture of three live is a mixture of three live
attenuated virusesattenuated viruses, administered via injection for , administered via injection for immunizationimmunization against against measlesmeasles, , mumpsmumps and and rubellarubella. It is generally administered to children . It is generally administered to children around the age of one year, with a second dose around the age of one year, with a second dose before starting school (i.e. age 4/5). The second before starting school (i.e. age 4/5). The second dose is not a dose is not a boosterbooster; it is a dose to produce ; it is a dose to produce immunity in the small number of persons (2-5%) immunity in the small number of persons (2-5%) who fail to develop measles immunity after the who fail to develop measles immunity after the first dose In the United States, the vaccine was first dose In the United States, the vaccine was licensed in 1963 and the second dose was licensed in 1963 and the second dose was introduced in the mid 1990s. It is widely used in introduced in the mid 1990s. It is widely used in all National, Universal Immunization programmes all National, Universal Immunization programmes
Created for Awareness Created for Awareness on Rubella for Medical on Rubella for Medical
and Paramedical and Paramedical studentsstudents
Dr.T.V.Rao MDDr.T.V.Rao MD
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