1. RUBELLA
Dr.T.V.Rao MD

2. 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 lives.

3. Rubella ( German Measles )
Rubella is also called as 3 day Measles or German Measles.
Family – Togaviridae
Genus - Rubivirus
In general belong to Togavirus group

4. Rubella Virus Rubella virus are ss – RNA virus Diameter 50 – 70 nm
Enveloped Spherical
Virus multiply in the cytoplasam of infected cell.

5. Epidemiology Rubella is world wide in distribution
Occurs round the year
Infection is transmitted by respiratory route
The use of Rubella vaccine has now eliminated both epidemic and endemic Rubella in USA and several developed countries

6. How Adults acquire Infection
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.

7. Systemic events of Rubella Infection

8. Rubella
Adult infection occurs through mucosa of the upper respiratory tract spread to cervical lymphnodes
Viremia devlops after 7 – 9 day
Lasts for 13 – 15 days
Leads to development of antibodies
In 20 – 50 % cases of primary infections are subclinical

9. Clinical findings Malaise Low grade fever Morbilliform rash
Rash starts on Face Extremities
Rarely lasts more than 5 days
No features of the rash give clues to definitive diagnosis of Rubella.

10. Rubella Rashes
When epidemics occur with similar features it is more suggestive of Rubella epidemics
Other Enterovirus infections can produce similar manifestations.

11. Immunity - Rubella
Antibodies appear in serum as rash fades and antibody titers raise
Rapid raise in 1 – 3 weeks
Antibodies persist for life

12. Immunity - Protects One attack of Rubella infection, protects for life
Immune mothers transfer antibodies to off springs who are in turn are protected for 4 – 6 months.

13. Diagnosis of Rubella in Adults
Clinical Diagnosis is unreliable
Many viral infections mimic Rubella

14. Treatment and Prevention
Rubella is a mild self limited illness.
No specific treatment or Antiviral treatment is indicated.
However Laboratory proved and clinically missed Rubella in the Ist 3-4 months of pregnancy is associated with fetal infections.

15. Congenital Rubella Syndrome
Maternal viremia with Rubella infection during pregnancy may result in infection of placenta and fetus.
The growth rate of fetal cells are reduced.
Results in fewer number of cells after the birth.
Lead to deranged and hypo plastic organ development.
Results in structural damage and abnormalities

16. MMR Vaccine
The MMR vaccine is a mixture of three live attenuated viruses, administered via injection for immunization against measles, mumps and rubella. It is generally administered to children around the age of one year, with a second dose before starting school (i.e. age 4/5). The second dose is not a booster; it is a dose to produce immunity in the small number of persons (2-5%) who fail to develop measles immunity after the first dose In the United States, the vaccine was licensed in 1963 and the second dose was introduced in the mid 1990s. It is widely used in all National, Universal Immunization programmes