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| '''For patient information click [[{{PAGENAME}} (patient information)|here]]''' | | __NOTOC__ |
| | '''For patient information click [[{{PAGENAME}} (patient information)|here]].''' |
| {{Infobox_Disease | | {{Infobox_Disease |
| | Name = Rubella | | | Name = Rubella |
| | Image = Rash of rubella on skin of child's back.JPG | | | Image = Rash of rubella on skin of child's back.JPG |
| | Caption = | | | Caption = By CDC - crop of File:Rash of rubella on skin of child's back.JPG, Public Domain, https://commons.wikimedia.org/w/index.php?curid=39884727 |
| | DiseasesDB = 11719 | | | DiseasesDB = 11719 |
| | ICD10 = {{ICD10|B|06||b|00}} | | | ICD10 = {{ICD10|B|06||b|00}} |
| | ICD9 = {{ICD9|056}} | | | ICD9 = {{ICD9|056}} |
| | ICDO = | | | ICDO = |
| | OMIM = | | | OMIM = |
| | MedlinePlus = 001574 | | | MedlinePlus = 001574 |
| | eMedicineSubj =
| | | MeshID = D012409 |
| | eMedicineTopic =
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| | eMedicine_mult =
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| | MeshID = | |
| }} | | }} |
| {{SI}} | | {{Rubella}} |
| {{CMG}} | | {{CMG}}; {{MJM}}, {{AKI}} |
| {{dablink|This page is for the disease. For the virus, see [[Rubella virus]].}} | |
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| ==Overview== | | {{SK}} German measles; 3 day measles |
| Rubella is a common childhood infection usually with minimal systemic upset although transient [[arthropathy]] may occur in adults. Serious complications are very rare. If it were not for the effects of transplacental infection on the developing foetus, rubella is a relatively trivial infection.
| | ==[[Rubella overview|Overview]]== |
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| ==Background== | | ==[[Rubella historical perspective|Historical Perspective]]== |
| '''Rubella''', commonly known as '''German measles''', is a [[disease]] caused by Rubella virus. The name is derived from the Latin, meaning ''little red''. Rubella is also known as German measles because the disease was first described by German physicians in the mid-eighteenth century. This disease is often mild and attacks often pass unnoticed. The disease can last one to five days. Children recover more quickly than adults. Infection of the mother by Rubella virus during pregnancy can be serious; if the mother is infected within the first 20 weeks of pregnancy, the child may be born with [[congenital rubella syndrome]] (CRS), which is a range of serious incurable illnesses. Spontaneous abortion occurs in up to 20% of cases.<ref name="pmid5581012">{{cite journal
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| |author=Siegel M, Fuerst HT, Guinee VF
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| |title=Rubella epidemicity and embryopathy. Results of a long-term prospective study
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| |journal=Am. J. Dis. Child.
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| |volume=121
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| |issue=6
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| |pages=469–73
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| |year=1971
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| |pmid=5581012
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| |doi=
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| }}</ref>
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| Rubella is a common childhood infection usually with minimal systemic upset although transient [[arthropathy]] may occur in adults. Serious complications are very rare. If it were not for the effects of transplacental infection on the developing foetus, rubella is a relatively trivial infection.
| | ==[[Rubella pathophysiology|Pathophysiology]]== |
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| Acquired, (i.e. not congenital), rubella is transmitted via airborne droplet emission from the upper respiratory tract of active cases. The virus may also be present in the urine, faeces 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.<ref name="pmid11332662">{{cite journal
| | ==[[Rubella causes|Causes]]== |
| |author=Richardson M, Elliman D, Maguire H, Simpson J, Nicoll A
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| |title=Evidence base of incubation periods, periods of infectiousness and exclusion policies for the control of communicable diseases in schools and preschools
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| |journal=Pediatr. Infect. Dis. J.
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| |volume=20
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| |issue=4
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| |pages=380–91
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| |year=2001
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| |pmid=11332662
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| |url=http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=0891-3668&volume=20&issue=4&spage=380
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| }}</ref>
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| In most people the virus is rapidly eliminated however, it may persist for some months post partum in infants surviving the CRS. These children were an important source of infection to other infants and, more importantly, pregnant female contacts.
| | ==[[Rubella differential diagnosis|Differentiating Rubella from other Diseases]]== |
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| ==Signs and Symptoms== | | ==[[Rubella epidemiology and demographics|Epidemiology and Demographics]]== |
| After an incubation period of 14-21 days, the primary symptom of rubella virus infection is the appearance of a rash ([[exanthem]]) on the face which spreads to the trunk and limbs and usually fades after three days. Other symptoms include low grade fever, swollen glands (post cervical lymphadenopathy), joint pains, headache, conjunctivitis.<ref name="pmid16022642">{{cite journal
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| |author=Edlich RF, Winters KL, Long WB, Gubler KD
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| |title=Rubella and congenital rubella (German measles)
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| |journal=J Long Term Eff Med Implants
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| |volume=15
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| |issue=3
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| |pages=319–28
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| |year=2005
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| |pmid=16022642
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| |doi=
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| |url=http://www.begellhouse.com/journals/1bef42082d7a0fdf,69622d0e4ea6cf4b,4fb4b32d494cf55c.html | |
| }}</ref> The swollen [[gland]]s or lymph nodes can persist for up to a week and the [[fever]] rarely rises above 38 <sup>o</sup>C (100.4 <sup>o</sup>F). The rash disappears after a few days with no staining or peeling of the skin. Forchheimer's sign occurs in 20% of cases, and is characterized by small, red [[papule]]s on the area of the [[soft palate]].
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| Rubella can affect anyone of any age and is generally a mild disease, rare in infants or those over the age of 40. The older the person is the more severe the symptoms are likely to be. Up to one-third of older girls or women experience joint pain or arthritic type symptoms with rubella. The virus is contracted through the respiratory tract and has an incubation period of 2 to 3 weeks. During this incubation period, the carrier is contagious but may show no symptoms.
| | ==[[Rubella risk factors|Risk Factors]]== |
| ====Congenital Rubella Syndrome====
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| {{main|Congenital rubella syndrome}}
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| Rubella can cause [[congenital rubella syndrome]] in the newly born. The syndrome (CRS) follows intrauterine infection by Rubella virus and comprises cardiac, cerebral, ophthalmic and auditory defects.<ref name="pmid15259032">{{cite journal
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| |author=Atreya CD, Mohan KV, Kulkarni S
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| |title=Rubella virus and birth defects: molecular insights into the viral teratogenesis at the cellular level.
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| |journal=Birth Defects Res. Part A Clin. Mol. Teratol.
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| |volume=70
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| |issue=7
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| |pages=431–7
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| |year=2004
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| |pmid=15259032
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| |doi=10.1002/bdra.20045
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| |url=http://dx.doi.org/10.1002/bdra.20045
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| }}</ref> It may also cause prematurity, low birth weight, and neonatal thrombocytopenia, anaemia and hepatitis. The risk of major defects or organogenesis is highest for infection in the first trimester. CRS is the main reason a vaccine for rubella was developed. Many mothers who contract rubella within the first critical trimester either have a miscarriage or a still born baby. If the baby survives the infection, it can be born with severe heart disorders (PDA being the most common), blindness, deafness, or other life threatening organ disorders. The skin manifestations are called "blueberry muffin lesions." <ref name="pmid16580940">{{cite journal
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| |author=De Santis M, Cavaliere AF, Straface G, Caruso A | |
| |title=Rubella infection in pregnancy.
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| |journal=Reprod. Toxicol.
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| |volume=21
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| |issue=4
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| |pages=390–8
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| |year=2006
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| |pmid=16580940
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| |doi=10.1016/j.reprotox.2005.01.014
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| |url=http://linkinghub.elsevier.com/retrieve/pii/S0890-6238(05)00073-0
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| }}</ref>
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| ==Cause== | | ==[[Rubella screening|Screening]]== |
| {{main|Rubella virus}}
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| The disease is caused by Rubella virus, a [[togavirus]] that is enveloped and has a single-stranded RNA genome.<ref name="pmid7817880">{{cite journal
| | ==[[Rubella natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
| |author=Frey TK
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| |title=Molecular biology of rubella virus.
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| |journal=Adv. Virus Res.
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| |volume=44
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| |issue=
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| |pages=69–160
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| |year=1994
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| |pmid=7817880
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| |doi=
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| }}</ref> The virus is transmitted by the respiratory route and replicates in the [[nasopharynx]] and [[lymph nodes]]. The virus is found in the blood 5 to 7 days after infection and spreads throughout the body. It is capable of crossing the placenta and infecting the foetus where it stops cells from developing or destroys them.<ref name="pmid16022642">{{cite journal
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| |author=Edlich RF, Winters KL, Long WB, Gubler KD | |
| |title=Rubella and congenital rubella (German measles).
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| |journal=J Long Term Eff Med Implants
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| |volume=15
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| |issue=3
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| |pages=319–28
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| |year=2005
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| |pmid=16022642
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| |doi=
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| |url=http://www.begellhouse.com/journals/1bef42082d7a0fdf,69622d0e4ea6cf4b,4fb4b32d494cf55c.html
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| }}</ref>
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| ==Diagnosis of acquired rubella== | | ==Diagnosis== |
| Rubella virus specific [[IgM]] antibodies are present in people recently infected by Rubella virus but these antibodies can persist for over a year and a positive test result needs to be interpreted with caution.<ref name="pmid17337363">{{cite journal
| | [[Rubella history and symptoms|History and Symptoms]] | [[Rubella physical examination|Physical Examination]] | [[Rubella laboratory findings|Laboratory Findings]] |
| |author=Best JM
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| |title=Rubella.
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| |journal=Semin Fetal Neonatal Med
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| |volume=12 | |
| |issue=3
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| |pages=182–92
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| |year=2007
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| |pmid=17337363
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| |doi=10.1016/j.siny.2007.01.017
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| |url=http://linkinghub.elsevier.com/retrieve/pii/S1744-165X(07)00018-2
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| }}</ref> The presence of these antibodies along with, or a short time after, the characteristic rash confirms the diagnosis.<ref name="pmid12150751">{{cite journal
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| |author=Stegmann BJ, Carey JC
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| |title=TORCH Infections. Toxoplasmosis, Other (syphilis, varicella-zoster, parvovirus B19), Rubella, Cytomegalovirus (CMV), and Herpes infections
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| |journal=Curr Womens Health Rep
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| |volume=2
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| |issue=4
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| |pages=253–8
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| |year=2002
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| |pmid=12150751
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| |doi=
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| }}</ref>
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| ==Prevention==
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| {{main|MMR vaccine}}
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| Rubella infections are prevented by active immunization programs using live, disabled virus [[vaccine]]s. Two live attenuated virus vaccines, RA 27/3 and Cendehill strains, were effective in the prevention of adult disease. However their use in prepubertile females did not produce a significant fall in the overall incidence rate of CRS in the UK. Reductions were only achieved by immunisation of all children.
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| The vaccine is now given as part of the [[MMR vaccine]]. The [[WHO]] recommends the first dose is given at 12 to 18 months of age with a second dose at 36 months. Pregnant women are usually tested for immunity to rubella early on. Women found to be susceptible are not vaccinated until after the baby is born because the vaccine contains live virus.<ref name="pmid9639369">{{cite journal
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| |author=Watson JC, Hadler SC, Dykewicz CA, Reef S, Phillips L
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| |title=Measles, mumps, and rubella--vaccine use and strategies for elimination of measles, rubella, and congenital rubella syndrome and control of mumps: recommendations of the Advisory Committee on Immunization Practices (ACIP)
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| |journal=MMWR Recomm Rep
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| |volume=47 | |
| |issue=RR-8
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| |pages=1–57
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| |year=1998
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| |pmid=9639369
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| |doi=
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| }}</ref>
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| The [[Immunization (medicine)|immunization]] program has been quite successful with Cuba declaring the disease eliminated in the 1990s. In 2004 the [[Centers for Disease Control and Prevention]] announced that both the congenital and acquired forms of rubella had been eliminated from the [[United States]].<ref>{{cite journal |author=Dayan GH, Castillo-Solórzano C, Nava M, ''et al'' |title=Efforts at rubella elimination in the United States: the impact of hemispheric rubella control |journal=Clin. Infect. Dis. |volume=43 Suppl 3 |issue= |pages=S158–63 |year=2006 |pmid=16998776 |doi=10.1086/505949}}</ref><ref>{{cite journal |author= |title=Elimination of rubella and congenital rubella syndrome--United States, 1969-2004 |url= http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5411a5.htm|journal=MMWR Morb. Mortal. Wkly. Rep. |volume=54 |issue=11 |pages=279–82 |year=2005 |pmid=15788995 |doi=}}</ref>
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| ==Treatment== | | ==Treatment== |
| Symptoms are usually treated with [[paracetamol]] until the disease has run its course. Treatment of newly born babies is focused on management of the complications. Congenital heart defects and cataracts can be corrected by surgery.<ref name="pmid17197734">{{cite journal
| | [[Rubella medical therapy|Medical Therapy]] | [[Rubella primary prevention|Primary Prevention]] | [[Rubella secondary prevention|Secondary Prevention]] | [[Rubella cost-effectiveness of therapy|Cost-effectiveness of Therapy]] |
| |author=Khandekar R, Sudhan A, Jain BK, Shrivastav K, Sachan R | |
| |title=Pediatric cataract and surgery outcomes in Central India: a hospital based study.
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| |journal=Indian J Med Sci
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| |volume=61
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| |issue=1
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| |pages=15–22
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| |year=2007
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| |pmid=17197734
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| |doi=
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| |url=http://www.indianjmedsci.org/article.asp?issn=0019-5359;year=2007;volume=61;issue=1;spage=15;epage=22;aulast=Khandekar
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| }}</ref> Management for ocular CRS is similar to that for age-related macular degeneration, including counseling, regular monitoring, and the provision of low vision devices, if required.<ref name="pmid12365660">{{cite journal
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| |author=Weisinger HS, Pesudovs K
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| |title=Optical complications in congenital rubella syndrome
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| |journal=Optometry
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| |volume=73
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| |issue=7
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| |pages=418–24
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| |year=2002
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| |pmid=12365660
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| |doi=
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| }}</ref>
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| ==Prognosis==
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| Rubella infection of children and adults is usually mild, self-limiting and often asymptomatic. The prognosis in children born with CRS is poor.<ref name="pmid3288422">{{cite journal
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| |author=Freij BJ, South MA, Sever JL
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| |title=Maternal rubella and the congenital rubella syndrome
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| |journal=Clin Perinatol
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| |volume=15
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| |issue=2
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| |pages=247–57
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| |year=1988
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| |pmid=3288422
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| |doi=
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| }}</ref>
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| ==Epidemiology==
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| Rubella is a disease that occurs worldwide. The virus tends to peak during the spring in countries with temperate climates. Before the vaccine to rubella was introduced in 1969, widespread outbreaks usually occurred every 6-9 years in the United States and 3-5 years in Europe, mostly affecting children in the 5-9 year old age group.<ref name="pmid11798368">{{cite journal | |
| |author=Reef SE, Frey TK, Theall K, ''et al''
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| |title=The changing epidemiology of rubella in the 1990s: on the verge of elimination and new challenges for control and prevention
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| |journal=JAMA | |
| |volume=287
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| |issue=4
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| |pages=464–72
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| |year=2002
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| |pmid=11798368
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| |doi=
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| |url=http://jama.ama-assn.org/cgi/pmidlookup?view=long&pmid=11798368
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| }}</ref> Since the introduction of vaccine, occurrences have become rare in those countries with high uptake rates. However, in the UK there remains a large population of men susceptible to rubella who have not been vaccinated. Outbreaks of rubella occurred amongst many young men in the UK in 1993 and in 1996 the infection was transmitted to pregnant women, many of whom were immigrants and were susceptible. Outbreaks still arise, usually in developing countries where the vaccine is not as accessible.<ref name="pmid16989272">{{cite journal
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| |author=Reef S | |
| |title=Rubella mass campaigns
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| |journal=Curr. Top. Microbiol. Immunol.
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| |volume=304
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| |issue=
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| |pages=221–9
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| |year=2006
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| |pmid=16989272
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| |doi=
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| }}</ref>
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| During the epidemic in the US between 1962-1965, Rubella virus infections during pregnancy were estimated to have caused 30,000 still births and 20,000 children to be born impaired or disabled as a result of CRS.<ref name="pmid11348695">{{cite journal
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| |author=Plotkin SA
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| |title=Rubella eradication
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| |journal=[[Vaccine]]
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| |volume=19 | |
| |issue=25-26
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| |pages=3311–9
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| |year=2001
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| |pmid=11348695
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| |doi=
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| |url=http://linkinghub.elsevier.com/retrieve/pii/S0264410X01000731
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| }}</ref><ref>Cooper,L.Z. Congenital Rubella in the United States. 1975 In: Krugman,S Gershon,A (eds), Symposium on Infections Of the Fetus and Newborn Infant. New York, Alan R. Liss Inc.,p.1.</ref>
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| Universal immunisation producing a high level of [[herd immunity]] is important in the control of epidemics of rubella.<ref name="pmid11105178">{{cite journal
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| |author=Danovaro-Holliday MC, LeBaron CW, Allensworth C, ''et al''
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| |title=A large rubella outbreak with spread from the workplace to the community
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| |journal=JAMA
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| |volume=284
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| |issue=21 | |
| |pages=2733–9
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| |year=2000
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| |pmid=11105178
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| |doi=
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| |url=http://jama.ama-assn.org/cgi/pmidlookup?view=long&pmid=11105178
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| }}</ref>
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| ==History==
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| Rubella was first described in the mid-eighteenth century. [[Friedrich Hoffmann]] made the first clinical description of rubella in 1740,<ref name=Ackerknecht1982>{{cite book |author=Ackerknecht, Erwin Heinz |title=A short history of medicine |publisher=Johns Hopkins University Press |location=Baltimore |year=1982 |pages=129 |isbn=0-8018-2726-4}}</ref> which was confirmed by de Bergen in 1752 and Orlow in 1758.<ref name="pmid18109609">{{cite journal
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| |author=Wesselhoeft C
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| |title=Rubella and congenital deformities
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| |journal=N. Engl. J. Med.
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| |volume=240
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| |issue=7
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| |pages=258–61
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| |year=1949
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| |pmid=18109609
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| |doi=
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| }}</ref>
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| In 1814, George de Maton first suggested that it be considered a disease distinct from both measles and scarlet fever. All these physicians were German, and the disease was known as Rötheln (from the German name ''Röteln''), hence the common name of "German measles". <ref>Best, J.M., Cooray, S., Banatvala J.E. '''Rubella''' in ''Topley and Wilson's Microbiology and Microbial Infections'', Vol. 2, Virology, Chapter 45, p.960-92, ISBN 0 340 88562 9, 2005 </ref> Henry Veale, an English Royal Artillery surgeon, described an outbreak in India. He coined the name "rubella" (from the Latin, meaning "little red") in 1866.<ref name=Ackerknecht1982/><ref name=Lee2000>{{cite journal |author=Lee JY, Bowden DS |title=Rubella virus replication and links to teratogenicity |journal=Clin. Microbiol. Rev. |volume=13 |issue=4 |pages=571-87 |year=2000 |pmid=11023958 |url=http://cmr.asm.org/cgi/content/full/13/4/571}}</ref><ref name=cdc>{{cite book
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| | author = Atkinson W, Hamborsky J, McIntyre L, Wolfe S, eds.
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| | year = 2007
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| | url = http://www.cdc.gov/vaccines/pubs/pinkbook/pink-chapters.htm
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| | title = Epidemiology and Prevention of Vaccine-Preventable Diseases. 10th ed.
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| | chapter = Chapter 12. Rubella
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| | chapterURL = http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/rubella.pdf
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| | publisher = Centers for Disease Control and Prevention
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| | accessdate = 2007-07-03
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| }}</ref><ref name=MoHNZ>{{cite book
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| | year = 2006
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| | month = April
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| | title = Immunisation Handbook 2006
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| | publisher = Ministry of Health, Wellington, NZ.
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| | url = http://www.moh.govt.nz/moh.nsf/indexmh/immunisation-handbook-2006
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| | chapter = Chapter 11 - Rubella
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| | chapterURL = http://www.moh.govt.nz/moh.nsf/pagesmh/4617/$File/2006-11rubella.pdf
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| | isbn=0-478-29926-5
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| | accessdate = 2007-07-03
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| }}</ref>
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| It was formally recognised as an individual entity in 1881, at the International Congress of Medicine in London.<ref>Smith, J. L. Contributions to the study of Rötheln. Trans. Int. Med. Congr. Phil. '''4''',14. 1881</ref> In 1914, Alfred Fabian Hess theorised that rubella was caused by a virus, based on work with monkeys.<ref name=whonamedit>{{cite journal
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| | first = Alfred Fabian
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| | last = Hess
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| | year = 1914
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| | title = German measles (rubella): an experimental study
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| | journal = The Archives of Internal Medicine
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| | location = Chicago
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| | volume = 13
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| | pages = 913-916
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| }} as cited by {{cite web
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| | first = Ole Daniel
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| | last = Enersen
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| | url = http://www.whonamedit.com/doctor.cfm/2283.html
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| | title = Alfred Fabian Hess
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| | publisher = WhoNamedIt
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| | accessdate = 2007-07-03
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| }}</ref> In 1938, Hiro and Tosaka confirmed this by passing the disease to children using filtered nasal washings from acute cases.<ref name=cdc/>
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| In 1940, there was a widespread epidemic of rubella in Australia. Subsequently, ophthalmologist Norman McAllister Gregg found 78 cases of congenital cataracts in infants and 68 of them were born to mothers who had caught rubella in early pregnancy.<ref name=Lee2000/><ref name=cdc/> Gregg published an account, ''Congenital Cataract Following German Measles in the Mother'', in 1941. He described a variety of problems now know as [[congenital rubella syndrome]] (CRS) and noticed that the earlier the mother was infected, the worse the damage was. The virus was isolated in tissue culture in 1962 by two separate groups led by physicians Parkman and Weller.<ref name=MoHNZ/><ref name=Lee2000/>
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| There was a pandemic of rubella between 1962 and 1965, starting in Europe and spreading to the United States.<ref name=MoHNZ/> In the years 1964-65, the United States had an estimated 12.5 million rubella cases. This led to 11,000 miscarriages or therapeutic abortions and 20,000 cases of congenital rubella syndrome. Of these, 2,100 died as neonates, 12,000 were deaf, 3,580 were blind and 1,800 were mentally retarded. In New York alone, CRS affected 1% of all births <ref> J.B. Hanshaw, J.A. Dudgeon, and W.C. Marshall. Viral diseases of the fetus and newborn. W.B. Saunders Co., Philadelphia, 1985 </ref>
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| In 1969 a live attenuated virus vaccine was licensed.<ref name=cdc/> In the early 1970s, a triple vaccine containing attenuated measles, mumps and rubella (MMR) viruses was introduced.<ref name=MoHNZ/>
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| ==See also==
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| * [[Eradication of infectious diseases]]
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| == References == | | ==Cases Studies== |
| <!--<nowiki>
| | [[Rubella case study one|Case #1]] |
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| {{Reflist|2}}
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| ==External links== | | ==External Links== |
| * [http://www.virology-online.com/viruses/Rubella.htm Rubella] at Wong's Virology.
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| * [http://www.immunize.org/rubella/index.htm Immunization Action Coalition: Rubella]
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| * {{DermNet|viral/rubella}} | | * {{DermNet|viral/rubella}} |
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| [[Category:Pediatrics]] | | [[Category:Pediatrics]] |
| [[Category:Togaviruses]] | | [[Category:Togaviruses]] |
| [[Category:Infectious disease]]
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| [[Category:Emergency medicine]] | | [[Category:Emergency medicine]] |
| [[Category:Mature chapter]]
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| [[Category:Overview complete]]
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| [[bg:Рубеола]] | | [[Category:Dermatology]] |
| [[cs:Zarděnky]] | | [[Category:Emergency mdicine]] |
| [[de:Röteln]] | | [[Category:Disease]] |
| [[eo:Rubeolo]]
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| [[es:Rubéola]]
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| [[fa:سرخجه]]
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| [[fi:Vihurirokko]]
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| [[fr:Rubéole]]
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| [[he:אדמת]]
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| [[id:Rubela]]
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| [[it:Rosolia]]
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| [[ja:風疹]]
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| [[la:Rubella]]
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| [[lb:Riselen]]
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| [[ms:Penyakit Rubela]]
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| [[nl:Rodehond]]
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| [[no:Røde hunder]]
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| [[pl:Różyczka]]
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| [[pt:Rubéola]]
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| [[ro:Rubeolă]]
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| [[simple:Rubella]]
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| [[sv:Röda hund]]
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| [[th:โรคหัดเยอรมัน]]
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| [[tr:Kızamıkçık]]
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| [[vi:Sởi Đức]]
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| | [[Category:Infectious disease]] |
| | [[Category:Pediatrics]] |
| | [[Category:Dermatology]] |
