Rubella

Andre Brincat, Claire Grima

& Marie Liz Grima
Rubella


Rubella is a mild viral disease caused by the Rubivirus.
Discovered in the 18
th
centaury by German physicians.
Since one of the symptoms is a red rash similar, to
measles it also became known as German Measles.
This virus is a member of the Family Togaviridae
together with Alphavirus and Anterivirus. This family is
known to cause encephalitis.
The members of this family have single stranded RNA.

Diagrammatic representation
of the Viron


Mechanism of Infection

Rubella Transmission
Aerosol
Direct contact
CRS via pharyngeal secretions and urine for months or even
years.
HOSTS AND SYMPTOMS
Rubella is an acute, contagious viral
infection that occurs most often in children
and young adults.

Humans are the only known host.
Spreading of the virus
Once a person is infected, the virus spreads
throughout the body in about 5-7 days.
Symptoms usually appear two to three
weeks after exposure.

The most infectious period is usually 15
days after the appearance of the rash.
Symptoms in children
Rash
It appears as pink or light red spots,
which may merge to form evenly colored patches.
The rash can itch and lasts 1- 3 days.
As the rash clears, the affected skin occasionally
sheds in very fine flakes.







Symptoms in children
(continued)
Low grade fever (<39C)

Nausea

Mild conjuctivitis (inflammation of the
lining of the eyelids and eyeballs)



Symptoms in children
(continued)
Swollen lymph glands behind the ears and in the neck are
the most characteristic clinical feature.

Symptoms in adults
In addition to the symptoms observed in youngsters,
infected adults, more commonly women, may
develop arthritis and arthralgia that usually last from
310 days.

In most cases, the disease is self-limiting and rarely
causes complications. Nevertheless, it may cause
congenital rubella syndrome (CRS) when the
infection occurs during the first trimester of
gestation.
The transmission of the virus from
mother to fetus
Virus causes cell death, growth disruption and impaired
differentiation
Virus replicates extensively in fetal tissue
Infection during pregnancy results in virus crossing the
placenta
Congenital Rubella Syndrome
Congenital rubella syndrome (CRS) has many
manifestations and affects virtually all organ
systems.
In addition to affecting 3 core organsthe
optic lens, the cochlea, and the heart, CRS
was recognized as a cause of pathology in
the brain, lungs, liver, spleen, kidney, bone
marrow, bones, and endocrine organs
Common clinical manifestations of congenital
rubella syndrome
Congenital Rubella Syndrome
(continued)
Worldwide, an estimated 110 000 babies are born with CRS every
day (WHO statistics, 2012).
The rates are highest in the WHO African and South-East Asian
regions where vaccine coverage is lowest.


References
http://www.who.int/mediacentre/factsheets/fs367/en/
http://www.esciencecentral.org/journals/clinical-approach-to-
skin-eruption-and-measles-a-mini-review-2329-
9126.1000118.php?aid=17126
http://www.virologyj.com/content/8/1/244
http://pedsinreview.aappublications.org/content/31/3/129.ex
tract
http://cid.oxfordjournals.org/content/43/Supplement_3/S164
.full

TREATMENT & DIAGNOSIS
DIAGNOSIS
In order to diagnose rubella, nasal or throat swab are usually
taken and sent for culture growth and testing.
It is highly recommended that women should be protected
against test prior to pregnancy.
A blood test is usually taken in order to verify whether a
person is already protected against rubella. If the test is
negative, a vaccine should be administered.
If there is a suspect of rubella in an individual, a sample of saliva or a
blood sample is usually taken and tested for antibodies.
If an individual has been exposed to the rubella virus, the blood and
saliva samples will test positive for certain antibodies namely:
IgM type antibody: this antibody will be present if the individual who
contracted the rubella virus for the first time.
IgG type antibody: this antibody will be present if the individual has
been exposed to the rubella virus at some point in time either through
vaccination or he had the infection in the past. This grants life time
immunity.

Test is negative for the presence of rubella, when both of these
antibodies are not found. This also signifies that the individual is not
immunized against this particular infection.
IgM antibody is usually present for the first 10 days of infection.
After this period of time, the levels of IgM decrease and the IgG
levels start to increase (Figure 1).
During pregnancy, it is important that the mother should have
immunity against rubella virus, as this is usually transmitted to the
foetus causing serious complications.
For this reason, the mother should be checked for immunity against
rubella as part of her antenatal care.
Figure 1: shows a graph for the levels of IgM and IgG in the blood
over a period of time after the virus was detected in the blood of
an infected individual. (Manual for the laboratory diagnosis of
measles and rubella virus infection, 2007)

TREATMENT
There is no treatment for the rubella virus, as antibiotic are
ineffective against viruses.
Treatment usually focuses on relief of the symptoms which are
commonly caused by this virus. Such symptoms include fever,
rash consisting of small red spots, mild conjunctivitis (pink
eye) and runny nose.
Treatment includes the intake of fluids, rest and medications
such as acetaminophen or ibuprofen to control the fever and
pain.
Rubella is considered as a mild infection in adults and children, with
few complications.
Pregnant women are those at high risk as the rubella virus can
cause congenital rubella syndrome in the foetus namely:
Deafness
Cataracts
Heart defects
Mental retardation
Liver and spleen damage
The vaccine for the rubella virus is known as MMR Measles,
Mumps and Rubella a 3 in 1 vaccine.
This vaccine contains an attenuated form of all the three viruses but
it is still immunogenic meaning it still generates an immune
response.
It is important to note that the vaccine is not a cure or treatment,
but rather is simply there to prevent the viral infection.
Reference List
Diagnosing rubella. (2013, October 07). Retrieved December 18,
2013, from NHS:
http://www.nhs.uk/Conditions/Rubella/Pages/Diagnosis.aspx
Manual for the laboratory diagnosis of measles and rubella virus
infection, Second Edition. (2007, August). Retrieved December
18, 2013, from World Health Organization:
http://www.who.int/ihr/elibrary/manual_diagn_lab_mea_rub
_en.pdf
Measles, mumps, rubella vaccine. (2013, October 31). Retrieved
December 18, 2013, from Medline Plus:
http://www.nlm.nih.gov/medlineplus/ency/article/002026.ht
m
Rubella Treatment. (2006-2013). Retrieved December 18, 2013,
from eMedTV: http://measles.emedtv.com/rubella/rubella-
treatment.html