rubella

Definition

Rubella is a highly contagious viral disease, spread through contact with discharges from the nose and throat of an infected person. Although rubella causes only mild symptoms of low fever, swollen glands, joint pain, and a fine red rash in most children and adults, it can have severe complications for women in their first trimester of pregnancy. These complications include severe birth defects or death of the fetus.

Description

Rubella is also called German measles or three-day measles. This disease was once a common childhood illness, but its occurrence has been drastically reduced since vaccine against rubella became available in 1969. In the 20 years following the introduction of the vaccine, reported rubella cases dropped 99.6%. Only 229 cases of rubella were reported in the United States in 1996.

Rubella is spread through contact with fluid droplets expelled from the nose or throat of an infected person. A person infected with the rubella virus is contagious for about seven days before any symptoms appear and continues to be able to spread the disease for about four days after the appearance of symptoms. Rubella has an incubation period of 12–23 days.

Although rubella is generally considered a childhood illness, people of any age who have not been vaccinated or previously caught the disease can become infected. Having rubella once or being immunized against rubella normally gives lifetime immunity. This is why vaccination is so effective in reducing the number of rubella cases.

Women of childbearing age who do not have immunity against rubella should be the most concerned about getting the disease. Rubella infection during the first three months of pregnancy can cause a woman to miscarry or cause her baby to be born with birth defects. Although it has been practically eradicated in the United States, rubella is still common in less developed countries because of poor immunization penetration, creating a risk to susceptible travelers. Some countries have chosen to target rubella vaccination to females only and outbreaks in foreign-born males have occurred on cruise ships and at U.S. summer camps.

— Tish Davidson

A mild contagious eruptive disease caused by a virus and capable of producing congenital defects in infants born to mothers infected during the first three months of pregnancy. Also called German measles.

[From Latin, neuter pl. of rubellus, red, from ruber.]

A benign, infectious virus disease of humans characterized by coldlike symptoms and transient, generalized rash. This disease, also known as German measles, is primarily a disease of childhood. However, maternal infection during early pregnancy may result in infection of the fetus, giving rise to serious abnormalities and malformations. The congenital infection persists in the infant, who harbors and sheds virus for many months after birth.

In rubella infection acquired by ordinary person-to-person contact, the virus is believed to enter the body through respiratory pathways. Antibodies against the virus develop as the rash fades, increase rapidly over a 2–3-week period, and then fall during the following months to levels that are maintained for life. One attack confers life-long immunity, since only one antigenic type of the virus exists. Immune mothers transfer antibodies to their offspring, who are then protected for approximately 4–6 months after birth. See also Immunity.

Live attenuated rubella vaccines have been available since 1969. The vaccine induces high antibody titers and an enduring and solid immunity. It may also induce secretory immunoglobulin (IgA) antibody in the respiratory tract and thus interfere with establishment of infection by wild virus. This vaccine is available as a single antigen or combined with measles and mumps vaccines (MMR vaccine). The vaccine induces immunity in at least 95% of recipients, and that immunity endures for at least 10 years. See also Biologicals; Vaccination.

Definition

Rubella is a highly contagious viral disease, spread through contact with discharges from the nose and throat of an infected person. A person infected with the rubella virus is contagious for about seven days before any symptoms appear and continues to spread the disease for about four days after the appearance of symptoms. Rubella has an incubation period of 12–23 days.

Description

Rubella is also called German measles or the three-day measles. This disease was once a common childhood illness, but its occurrence has been drastically reduced since vaccine against rubella became available in 1969. In the three decades following the introduction of the vaccine, reported rubella cases dropped 99.6%. Only 229 cases of rubella were reported in the United States in 1996. A recent study indicates, however, that the age group pattern of rubella is shifting. As of 2002, the number of cases reported in people aged 15 years or younger is dropping, while the number of cases in people between 25 and 45 is rising.

People of any age who have not been vaccinated or previously caught the disease can become infected. Having rubella once or being immunized against rubella normally gives lifetime immunity. This is why vaccination is so effective in reducing the number of rubella cases. The United States had a public health goal of eliminating all rubella within its borders by the year 2000; however, this goal was not attained because of new strains of the rubella virus entering the country from the Caribbean and Central America. The availability of molecular typing indicates that three separate strains of the virus caused localized outbreaks that were quickly contained. As of 2002, cases of rubella in the United States are more common among Hispanics than among Caucasians, Native Americans, or African Americans.

Women of childbearing age who do not have immunity against rubella should be the most concerned about infection. Rubella infection during the first three months of pregnancy can cause a woman to miscarry or cause the baby to be born with severe birth defects, including mental retardation and sensory impairments. In addition, recent studies indicate that infants exposed to rubella in utero (in the womb) are at increased risk of developing schizophrenia as adults.

Although it has been practically eradicated in the United States, rubella is still common in less developed countries because of poor immunization penetration, creating a risk to susceptible travelers. Some countries have chosen to target rubella vaccination to females only. As a result, outbreaks among foreign-born males have occurred on cruise ships and at summer camps in the United States. The United Kingdom is considering targeting immigrants of either sex from underdeveloped countries for rubella immunization following several cases of babies born with congenital rubella syndrome.

Causes & Symptoms

Rubella is caused by the rubella virus (Rubivirus). Symptoms are generally mild, and complications are rare in anyone who is not pregnant.

The first visible sign of rubella is a fine red rash that begins on the face and rapidly moves downward to cover the whole body within 24 hours. The rash lasts about three days, which is why rubella is sometimes called the three-day measles. A low fever and swollen glands, especially in the head (around the ears) and neck, often accompany the rash. Joint pain and sometimes joint swelling can occur, more often in women. It is quite common to get rubella and not show any symptoms (subclinical infection).

Symptoms disappear within three to four days, except for joint pain, which may linger for a week or two. Most people recover fully with no complications. Although rubella causes only mild symptoms of low fever, swollen glands, joint pain, and a fine red rash in most children and adults, it can have severe complications for women in their first trimester of pregnancy. Babies may be miscarried or stillborn and a high percentage are born with birth defects. Birth defects are reported to occur in 50% of women who contract the disease during the first month of pregnancy, 20% of those who contract it in the second month, and 10% of those who contract it in the third month. The most common birth defects resulting from congenital rubella infection are eye defects, such as cataracts, glaucoma, and blindness, deafness, congenital heart defects, and mental retardation. Taken together, these conditions are called congenital rubella syndrome (CRS). The risk of birth defects drops after the first trimester, and by the fifth month, there are rarely any complications.

Diagnosis

The rash caused by the rubella virus and the accompanying symptoms are so similar to other viral infections that it is impossible for a physician to make a confirmed diagnosis on visual examination alone. The only sure way to confirm a case of rubella is by checking for antibodies with a blood test or in a laboratory culture.

When the body is infected with the rubella virus, it produces both immunoglobulin G (IgG) and immunoglobulin

M (IgM) antibodies to fight the infection. Once IgG exists, it persists for a lifetime, but the special IgM antibody usually wanes over six months. A blood test can be used either to confirm a recent infection (IgG and IgM) or determine whether a person has immunity to rubella (IgG only). The lack of antibodies indicates that a person is susceptible to rubella.

All pregnant women should be tested for rubella early in pregnancy, whether or not they have a history of vaccination. If the woman lacks immunity, she is counseled to avoid anyone with the disease and to be vaccinated after giving birth.

Treatment

Rather than vaccinating a healthy child against rubella, some alternative practitioners recommend allowing the child to contract the disease naturally at the age of five or six years, since the immunity conferred by contracting the disease naturally lasts a lifetime. It is, however, difficult for a child to contract rubella naturally when everyone around him or her has been vaccinated.

Ayurvedic practitioners recommend making the patient comfortable and giving the patient ginger or clove tea to hasten the progress of the disease. Traditional Chinese medicine uses a similar approach. Believing that inducing the skin rash associated with rubella hastens the progress of the disease, traditional Chinese practitioners prescribe herbs such as peppermint (Mentha piperita) and chai hu (Bupleurum chinense). Cicada is often prescribed as well. Western herbal remedies may be used to alleviate rubella symptoms. Distilled witch hazel (Hamamelis virginiana) helps calm the itching associated with the skin rash and an eyewash made from a filtered diffusion of eyebright (Euphrasia officinalis) can relieve eye discomfort. Antiviral western herbal or Chinese remedies can be used to assist the immune system in establishing equilibrium during the healing process. Depending on the patient's symptoms, among the remedies a homeopath may prescribe are Belladonna, Pulsatilla, or Phytolacca. These can be used with or with out bilberry.

Allopathic Treatment

There is no drug treatment for rubella. Bed rest, fluids, and acetaminophen or Motrin for pain and temperatures over 102°F (38.9°C) are usually all that is necessary.

Babies born with suspected CRS are isolated and cared for only by people who are sure they are immune to rubella. Congenital heart defects are treated with surgery.

Expected Results

Complications from rubella infection are rare in children, pregnant women past the fifth month of pregnancy, and other adults.

Prevention

Vaccination is the best way to prevent rubella and is normally required by law for children entering school. Rubella vaccine is usually given in conjunction with measles and mumps vaccines in a shot referred to as MMR (mumps, measles, and rubella). Children receive one dose of MMR vaccine at 12–15 months and another dose at four to six years. The MMR vaccine has aroused some controversy since early 2000 because of media reports that it increases the risk of wheezing and lower respiratory tract disorders in young children. A recent study of vaccine safety has concluded, however, that there is no connection between the MMR vaccine and a reported rise in the incidence of wheezing in children.

Pregnant women should not be vaccinated; women who are not pregnant should avoid conceiving for at least three months following vaccination. To date, however, accidental rubella vaccinations during pregnancy have not clearly been associated with the same risk as the natural infection itself. Women may be vaccinated while they are breast-feeding. People whose immune systems are compromised, either by the use of such drugs as steroids or by disease, should discuss possible complications with their doctor before being vaccinated.

Resources

Books

Cooper, Louis Z. "Rubella." In Rudolph's Pediatrics, 21st ed., edited by M. M. Rudolph, J. I. E. Hoffman, and C. D. Rudolph. Stamford, CT: McGraw-Hill, 2002.

Gershon, Anne. "Rubella (German Measles)." In Harrison's Principles of Internal Medicine, 15th ed., edited by Anthony S. Fauci. New York: McGraw-Hill, 2001.

Periodicals

Brown, A. S., and E. S. Susser. "In Utero Infection and Adult Schizophrenia." Mental Retardation and Developmental Disabilities Research and Review 8 (January 2002): 51–7.

Carvill, S., and G. Marston. "People with Intellectual Disability, Sensory Impairments and Behaviour Disorder: A Case Series." Journal of Intellectual Disability Research 46 (March 2002): 264–72.

Case Definitions for Infectious Conditions under Public Health Surveillance. Morbidity and Mortality Weekly Report 46 (1997): 30.

Dixon, B. "Triple Vaccine Fears Mask Media Efforts at Balance." Current Biology 12 (March 5, 2002): R151-R152.

Mullooly, J. P., J. Pearson, L. Drew, et al. "Wheezing Lower Respiratory Disease and Vaccination of Full-Term Infants." Pharmacoepidemiology and Drug Safety 11 (January-February 2002): 21–30.

Reef, S. E., T. K. Frey, K. Theall, et al. "The Changing Epidemiology of Rubella in the 1990s: On the Verge of Elimination and New Challenges for Control and Prevention." Journal of the American Medical Association 287 (January 23, 2002): 464–72.

Sheridan E., C. Aitken, D. Jeffries, et al. "Congenital Rubella Syndrome: A Risk in Immigrant Populations." Lancet 359 (February 23, 2002): 674–675.

Organizations

March of Dimes Resource Center. 1275 Mamaroneck Avenue, White Plains, NY 10605. (888) 663-4637. .

National Organization of Rare Disorders. 55 Kenosia Avenue PO Box 1968 Danbury, CT 06813-1968. (800) 999-6673. orphan@rarediseases.org. .

[Article by: Kathleen Wright; Rebecca J. Frey, PhD]

Definition

Rubella, also called German measles or three-day measles, is a highly contagious viral disease that in most children and adults causes mild symptoms of low fever, swollen glands, joint pain, and a fine red rash. Although rubella causes only mild symptoms in child and adult sufferers, the infection can have severe complications for the fetus of a woman who becomes infected with the virus during the first trimester of pregnancy. These complications include severe birth defects or death of the fetus.

Description

Rubella is spread through contact with fluid droplets expelled from the nose or throat of an infected person. A person infected with the rubella virus is contagious for about seven days before any symptoms appear and continues to be able to spread the disease for about four days after the appearance of symptoms. Rubella has an incubation period of 12 to 23 days.

Although rubella is generally considered a childhood illness, people of any age who have not been vaccinated or previously caught the disease can become infected. Having rubella once or being immunized against rubella normally gives lifetime immunity. For this reason vaccination is highly effective in reducing the number of rubella cases.

Women of childbearing age who do not have immunity against rubella should be particularly concerned about getting the disease. Rubella infection during the first three months of pregnancy can cause a woman to miscarry or cause her baby to be born with birth defects. Although it has been practically eradicated in the United States, rubella is still common in less developed countries because of poor immunization penetration, creating a risk to susceptible travelers. Some countries have chosen to target rubella vaccination to females only and outbreaks in foreign-born males have occurred on cruise ships and at U.S. summer camps.

Demographics

Although rubella was once a common childhood illness, its occurrence has been drastically reduced since vaccine against it became available in 1969. According to statistics for 1964–1965, prior to routine rubella immunization in the United States, there were 2,100 newborn deaths and 11,250 miscarriages attributed to rubella infection of pregnant women. In addition, about 20,000 infants were born with birth defects attributable to rubella infection in utero. Of these babies, 11,600 were born deaf; 3,580 were born blind; and 1,800 suffered severe developmental delay. In the 20 years following the introduction of the vaccine, reported rubella cases dropped 99.6 percent. In 2000, there were only 152 reported cases of rubella infection and seven reported cases of congenital rubella.

Causes and Symptoms

Rubella is caused by the rubella virus (Rubivirus). Symptoms are generally mild, and complications are rare in anyone who is not pregnant.

The first visible sign of rubella is a fine red rash that begins on the face and rapidly moves downward to cover the whole body within 24 hours. The rash lasts about three days, which is why rubella is sometimes called the three-day measles. A low fever and swollen glands, especially in the head (around the ears) and neck, often accompany the rash. Joint pain and sometimes joint swelling can occur, more often in women. It is quite common to get rubella and not show any symptoms (subclinical infection).

Symptoms disappear within three to four days, except for joint pain, which may linger for a week or two. Most people recover fully with no complications. However, severe complications may arise in the unborn children of women who get rubella during the first three months of their pregnancy. These babies may be miscarried or stillborn. A high percentage is born with birth defects. Birth defects are reported to occur in 50 percent of women who contract the disease during the first month of pregnancy, 20 percent of those who contract it in the second month, and 10 percent of those who contract it in the third month.

The most common birth defects resulting from congenital rubella infection are eye defects such as cataracts, glaucoma, and blindness; deafness; congenital heart defects; and mental retardation. Taken together, these conditions are called congenital rubella syndrome (CRS). The risk of birth defects drops after the first trimester, and by the twentieth week, there are rarely any complications.

Diagnosis

The rash caused by the rubella virus and the accompanying symptoms are so similar to other viral infections that it is impossible for a physician to make a confirmed diagnosis on visual examination alone. The only sure way to confirm a case of rubella is by isolating the virus with a blood test or in a laboratory culture.

A blood test is done to check for rubella antibodies. When the body is infected with the rubella virus, it produces both immunoglobulin G (IgG) and immunoglobulin M (IgM) antibodies to fight the infection. Once IgG exists, it persists for a lifetime, but the special IgM antibody usually wanes over six months. A blood test can be used either to confirm a recent infection (IgG and IgM) or determine whether a person has immunity to rubella (IgG only). The lack of antibodies indicates that a person is susceptible to rubella.

All pregnant women should be tested for rubella early in pregnancy, whether they have a history of vaccination. If the woman lacks immunity, she is counseled to avoid anyone with the disease and to be vaccinated after giving birth.

Treatment

There is no drug treatment for rubella. Bed rest, fluids, and acetaminophen for pain and temperatures over 102°F (38.9°C) are usually all that is necessary.

Babies born with suspected CRS are isolated and cared for only by people who are sure they are immune to rubella. Congenital heart defects are treated with surgery.

Prognosis

Complications from rubella infection are rare in children, pregnant women past the twentieth week of pregnancy, and other adults. For women in the first trimester of pregnancy, there is a high likelihood of the child being born with one or more birth defect. Unborn children exposed to rubella early in pregnancy are also more likely to be miscarried, stillborn, or have a low birth weight. Although the symptoms of rubella pass quickly for the mother, the consequences to the unborn child can last a lifetime.

Prevention

Vaccination is the best way to prevent rubella and is normally required by law for children entering school. Rubella vaccine is usually given in conjunction with measles and mumps vaccines in a shot referred to as MMR (mumps, measles, and rubella). Children receive one dose of MMR vaccine at 12 to 15 months and another dose at four to six years.

Pregnant women should not be vaccinated, and women who are not pregnant should avoid conceiving for at least three months following vaccination. As of 2004, however, accidental rubella vaccinations during pregnancy had not clearly been associated with the same risk as the natural infection itself. Women may be vaccinated while they are breastfeeding. People whose immune systems are compromised, either by the use of drugs such as steroids or by disease, should discuss possible complications with their doctor before being vaccinated.

Parental Concerns

While rubella infection in an older child or adult is rarely complicated, the risks of not immunizing a child against rubella are highest in the unborn. Congenital rubella is a serious, life-changing condition, and adherence to immunization recommendations is crucial to the public health.

Resources

Books

Maldonado, Yvonne A. "Rubella Virus." In Principles and Practice of Pediatric Infectious Diseases, 2nd ed. Edited by Sarah S. Long et al. St. Louis, MO: Elsevier, 2003.

Thompson, George H. "The Neck." In Nelson Textbook of Pediatrics. Edited by Richard E. Behrman et al. Philadelphia: Saunders, 2004.

Organizations

March of Dimes Birth Defects Foundation. 1275 Mamaroneck Ave., White Plains, NY 10605. Web site: www.modimes.org.

National Organization for Rare Disorders. PO Box 8923, New Fairfield, CT 06812-8923. Web site: www.rarediseases.org.

[Article by: Tish Davidson, A.M. Rosalyn Carson-DeWitt, MD]

Rubella, also known as German measles or three-day measles, is a mild, self-limited viral disease. Humans are the only known natural host. In up to 50 percent of persons who are not immune, a diffuse maculopapular red rash develops in two to three weeks after contact with secretions from the mouth or nose of an infected person. From 20 to 50 percent of those infected do not develop symptoms, however. Along with the rash, infected persons may experience enlarged lymph glands, conjunctivitis, and runny nose. Adult women may also experience joint pain or swelling.

When infection occurs early in pregnancy, the risk of the fetus being infected may be as high as 90 percent. Consequences of fetal infection include miscarriages, stillbirths, and severe birth defects, known as congenital rubella syndrome (CRS). Known defects include cataracts, heart defects, and hearing impairment. Up to 20 percent of the infants born to mothers infected during the first half of their pregnancy have CRS.

Because many people with rubella do not have symptoms, and because many rash illnesses look similar to rubella, a laboratory test is required to confirm rubella infection. A blood test can be used to detect rubella antibodies, and the virus can be cultured and isolated from a sample of blood, nasal or throat secretion, urine, spinal fluid, or body tissues such as cataracts.

Rubella circulates year-round, with a regular seasonal peak during springtime. Before the rubella vaccine was used in the United States, major epidemics occurred every six to nine years. The last major U.S. rubella epidemic occurred in 1964–1965 and caused an estimated 12.5 million cases of rubella and 20,000 cases of CRS in live-born infants. Prior to vaccine use, rubella occurred mainly among children. With the success of the U.S. rubella immunization program, the incidence of rubella has decreased by 99 percent to a reported 267 cases of rubella and six cases of CRS in 1999. In the United States, most cases of rubella now occur mainly among adults who were born in countries that do not have a long history of widespread vaccination.

In 1969, three rubella vaccines were licensed for use in the United States. In 1979, the currently used vaccine—called RA27/3—was introduced, replacing the other three. More than 95 percent of those vaccinated develop lifelong immunity. In the United States, one dose of rubella vaccine is recommended for all susceptible persons twelve months of age and older, unless vaccination is contraindicated.

Side effects following vaccination include low-grade fever, rash, joint pain and swelling, and lymphadenopathy. Joint pain and transient joint swelling tend to be more severe in vaccinated women than in men or children. Overall, joint pain and swelling tend to be more severe and last longer in persons who have the natural rubella disease than those who receive the rubella vaccine.

Although use of rubella vaccine is contraindicated in pregnant women or women planning pregnancy within three months, the U.S. registry on inadvertent vaccination in pregnancy has documented that all infants listed in the registry were free of defects associated with CRS. These data are consistent with results reported from other countries. Other groups that should not be given the vaccine include persons with immunodeficiency diseases or compromised immune systems and those who have recently received immunoglobulin or have severe fever.

(SEE ALSO: Communicable Disease Control; Contagion; Immunizations)

Bibliography

Cooper, L. Z., and Alford, C. A., Jr. (2001). "Rubella." In Infectious Diseases of the Fetus and Newborn Infant, 5th edition, eds. J. S. Remington and J. O. Klein. Philadelphia, PA: W. B. Saunders.

"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)." Mortality and Morbidity Weekly Report 47(RR-8):1–57.

Plotkin, S. A. (1999). "Rubella Vaccine." In Vaccines, 3rd edition, eds. S. A. Plotkin and W. A. Orenstein. Philadelphia, PA: W. B. Saunders Company.

— SUSAN E. REEF

For more information on rubella, visit Britannica.com.

See German measles.

This page is for the disease. For the virus, see rubella virus.

Rubella
Classification and external resources
ICD-10	B06.
ICD-9	056
DiseasesDB	11719
MedlinePlus	001574
eMedicine	emerg/388 peds/2025 derm/259
MeSH	D012409

Rubella, commonly known as German measles, is a disease caused by the rubella virus. The name "rubella" is derived from the Latin, meaning little red. Rubella is also known as German measles because the disease was first described by German physicians in the mid-eighteenth century. This disease is often mild and attacks often pass unnoticed. The disease can last one to three days. Children recover more quickly than adults. Infection of the mother by Rubella virus during pregnancy can be serious; if the mother is infected within the first 20 weeks of pregnancy, the child may be born with congenital rubella syndrome (CRS), which entails a range of serious incurable illnesses. Spontaneous abortion occurs in up to 20% of cases.^[1]

Rubella is a common childhood infection usually with minimal systemic upset although transient arthropathy may occur in adults. Serious complications are very rare. Apart from the effects of transplacental infection on the developing fetus, rubella is a relatively trivial 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.^[2]

In most people the virus is rapidly eliminated. However, it may persist for some months post partum in infants surviving the CRS. These children are a significant source of infection to other infants and, more importantly, to pregnant female contacts.

The name rubella is sometimes confused with rubeola, an alternative name for measles in English-speaking countries; the diseases are unrelated.^[3][4] In some other European languages, rubella and rubeola are synonyms, and rubeola is not an alternative name for measles.^[5]

Contents 1 Signs and symptoms 1.1 Congenital rubella syndrome 2 Cause 3 Diagnosis of acquired rubella 4 Prevention 5 Treatment 6 Prognosis 7 Epidemiology 8 History 9 See also 10 References 11 External links

Signs and symptoms

After an incubation period of 14–21 days, the primary symptom of rubella virus infection is the appearance of a rash (exanthem) on the face which spreads to the trunk and limbs and usually fades after three days. Other symptoms include low grade fever, swollen glands (post cervical lymphadenopathy), joint pains, headache and conjunctivitis.^[6] The swollen glands or lymph nodes can persist for up to a week and the fever rarely rises above 38 ^oC (100.4 ^oF). The rash disappears after a few days with no staining or peeling of the skin. Forchheimer's sign occurs in 20% of cases, and is characterized by small, red papules on the area of the soft palate.

Rubella can affect anyone of any age and is generally a mild disease, rare in infants or those over the age of 40. The older the person is the more severe the symptoms are likely to be. Up to one-third of older girls or women experience joint pain or arthritic type symptoms with rubella. The virus is contracted through the respiratory tract and has an incubation period of 2 to 3 weeks. During this incubation period, the carrier is contagious but may show no symptoms.

Congenital rubella syndrome

Main article: Congenital rubella syndrome

Rubella can cause congenital rubella syndrome in the newly born. The syndrome (CRS) follows intrauterine infection by Rubella virus and comprises cardiac, cerebral, ophthalmic and auditory defects.^[7] It may also cause prematurity, low birth weight, and neonatal thrombocytopenia, anaemia and hepatitis. The risk of major defects or organogenesis is highest for infection in the first trimester. CRS is the main reason a vaccine for rubella was developed. Many mothers who contract rubella within the first critical trimester either have a miscarriage or a still born baby. If the baby survives the infection, it can be born with severe heart disorders (PDA being the most common), blindness, deafness, or other life threatening organ disorders. The skin manifestations are called "blueberry muffin lesions." ^[8]

Cause

Main article: Rubella virus

The disease is caused by Rubella virus, a togavirus that is enveloped and has a single-stranded RNA genome.^[9] 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. The virus has teratogenic properties and is capable of crossing the placenta and infecting the fetus where it stops cells from developing or destroys them.^[6]

Increased susceptibility to infection might be inherited as there is some indication that HLA-A1 or factors surrounding A1 on extended haplotypes are involved in virus infection or non-resolution of the disease.^{[10] [11]}

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.^[12] The presence of these antibodies along with, or a short time after, the characteristic rash confirms the diagnosis.^[13]

Prevention

Main article: MMR vaccine

Rubella infections are prevented by active immunisation 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.^[14]

The immunisation program has been quite successful. Cuba declared the disease eliminated in the 1990s, and 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.^[15][16]

Treatment

There is no specific treatment for Rubella; however, management is a matter of responding to symptoms to diminish discomfort. Treatment of newly born babies is focused on management of the complications. Congenital heart defects^{[citation needed]} and cataracts can be corrected by direct surgery.^[17] 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.^[18]

Prognosis

Rubella infection of children and adults is usually mild, self-limiting and often asymptomatic. The prognosis in children born with CRS is poor.^[19]

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.^[20] 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.^[21]

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.^[22][23] Universal immunisation producing a high level of herd immunity is important in the control of epidemics of rubella.^[24]

History

Rubella was first described in the mid-eighteenth century. Friedrich Hoffmann made the first clinical description of rubella in 1740,^[25] which was confirmed by de Bergen in 1752 and Orlow in 1758.^[26]

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". ^[27] 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.^{[25][28][29][30]}

It was formally recognised as an individual entity in 1881, at the International Congress of Medicine in London.^[31] In 1914, Alfred Fabian Hess theorised that rubella was caused by a virus, based on work with monkeys.^[32] In 1938, Hiro and Tosaka confirmed this by passing the disease to children using filtered nasal washings from acute cases.^[29]

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.^[28][29] Gregg published an account, Congenital Cataract Following German Measles in the Mother, in 1941. He described a variety of problems now known 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.^[28][30]

There was a pandemic of rubella between 1962 and 1965, starting in Europe and spreading to the United States.^[30] 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 ^[33]

In 1969 a live attenuated virus vaccine was licensed.^[29] In the early 1970s, a triple vaccine containing attenuated measles, mumps and rubella (MMR) viruses was introduced.^[30]

See also

• Eradication of infectious diseases
• Roseola (exanthem subitum)

References

1. ^ Siegel M, Fuerst HT, Guinee VF (1971). "Rubella epidemicity and embryopathy. Results of a long-term prospective study". Am. J. Dis. Child. 121 (6): 469–73. PMID 5581012. 
2. ^ Richardson M, Elliman D, Maguire H, Simpson J, Nicoll A (2001). "Evidence base of incubation periods, periods of infectiousness and exclusion policies for the control of communicable diseases in schools and preschools". Pediatr. Infect. Dis. J. 20 (4): 380–91. doi:10.1097/00006454-200104000-00004. PMID 11332662. http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=0891-3668&volume=20&issue=4&spage=380. 
3. ^ Merriam-webster:Rubeola Accessed 2009-09-20.
4. ^ T. E. C. Jr. Letters to the editor Pediatrics Vol. 49 No. 1 January 1972, pp. 150-151.
5. ^ Webster's Online Dictionary: German measles Accessed 2009-09-20
6. ^ ^{a b} 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. doi:10.1615/JLongTermEffMedImplants.v15.i3.80. PMID 16022642. 
7. ^ Atreya CD, Mohan KV, Kulkarni S (2004). "Rubella virus and birth defects: molecular insights into the viral teratogenesis at the cellular level". Birth Defects Res. Part a Clin. Mol. Teratol. 70 (7): 431–7. doi:10.1002/bdra.20045. PMID 15259032. 
8. ^ De Santis M, Cavaliere AF, Straface G, Caruso A (2006). "Rubella infection in pregnancy". Reprod. Toxicol. 21 (4): 390–8. doi:10.1016/j.reprotox.2005.01.014. PMID 16580940. http://linkinghub.elsevier.com/retrieve/pii/S0890-6238(05)00073-0. 
9. ^ Frey TK (1994). "Molecular biology of rubella virus". Adv. Virus Res. 44: 69–160. doi:10.1016/S0065-3527(08)60328-0. PMID 7817880. 
10. ^ Forrest JM, Turnbull FM, Sholler GF, et al. (2002). "Gregg's congenital rubella patients 60 years later". Med. J. Aust. 177 (11-12): 664–7. PMID 12463994. http://www.mja.com.au/public/issues/177_11_021202/for10634_fm.html. 
11. ^ Honeyman MC, Dorman DC, Menser MA, Forrest JM, Guinan JJ, Clark P (February 1975). "HL-A antigens in congenital rubella and the role of antigens 1 and 8 in the epidemiology of natural rubella". Tissue Antigens 5 (1): 12–8. PMID 1138435. 
12. ^ Best JM (2007). "Rubella". Semin Fetal Neonatal Med 12 (3): 182–92. doi:10.1016/j.siny.2007.01.017. PMID 17337363. http://linkinghub.elsevier.com/retrieve/pii/S1744-165X(07)00018-2. 
13. ^ Stegmann BJ, Carey JC (2002). "TORCH Infections. Toxoplasmosis, Other (syphilis, varicella-zoster, parvovirus B19), Rubella, Cytomegalovirus (CMV), and Herpes infections". Curr Women's Health Rep 2 (4): 253–8. PMID 12150751. 
14. ^ 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. 
15. ^ 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. 
16. ^ "Elimination of rubella and congenital rubella syndrome--United States, 1969-2004". MMWR Morb. Mortal. Wkly. Rep. 54 (11): 279–82. 2005. PMID 15788995. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5411a5.htm. 
17. ^ 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. http://www.indianjmedsci.org/article.asp?issn=0019-5359;year=2007;volume=61;issue=1;spage=15;epage=22;aulast=Khandekar. 
18. ^ Weisinger HS, Pesudovs K (2002). "Optical complications in congenital rubella syndrome". Optometry 73 (7): 418–24. PMID 12365660. 
19. ^ Freij BJ, South MA, Sever JL (1988). "Maternal rubella and the congenital rubella syndrome". Clin Perinatol 15 (2): 247–57. PMID 3288422. 
20. ^ 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. doi:10.1001/jama.287.4.464. PMID 11798368. http://jama.ama-assn.org/cgi/pmidlookup?view=long&pmid=11798368. 
21. ^ Reef S (2006). "Rubella mass campaigns". Curr. Top. Microbiol. Immunol. 304: 221–9. doi:10.1007/3-540-36583-4_12. PMID 16989272. 
22. ^ Plotkin SA (2001). "Rubella eradication". Vaccine 19 (25-26): 3311–9. doi:10.1016/S0264-410X(01)00073-1. PMID 11348695. http://linkinghub.elsevier.com/retrieve/pii/S0264410X01000731. 
23. ^ 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.
24. ^ 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. doi:10.1001/jama.284.21.2733. PMID 11105178. http://jama.ama-assn.org/cgi/pmidlookup?view=long&pmid=11105178. 
25. ^ ^{a b} Ackerknecht, Erwin Heinz (1982). A short history of medicine. Baltimore: Johns Hopkins University Press. pp. 129. ISBN 0-8018-2726-4. 
26. ^ Wesselhoeft C (1949). "Rubella and congenital deformities". N. Engl. J. Med. 240 (7): 258–61. PMID 18109609. 
27. ^ 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
28. ^ ^{a b c} Lee JY, Bowden DS (2000). "Rubella virus replication and links to teratogenicity". Clin. Microbiol. Rev. 13 (4): 571–87. doi:10.1128/CMR.13.4.571-587.2000. PMID 11023958. http://cmr.asm.org/cgi/content/full/13/4/571. 
29. ^ ^{a b c d} 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. http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/rubella.pdf. Retrieved 2007-07-03. 
30. ^ ^{a b c d} "Chapter 11 - Rubella". Immunisation Handbook 2006. Ministry of Health, Wellington, NZ.. April 2006. ISBN 0-478-29926-5. http://www.moh.govt.nz/moh.nsf/pagesmh/4617/$File/2006-11rubella.pdf. Retrieved 2007-07-03. 
31. ^ Smith, J. L. Contributions to the study of Rötheln. Trans. Int. Med. Congr. Phil. 4,14. 1881
32. ^ 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. http://www.whonamedit.com/doctor.cfm/2283.html. Retrieved 2007-07-03. 
33. ^ 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
• DermNet viral/rubella

v • d • e Infectious diseases · Viral diseases (A80–B34, 042–079) Oncovirus DNA virus: HBV (Hepatocellular carcinoma) · HPV (Cervical cancer) · Kaposi's sarcoma-associated herpesvirus (Kaposi's sarcoma) · Epstein-Barr virus (Nasopharyngeal carcinoma, Burkitt's lymphoma, Primary central nervous system lymphoma) · MCPyV (Merkel cell cancer) · SV40 RNA virus: HCV (Hepatocellular carcinoma) · HTLV-I (Adult T-cell leukemia/lymphoma) Immune disorders HIV (AIDS) Central nervous system Encephalitis/ meningitis DNA virus: JCV (Progressive multifocal leukoencephalopathy) RNA virus: MeV (Subacute sclerosing panencephalitis) · LCV (Lymphocytic choriomeningitis) · Arbovirus encephalitis · Orthomyxoviridae (probable) (Encephalitis lethargica) · RV (Rabies) Myelitis Poliovirus (Poliomyelitis, Post-polio syndrome) · HTLV-I (Tropical spastic paraparesis) Eye Cytomegalovirus (Cytomegalovirus retinitis) · HSV (Herpetic keratitis) Cardiovascular CBV (Pericarditis, Myocarditis) Respiratory system/ acute viral nasopharyngitis/ viral pneumonia DNA virus Epstein-Barr virus (EBV infection/Infectious mononucleosis) · Cytomegalovirus RNA virus IV: SARS coronavirus (Severe acute respiratory syndrome) V, Orthomyxoviridae: Influenzavirus A/B/C (Influenza/Avian influenza) V, Paramyxovirus: Human parainfluenza viruses (Parainfluenza) · RSV · hMPV Digestive system Oropharynx/Esophagus MuV (Mumps) · Cytomegalovirus (Cytomegalovirus esophagitis) Gastroenteritis/ diarrhea DNA virus: Adenovirus (Adenovirus infection) RNA virus: Rotavirus · Norovirus · Astrovirus · Coronavirus Hepatitis DNA virus: HBV (B) RNA virus: CBV · HAV (A) · HCV (C) · HDV (D) · HEV (E) · HGV (G) Pancreatitis CBV Skin and mucous membrane lesions, including exanthem DNA virus Herpesviridae HSV (Herpes simplex, Herpetic whitlow) · VZV (Chickenpox, Herpes zoster) · Human herpesvirus 6/Roseolovirus (Exanthema subitum) · KSHV (Kaposi's sarcoma) · Herpes B Virus Poxviridae Variola (Smallpox) · MoxV (Monkeypox) · CV (Cowpox) · VV (Vaccinia) · MCV (Molluscum contagiosum) Other HPV (Wart/Plantar wart) · Parvovirus B19 (Erythema infectiosum, Reticulocytopenia) RNA virus MeV (Measles) · Rubella virus (Rubella, Congenital rubella syndrome) picornavirus: CAV (Hand, foot and mouth disease, Herpangina) · FMDV (Foot-and-mouth disease) Urogenital BK virus · MuV (Mumps) see also DNA antivirals, RNA antivirals, Antiretroviral drug

v • d • e Exanthema Viral RNA virus Measles (1st disease) · Rubella (3rd disease) DNA virus Slap cheek (5th disease) · Roseola (6th disease) · Chickenpox Obsolete Duke's disease (4th disease) Bacterial Scarlet fever (2nd disease)

This entry is from Wikipedia, the leading user-contributed encyclopedia. It may not have been reviewed by professional editors (see full disclaimer)

Dansk (Danish)
n. - [med.] rubella, røde hunde

Nederlands (Dutch)
rodehond

Français (French)
n. - rubéole

Deutsch (German)
n. - Röteln

Ελληνική (Greek)
n. - (παθολ.) ερυθρά

Italiano (Italian)
rosolia

Português (Portuguese)
n. - rubéola (f) (Med.)

Русский (Russian)
(мед.) краснуха

Español (Spanish)
n. - rubéola

Svenska (Swedish)
n. - röda hund

中文（简体）(Chinese (Simplified))
德国麻疹, 风湿疹

中文（繁體）(Chinese (Traditional))
n. - 德國麻疹, 風濕疹

한국어 (Korean)
n. - 풍진

日本語 (Japanese)
n. - 風疹

العربيه (Arabic)
‏(الاسم) الحصبه الألمانيه‏

עברית (Hebrew)
n. - ‮אדמת, אדמדמת‬

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