Rubella

1. Dr Jazeela Mohamed Siddique
Senior resident
Department Of Community Medicine

2. RUBELLA
Image in a 4-year-old girl with a 4-day history of low-grade fever,
symptoms of an upper respiratory tract infection, and rash.
Courtesy of Pamela L. Dyne, MD.

3. • Rubella - Latin term meaning "little red."
• Rubella or German Measles or 3-day Measles.
• Rubella exanthema
o appears – face and neck  trunk and extremities on 1st day
o fades – face on 2nd day  disappears throughout the body
by 3rd day.
Introduction

4. • RNA virus (Togo virus
family), Genus Rubivirus
• Source of infection : Clinical
& sub clinical cases
• Period of communicability:
1 week before symptoms to
1 week after rash appears
Agent factors

5. • Age: 3-10 years; Developed countries – immunization
changed the epidemiological pattern to >15 years
• Immunity –life long
• Winter and spring season ; epidemic every 4-9 years
• Droplet transmission
• Vertical transmission
Host factors
Environmental factors
Mode of transmission
Incubation period : 2-3 weeks

6. Clinical features
• Prodromal : Low grade fever, sore throat, coryza
(onset of viraemia)
• Tender lymphadenopathy  5-10 days before rash
appears (posterior auricular, posterior cervical and
occipital lymph nodes)
• Rash : Face – trunk – extremities
• Forchheimer sign - pinpoint or larger petechiae that
usually occur on the soft palate

7. Congenital Rubella syndrome
• Rubella: A mild, self limiting viral illness
– (>90% infection in India is < 15 years)
• Congenital rubella syndrome (CRS):
– Rubella infection during early pregnancy
– miscarriage, birth defects or fetal death
• Public health importance of rubella potential to
cause CRS

8. Complications
Rubella
• Lymphadenopathy
• Arthritis (rare)
• Thrombocytopenic purpura
• Encephalitis (rare)
• CRS is the most potential
complication
– 90% chance if infected during
1st trimester of pregnancy)
Congenital Rubella
Syndrome
• Deafness
• Cataract
• Cardiac defects
• Microcephaly
• Developmental Delay
• Mental retardation
• Hematological disorder
• Liver and spleen damage

10. Diagnosis
• History and clinical picture
• Lab diagnosis
– Serum (1 week – 28 days)  IgM Rubella
– Virology samples (upto 1 week)
• Throat swab / Nasopharyngeal swab
• Urine

11. Treatment
• No specific treatment
• Supportive management
• Patient isolation
• Vit A 2 doses
– 50,000 IU for <6 months
– 1 lakh IU for 6 months – 1 year
– 2 lakh for IU 1 – 6 years

12. • MR vaccine has to be given at 9 months and 1.5 years
• Post exposure prophylaxis
– Immunoglobulin within 4 – 6 days of exposure
– Live vaccine to be immunized 8-12 weeks later
• Susceptible non pregnant, adolescent and adult
females - Rubella Vaccine
Prevention

13. Family level
• Household contact with symptom  start treatment
• Immunization status of other children
• Cough etiquette, health education
Community level
• Fever survey – within 100 houses of case
– Check for contacts and similar symptoms
– Symptoms +  samples sent
– Age 6 months onwards – 1 dose MR vaccine
• Immunization status of community  2 doses MR vaccine
• Health education – spread , complication, vaccination

14. MEASLES RUBELLA ELIMINATION
• WHO South East Asia Region resolved in Sep 2019 to
eliminate measles and rubella by 2023 to prevent
deaths and disabilities caused by these infectious
childhood diseases

15. MEASLES RUBELLA ELIMINATION
India – MR surveillance
 Fever and rash surveillance
• All cases to be notified in IDSP
• Case investigation form to be filled by MO
• Samples collected and transported to NIV
– Virology samples (upto 1 week)
– Serum samples (1 week – 28 days)

16. Thank you
Polio is gone!
Measles-Rubella is next!
https://www.slideshare.net/JazeelaMohamedSiddiq