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Rubella – German Measles Dr. Harivansh Chopra, DCH, MD Professor, Community Medicine, LLRM Medical College, Meerut.

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Presentation on theme: "Rubella – German Measles Dr. Harivansh Chopra, DCH, MD Professor, Community Medicine, LLRM Medical College, Meerut."— Presentation transcript:

1 Rubella – German Measles Dr. Harivansh Chopra, DCH, MD Professor, Community Medicine, LLRM Medical College, Meerut. harichop@gmail.com

2 Dr. Harivansh Chopra Objectives of Lecture 1. To study the epidemiology of Rubella. 2. To study Rubella in pregnancy and its management. 3. Understanding the manifestations of Congenital Rubella. 4. Prevention of Rubella and strategies for Rubella vaccination.

3 Dr. Harivansh Chopra Why Rubella is k/a “German Measles”? The word "German" in the name of this disease has nothing to do with the country. The name likely comes from the Latin term "germanus" meaning "similar." And indeed, rubella and measles (rubeola) share some characteristics, but they're caused by different viruses.

4 Dr. Harivansh Chopra Etiology  Pleomorphic RNA virus. Family Togaviridae; Genus Rubivirus. RUBELLA (GERMAN / 3-DAY MEASLES)

5 Dr. Harivansh Chopra Epidemiology  1.Spread by oral droplet or transplacentally through congenital infection. RUBELLA (GERMAN / 3-DAY MEASLES)

6 Dr. Harivansh Chopra Epidemiology  2.The period of infectivity is 7 days prior to onset of rash and 7 days after disappearance of rash. 3.The incubation period ranges from 14 days to 21 days (average = 18 days). RUBELLA (GERMAN / 3-DAY MEASLES)

7 Dr. Harivansh Chopra Epidemiology  4.Peak incidence of disease in children 3-10 yrs. of age (> 70% of cases in developed countries occur in > 15 yrs. old). 5.Many infections are sub clinical with a ratio of 2:1; inapparent to overt disease. RUBELLA (GERMAN / 3-DAY MEASLES)

8 Dr. Harivansh Chopra Epidemology  6.In closed population, almost 100% of susceptible individuals may become infected. In family setting spread of virus is less – 50-60%. RUBELLA (GERMAN / 3-DAY MEASLES)

9 Dr. Harivansh Chopra RUBELLA (GERMAN / 3-DAY MEASLES) Epidemiology 7.A single attack usually confers permanent immunity. 8.Epidemics occurred every 6-9 years before vaccine was available. 9.Infants with rubella are a source of infection for older children who are not immune & for non-immune adults, including pregnant women & nursery personnel.

10 Dr. Harivansh Chopra RUBELLA (GERMAN / 3-DAY MEASLES) Epidemiology 10.Disease occurs in seasonal pattern i.e. during the later winter and spring, with epidemics repeating every 4 – 9 years.

11 Dr. Harivansh Chopra 1.Prodromal phase – Mild catarrhal symptoms; shorter than measles; may be so mild as to go unnoticed. 2.Most characteristic sign is Retroauricular, Posterior Cervical & Post-Occipital adenopathy which is tender. 3.Lymphadenopathy is evident at least 24 hrs. before rash appears & remains for 1 week or more. CLINICAL MANIFESTATIONS OF RUBELLA

12 Dr. Harivansh Chopra 3.An enanthem may appear just before the onset of skin rash. It is discrete rose spots on soft palate that may coalesce into a red bluish & extend over the fauces. (Forchheimer spots) 4.Rash begins on face & spread quickly; rash may be fading on face by the time it appears on the trunk. CLINICAL MANIFESTATIONS OF RUBELLA

13 Dr. Harivansh Chopra CLINICAL MANIFESTATIONS OF RUBELLA 5.Rash is discrete maculo-papular with large areas of flushing; spreads rapidly over the entire body within 24 hrs. 6.Rubella without a rash has been described. 7.Fever is slight or absent during the rash & persists for 1-2 or occasionally 3 days.

14 Dr. Harivansh Chopra 8.Anorexia, Headache & Malaise are not common. 9.Spleen is often slightly enlarged. 10.Thrombocytopenia is rare. 11.Paraesthesia. CLINICAL MANIFESTATIONS OF RUBELLA

15 Dr. Harivansh Chopra 12. In older children Polyarthritis may with Arthralgia & Swelling, Tenderness & Effusion but without Residuum; Small joints of hands are affected most frequently. Duration is usually several days to 2 weeks rarely for months. 13.Orchidalgia also reported. CLINICAL MANIFESTATIONS OF RUBELLA

16 Dr. Harivansh Chopra ViralOthers Measles.Meningococcemia. Roseola Infantum.Typhoid fever. Erythema Infectiosum.Scarlet fever. Infectious Mononucleosis. Live viral vaccine. Drug eruption. DIFFERENTIAL DIAGNOSIS

17 Dr. Harivansh Chopra Stage of Gestation (weeks) when mother is infected Percentage of fetus infected Percentage of infected fetus damaged Overall risk damages to fetus (in percent) < 119010090 11-16553720 17-263300 27-365300 Risk of damage to fetus by Maternal Rubella during pregnancy

18 Dr. Harivansh Chopra Latex agglutination, enzyme immunoassay, passive hemagglutination, and fluorescent immunoassay appear to be equal or superior to the HI test in sensitivity. Immunoglobulin (Ig) M antibodies are detectable in the first few days of illness and are considered diagnostic. DIAGNOSIS

19 Dr. Harivansh Chopra Detection of IgM antibodies, which do not cross the placenta, in the newborn is especially useful for the diagnosis of congenital rubella syndrome. Seroconversion, or a fourfold increase in IgG titer, is diagnostic. DIAGNOSIS

20 Dr. Harivansh Chopra TREATMENT SYMPTOMATIC PARACETAMOL FOR FEVER

21 Dr. Harivansh Chopra COMPLICATIONS Complications are relatively uncommon in childhood. Encephalitis similar to that seen with measles occurs in about 1 in 6,000 cases. The severity is highly variable, and there is an overall mortality rate of 20% Thrombocytopenic purpura occurs at an overall rate of 1 in 3,000 cases.

22 Dr. Harivansh Chopra PREGNANCY & RUBELLA Pregnant Female with unknown immune status exposed to Rubella ANTIBODY TESTING SUSCEPTIBLENOT SUSCEPTIBLE Abortion advisedReassurance

23 Dr. Harivansh Chopra PREGNANCY & RUBELLA Female susceptible but Abortion unacceptable Rubella Immunoglobulin 0.55 ml/kg body weight given IM Under no condition in pregnancy should an Active Immunisation against Rubella be performed in pregnancy.

24 Dr. Harivansh Chopra 1.IUGR is most common. 2.Cataract B/L or U/L; Associated with micro-ophthalmia. 3.Blueberry skin lesion, similar to CMV infection. CONGENITAL RUBELLA SYNDROME

25 Dr. Harivansh Chopra 4.Myocarditis & structural cardiac defects – PDA or Pulmonary Artery Stenosis. 5.Hearing loss from Sensorineural deafness. 6.May have active meningo- encephalitis at birth; Later motor & mental retardation. CONGENITAL RUBELLA SYNDROME

26 Dr. Harivansh Chopra 7.Pneumonia. 8.Hepatitis. 9.Thrombocytopenic Purpura. CONGENITAL RUBELLA SYNDROME

27 Dr. Harivansh Chopra 10.Pancreatitis. 11.Syndactyly. 12.Retinal lesions – Salt and Pepper retinitis. CONGENITAL RUBELLA SYNDROME

28 Dr. Harivansh Chopra Prevention against Rubella Rubella Vaccine – RA 27/3 1. Produced in human diploid fibroblast. 2. Produces an immune response more closely paralleling natural infection & largely prevents sub clinical infection. 3. Single dose of 0.5 ml subcutaneously 4. Seroconversion in >95% vaccinees. 5. Immunity persists for at least 14 – 16 years and probably lifelong.

29 Dr. Harivansh Chopra MMR Vaccine Composition – 1. Live hyperattenuated Measles virus (Schwartz strain) – 1000 TCID 50 2. Live attenuated Mumps virus (Urabe AM 9 strain) – 5000 TCID 50 3. Live attenuated Rubella virus (Wistar RA 27/3M strain) – 1000 TCID 50 4. Stabilizer excipient (containing human albumin)

30 Dr. Harivansh Chopra MMR Vaccine Route and Dose – 1. 0.5 ml Subcutaneous or Intramuscular. 2. Single dose between 12 and 15 months of age (Recommended age). 3. Second dose recommended 6 months later in children vaccinated below 12 months of age, particularly in collective environment.

31 Dr. Harivansh Chopra MMR Vaccine 1.It is freezed dried vaccine 2.Has to be reconstituted with distilled water 3.Reconstituted vaccine must be used as early as possible

32 Dr. Harivansh Chopra MMR Vaccine 1. It has shell life for 2 years 2. Must be stored between 2-8 degree centirgade

33 Dr. Harivansh Chopra Complications of vaccine 1. Fever 2. Rash 3. Rarely S.S.P.E

34 Dr. Harivansh Chopra Contraindications to Rubella 1. Congenital or Acquired immunodepressions. (An infection with HIV should not be contraindication to MMR vaccination, but advised only under specialised paediatric team). 2. True allergy to egg proteins.

35 Dr. Harivansh Chopra Contraindications to Rubella 3. Recent injection of Immunoglobulins (Vaccine must not be given till 3 months after Immunoglobulin transfusion, or Immunoglobulins must not be given 2 weeks after vaccination). 4. Pregnancy (Recipients of vaccine must not be advised to become pregnant over next 3 months).

36 Dr. Harivansh Chopra Vaccination Strategy – Rubella 1. First protect women of childbearing age (15 – 34 or 39 years of age). 2. Then interrupt transmission of Rubella by vaccinating children 1 – 14 years of age. 3. Subsequently vaccinating all children at 1 year of age.

37 Dr. Harivansh Chopra Conclusion 1. Rubella is a vaccine preventable disease, which is very similar to Measles in its presentation. 2. A relatively mild clinical manifestation but hazardous to developing foetus if contracted in pregnancy. 3. Affected foetus presents with a variety of signs grouped under “Congenital Rubella Syndrome”.

38 Dr. Harivansh Chopra

39 MCQ 1. Which of the following disease can result in congenital anomaly in the newborn child 1. HIV. 2. Hepatitis B. 3. Rubella. 4. All of the above. Answer – 3.

40 Dr. Harivansh Chopra MCQ 2.“Three day measles” is another name for 1. Roseola Infantum. 2. Erythema Infectiosum. 3. Scarlet fever. 4. None of the above. Answer – 4.

41 Dr. Harivansh Chopra MCQ 3.The most characteristic differentiating feature between measles and rubella is 1. Type of rash. 2. Prodromal period. 3. Tender enlargement of cervical group of glands. 4. Degree of fever. Answer – 3.

42 Dr. Harivansh Chopra MCQ 4.The efficacy of rubella vaccine is 1. 80% 2. 90% 3. 95% 4. 98% Answer – 3.

43 Dr. Harivansh Chopra MCQ 5.The pregnancy should be deferred in the recipient of Rubella vaccine for a period of 1. Next 1 month 2. Next 2 months 3. Next 3 months 4. Next 6 months Answer – 3.

44 Dr. Harivansh Chopra MCQ Q-6 Incubation period of rubella is 1. 1 – 7 days 2. 7 – 14 days 3. 14 – 21 days 4. 21 – 28 days Ans 3


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