1. ASPEK VIRUS RUBELLA

2. VIROLOGICAL ASPECT OF RUBELLA
History
From Latin meaning "little red"
1881 Rubella first described by German physicians, Friedrich Hoffmann
1941 Associated with congenital disease (Gregg)
1961 Rubella virus first isolated
1967 Serological tests available
1969 Rubella vaccines available

3. CHARACTERISTIC RNA enveloped virus member of Rubivirus
togavirus family
Only a single serotype
Rapidly inactivated by
(chemical agents, ultraviolet light,
low pH, and heat)
Occurs primarily in children and adolescents

4. PATHOPHYSIOLOGY Transmission is by respiratory
Replication in nasopharynx and regional lymph nodes
Viremia 5-7 days after exposure
with spread to tissues
Placenta and fetus infected during viremia
Incubation period is 2 to 3 weeks

5. CLINICAL MANIFESTATIONS
Malaise
Headache
Myalgias and arthralgias
Post-auricular adenopathy
Conjunctivitis
non-pruritic, erythematous,
maculopapular rash

6. LABORATORY TEST
isolated from the nasopharynx, the blood, the urine, and CSF.
Newer tests with a higher specificity latex agglutination
fluorescence immunoassay
passive hemagglutination
hemolysis in gel
enzyme immunoassay

7. Diagnosis of acute infection
LABORATORY DIAGNOSIS
Diagnosis of acute infection
Rising titres of antibody (mainly IgG) Presence of rubella-specific IgM
Immune Status Screen
latex agglutination are routinely used
15 IU/ml is regarded as the cut-off for immunity

8. Epidemic Rubella – United States, 1964-1965
12.5 million rubella cases
2,000 encephalitis cases
11,250 abortions (surgical/spontaneous)
2,100 neonatal deaths
20,000 CRS cases
deaf - 11,600
blind - 3,580
mentally retarded - 1,800 8

9. TREATMENT No specific treatment of rubella exists.
The disease is usually self-limited.
Rest and oral fluids are appropriate.

10. PREVENTION The best protection is vaccination
Given with the measles and mumps vaccine (MMR) at age months and again at school entry at 4-6 years.
One injection usually imparts lifelong immunity.

11. CONTRAINDICATIONS TO VACCINATION
Pregnant women
Patients receiving immunoglobulin
Patients who are seriously ill
Patients with severe altered immunity
Patients on immunosuppressive therapy Patients with HIV

12. ADVERSE REACTIONS TO VACCINATION
Fever %-15%
Rash 5%
Joint symptoms 25%
Thrombocytopenia <1/30,000 doses
Parotitis rare
Deafness rare
Encephalopathy <1/1,000,000 doses

13. COMPLICATION
Congenital Rubella Syndrome (CRS) is the most severe and important complication
the severity depends on how early the infection occurs.
The most common abnormalities ophthalmologic (cataracts, retinopathy).
Cardiac (patent ductus arteriosus, pulmonary stenosis)
Auditory ( sensineural deafness)

14. COMPLICATION
Neurologic disorders (meningoencephalitis, mental retardation with behavioral disorders)

16. RISK OF CONGENITAL RUBELLA%

17. MANIFESTATIONS OF CONGENITAL RUBELLA%

18. TERIMA KASIH

19. The Lytic Cycle

20. The Lysogenic Cycle