German Measles (Third Disease, Rubella)
German Measles (Third Disease, Rubella): Excerpt from The 5-Minute Pediatric Consult
Michael J. Smith, MD
German Measles - BASICS
German Measles - description
- Rubella derived from Latin, meaning “little red”
- Disease initially considered variant of measles
- Viral infection characterized by mild symptoms (often subclinical), with an erythematous rash progressing from head to toes
- Congenital rubella syndrome can be devastating
- Rubella virus:
- Classified in toga virus family as from genus Rubivirus
- RNA virus with single antigenic type
- 1st isolated in 1962 by Parkman and Weller
German Measles - general prevention
- Prevention of congenital rubella syndrome is main objective of vaccination programs
- Rubella vaccine:
- Current strain of vaccine (RA 27/3, developed at the Wistar Institute in Philadelphia) was licensed in 1979 and has replaced all other strains.
- Given as part of MMR vaccine at 12–15 months and again at 4–6 years
- Immunity occurs in 95% of vaccines and is thought to be lifelong.
- Important to ensure full vaccination for pre-school–aged children
- Vaccine virus is not communicable: Pregnant women and persons who are immunodeficient (except asymptomatic HIV infection) should not receive vaccine, but household contacts should.
- Isolation:
- Pregnant women should avoid contact with source patient
- Postnatal: Droplet precautions and/or school exclusion indicated for 7 days after onset of rash
- Congenital: Contact isolation until 1st birthday, or until multiple nasopharyngeal and urine cultures negative
German Measles - epidemiology
- Spread person to person via airborne transmission; worldwide infection
- Infection most contagious when rash is erupting. However, virus may be shed beginning 7 days before rash to 14 days after.
- Infants with congenital rubella syndrome may shed virus for up to 1 year.
German Measles - incidence
- In temperate regions, peaks in late winter and early spring
- In prevaccine era, incidence of infection in US was ~58 per 100,000 population
- From 2001 to 2004, nearly 1/2 of the 57 cases reported to the Centers for Disease Control (CDC) occurred in persons born outside the US.
- 2004: No longer endemic in the US
- Infection occurs equally in following age groups: <5 years, 5–19 years, and 20–39 years
- Congenital rubella syndrome:
- 1964: 20,000 newborns
- 1980s: Reported rarely, with <5 cases annually
- 1990–1991: ~30 cases reported annually
- 2001–2004: Total of 4 cases reported to CDC, only one with mother born in the US.
German Measles - pathophysiology
- Respiratory transmission
- Replication in nasopharynx and regional lymph nodes
- Viremia 5–7 days after exposure, with spread of virus throughout body
- In congenital rubella syndrome, transplanted infection of fetus occurs during viremia
German Measles - etiology
Rubella virus
German Measles - associated conditions
Congenital rubella syndrome (see “Complications”)
German Measles - DIAGNOSIS
If rubella suspected, should be reported to local public health authorities
German Measles - signs & symptoms
- Rash:
- Begins on face, then progresses to trunk and extremities
- Does not usually coalesce
- Lasts for 3 days
- Adenopathies, especially postauricular, posterior cervical, and suboccipital, are commonly noted, along with conjunctivitis.
- Arthralgia/arthritis may be seen in adolescents and adults.
German Measles - history
- In children, prodrome not often recognized
- In adults, a 1–5-day prodrome of low-grade fever, malaise, and cervical adenopathy may precede rash.
- Inquire about immunizations and exposures.
German Measles - tests
German Measles - lab
- Congenital infection:
- Serologic testing should be performed on both mother and infant.
- Rubella-specific IgM in infant is highly suggestive.
- Viral isolation from throat or nasal specimen can confirm diagnosis. Blood, urine, and CSF samples may also be diagnostic.
- Diagnosis difficult to verify after neonatal period
- Postnatally acquired:
- Rubella-specific IgM or a 4-fold or greater rise in rubella-sepcific IgG antibodies between acute and convalescent titers is diagnostic.
German Measles - differencial diagnosis
Infections that are sometimes confused with rubella include:
- Modified measles
- Scarlet fever
- Roseola
- Erythema infectiosum (fifth disease, parvovirus B19 infection)
- Enteroviral infections
- Infectious mononucleosis
- Drug eruptions
German Measles - FOLLOW UP
German Measles - prognosis
- Quite good; as many as 50% of infections are asymptomatic.
- Rubella infection in pregnant woman can be devastating for infant (see “Complications”).
German Measles - complications
- Tend to occur in adults; most are uncommon.
- Arthritis or arthralgia:
- Occur in 70% of adult women, lasting up to 1 month
- Usually affects small joints
- Encephalitis:
- 1 in 5,000 cases
- May be associated with mortality
- Bleeding:
- 1 in 3,000 cases
- Occurs in children more than in adults
- Thrombocytopenia: Commonly noted
- Orchitis and neuritis: Rare
- Congenital rubella syndrome:
- Rubella infection in early gestation can lead to fetal death, premature delivery, and congenital defects.
- Severity of defects is worse the earlier in gestation the infection occurs.
- 85% of infants are affected if infection occurs in 1st trimester.
- Defects are rare if infection occurs after 20th week.
- Common defects of congenital rubella syndrome:
- Deafness: Most common defect
- Ophthalmologic defects: Cataracts, glaucoma, microphthalmia
- Cardiac defects: Patent ductus, arteriosus, ventricular septal defect, pulmonic stenosis, coarctation of aorta
- Neurologic defects: Mental retardation, microcephalism
- Some manifestations of congenital rubella syndrome (diabetes mellitus, progressive encephalopathy) may be delayed for years.
German Measles - bibliography
American Academy of Pediatrics. Rubella. In: Pickering LK, Baker CJ, Long SS, et al, eds. 2006 Red Book: Report of the Committee on Infectious Diseases. 27th ed. Elk Grove Village, Ill: American Academy of Pediatrics; 2006:574–579.Atkinson W, Furphy L, et al. Epidemiology and Prevention of Vaccine-Preventable Diseases. 2nd ed. Bethesda, MD: Centers for Disease Control and Prevention; 1995.- Center for Disease Control and Prevention. Elimination of rubella and congenital rubella syndrome—United States, 1969–2004. MMWR Morb Mortal Wkly Rep. 2005;54:279–282.
Plotkin SA. Rubella vaccine. In: Plotkin SA, Mortimer EA, eds. Vaccines. Philadelphia: WB Saunders; 1988:235–262.
German Measles - CODES
German Measles - icd9
056.9 Rubella
German Measles - FAQ
- Q: While pregnancy is a contraindication to rubella vaccination, if a pregnant woman is inadvertently vaccinated, will there be harm to the fetus?
- A: Data collected since 1979 by the CDC show no evidence of congenital rubella syndrome in 321 susceptible women who were vaccinated while pregnant.
- Q: Is there any evidence that the MMR vaccine causes autism spectrum disorder?
- A: No. Multiple epidemiologic studies have shown no difference in the rates of autism spectrum disorder in children who received the MMR vaccine versus those who did not.
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Book Source Details
- Book Title: The 5-Minute Pediatric Consult
- Author(s): M. William Schwartz MD; et al.
- Year of Publication: 2008
- Copyright Details: The 5-Minute Pediatric Consult, Copyright © 2008 Lippincott Williams & Wilkins.
More About Rubella
More Medical Textbooks Online about Rubella
Review other book chapters online related to Rubella:
Medical Books Excerpts
- Rubella
- "Professional Guide to Diseases (Eighth Edition)" (2005)
- [ read ]
Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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More About This Book:
Title: The 5-Minute Pediatric Consult
Authors: M. William Schwartz MD; et al.
Publisher: Lippincott Williams & Wilkins
Copyright: 2008
ISBN: 0-7817-7577-9
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