Rubella virus: Difference between revisions

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* Also known as German measles
*Also known as German measles
* Causes fever, rash, ± arthritis
*Causes fever, rash, ± arthritis
* Congenital syndrome: deafness, cataracts, and CHD
*Congenital syndrome: deafness, cataracts, and CHD


== Background ==
==Background==
=== Microbiology ===
===Microbiology===
* RNA virus in the Matonaviridae family, genus ''Rubivirus''
** Previously in the Togaviridae family


*RNA virus in the Matonaviridae family, genus ''Rubivirus''
=== Epidemiology ===
**Previously in the Togaviridae family
* Seasonal, in spring, if no vaccine
* Less contaggious than measles, spread by respiratory droplets
** Most contagious while the rash is erupting, but ranges from 10 days prior to 15 days after
** Infants with congenital rubella can shed it in body fluids for months
* Epidemics happened every 6 to 9 years, with larger epidemics every 30 years
* Worldwide, until it was eliminated in the Americas in 2009
** All cases are imported


===Epidemiology===
== Clinical Manifestations ==
* Incubation period 18 days (range 12 to 23 days)
* Benign after birth (postnatal rubella)
* In adults, prodrome of fever, malaise, and anorexia, followed by the rash
* Rash appears along with development of immunity
** Rash starts at the head and moves down
** Maculopapular
** May desquamate during healing
** May be absent
** Can have Forschheimer's spots (petechial lesions on the soft palate), but not pathognomonic
* Adenopathy can last weeks, primarily posterior auricular, posterior cervical, and suboccipital
* Can develop arthritis in a third, usually fingers, wrists, and knees
** Onset soon after the rash, can take up to a month to resolve
* Hemorrhage from thrombocytopenia and vascular damage, more commonly in children
* Encephalitis is rare


*Seasonal, in spring, if no vaccine
=== Congenital rubella syndrome ===
*Less contaggious than measles, spread by respiratory droplets
* Refer to [[Congenital rubella]]
**Most contagious while the rash is erupting, but ranges from 10 days prior to 15 days after
**Infants with congenital rubella can shed it in body fluids for months
*Epidemics happened every 6 to 9 years, with larger epidemics every 30 years
*Worldwide, until it was eliminated in the Americas in 2009
**All cases are imported


==Clinical Manifestations==
== Diagnosis ==
* Acute and convalescent ELISA serology, or single IgM titre
* Can do PCR for viral RNA on throat swabs, CSF, or amniotic fluid


*Incubation period [[Usual incubation period::18 days]] (range [[Incubation period range::12 to 23 days]])
== Management ==
*Benign after birth (postnatal rubella)
* First trimester infection is more likely to have congenital rubella, rare in third trimester
*In adults, prodrome of fever, malaise, and anorexia, followed by the rash
* Confirm vaccination status of the exposed individual, in which case they will be very low risk
*Rash appears along with development of immunity
**Rash starts at the head and moves down
**Maculopapular
**May desquamate during healing
**May be absent
**Can have Forschheimer's spots (petechial lesions on the soft palate), but not pathognomonic
*Adenopathy can last weeks, primarily posterior auricular, posterior cervical, and suboccipital
*Can develop arthritis in a third, usually fingers, wrists, and knees
**Onset soon after the rash, can take up to a month to resolve
*Hemorrhage from thrombocytopenia and vascular damage, more commonly in children
*Encephalitis is rare


===Congenital rubella syndrome===
== Prevention ==

* Live attenuated vaccine is included in MMR at 12-15 months and 4-6 years
*Refer to [[Congenital rubella]]
* Vaccine is 95% effective

* Should revaccinate most young women
==Diagnosis==

*Acute and convalescent ELISA serology, or single IgM titre
*Can do PCR for viral RNA on throat swabs, CSF, or amniotic fluid

==Management==

*First trimester infection is more likely to have congenital rubella, rare in third trimester
*Confirm vaccination status of the exposed individual, in which case they will be very low risk

==Prevention==

*Live attenuated vaccine is included in MMR at 12-15 months and 4-6 years
*Vaccine is 95% effective
*Should revaccinate most young women


[[Category:Togaviridae]]
[[Category:Togaviridae]]

Latest revision as of 13:53, 5 August 2020

  • Also known as German measles
  • Causes fever, rash, ± arthritis
  • Congenital syndrome: deafness, cataracts, and CHD

Background

Microbiology

  • RNA virus in the Matonaviridae family, genus Rubivirus
    • Previously in the Togaviridae family

Epidemiology

  • Seasonal, in spring, if no vaccine
  • Less contaggious than measles, spread by respiratory droplets
    • Most contagious while the rash is erupting, but ranges from 10 days prior to 15 days after
    • Infants with congenital rubella can shed it in body fluids for months
  • Epidemics happened every 6 to 9 years, with larger epidemics every 30 years
  • Worldwide, until it was eliminated in the Americas in 2009
    • All cases are imported

Clinical Manifestations

  • Incubation period 18 days (range 12 to 23 days)
  • Benign after birth (postnatal rubella)
  • In adults, prodrome of fever, malaise, and anorexia, followed by the rash
  • Rash appears along with development of immunity
    • Rash starts at the head and moves down
    • Maculopapular
    • May desquamate during healing
    • May be absent
    • Can have Forschheimer's spots (petechial lesions on the soft palate), but not pathognomonic
  • Adenopathy can last weeks, primarily posterior auricular, posterior cervical, and suboccipital
  • Can develop arthritis in a third, usually fingers, wrists, and knees
    • Onset soon after the rash, can take up to a month to resolve
  • Hemorrhage from thrombocytopenia and vascular damage, more commonly in children
  • Encephalitis is rare

Congenital rubella syndrome

Diagnosis

  • Acute and convalescent ELISA serology, or single IgM titre
  • Can do PCR for viral RNA on throat swabs, CSF, or amniotic fluid

Management

  • First trimester infection is more likely to have congenital rubella, rare in third trimester
  • Confirm vaccination status of the exposed individual, in which case they will be very low risk

Prevention

  • Live attenuated vaccine is included in MMR at 12-15 months and 4-6 years
  • Vaccine is 95% effective
  • Should revaccinate most young women