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Rubella

Specialties > Child health

Background knowledge 🧠

Definition

  • Rubella, also known as German measles, is a contagious viral infection primarily affecting the skin and lymph nodes.
  • Caused by the rubella virus, part of the Togaviridae family.
  • Characterized by a rash, low-grade fever, and lymphadenopathy.
  • Typically a mild disease but has serious implications in pregnancy, leading to congenital rubella syndrome.

Epidemiology

  • Rubella is less common in the UK due to successful immunization programs.
  • Primarily affects children and young adults.
  • Outbreaks occur mainly in populations with low vaccination rates.
  • Elimination of rubella is a public health goal, particularly to prevent congenital rubella syndrome.

Aetiology and Pathophysiology

  • Caused by the rubella virus, an RNA virus of the Rubivirus genus.
  • Transmitted via respiratory droplets from person to person.
  • Virus replicates in the nasopharynx and lymph nodes.
  • Viraemia occurs within 5-7 days, spreading the virus to multiple tissues, including the skin and placenta.
  • Congenital rubella occurs when the virus crosses the placenta, leading to various developmental abnormalities.

Types

  • Postnatal rubella: typically mild, characterized by rash and lymphadenopathy.
  • Congenital rubella syndrome (CRS): results from maternal infection during pregnancy, can lead to serious congenital anomalies.

Clinical Features 🌡️

Symptoms

  • Mild fever (up to 38.5°C).
  • General malaise.
  • Rash starting on the face and spreading to the rest of the body.
  • Lymphadenopathy, particularly suboccipital and postauricular.
  • Mild conjunctivitis.
  • Joint pain, more common in adults.

Signs

  • Pinkish-red maculopapular rash, typically beginning on the face.
  • Rash spreads downwards, covering the body within 24 hours.
  • Rash fades after 3 days, leaving a fine desquamation.
  • Lymphadenopathy, particularly in the neck and behind the ears.
  • Forchheimer spots: small, red spots on the soft palate.
  • Enlarged spleen (less common).

Investigations 🧪

Tests

  • Serology: Detection of rubella-specific IgM antibodies confirms recent infection.
  • PCR: Detection of rubella virus RNA in nasopharyngeal swabs or blood.
  • Antenatal screening: Rubella immunity screening as part of routine antenatal care.
  • Fetal ultrasound: To detect abnormalities suggestive of congenital rubella syndrome in at-risk pregnancies.

Management 🥼

Management

  • No specific antiviral treatment; management is supportive.
  • Rest, hydration, and antipyretics for fever.
  • Isolation from school/work for 5 days after the rash onset to prevent spread.
  • Rubella vaccine (MMR) for prevention; not administered during pregnancy.
  • In pregnancy: Consider termination if rubella infection is confirmed in the first trimester.

Complications

  • Arthritis, particularly in adult women.
  • Encephalitis (rare).
  • Thrombocytopenic purpura.
  • Congenital rubella syndrome: Hearing loss, cataracts, heart defects, developmental delay.
  • Intrauterine growth restriction and fetal death in severe cases of congenital infection.

Prognosis

  • Generally excellent in postnatal rubella, with full recovery.
  • Prognosis for congenital rubella syndrome depends on the extent of anomalies.
  • Early detection and supportive care improve outcomes.

Key Points

  • Rubella is preventable through vaccination (MMR).
  • Key risk is to pregnant women and the fetus.
  • Antenatal screening is crucial to prevent congenital rubella syndrome.
  • No specific treatment; focus is on prevention and supportive care.

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Child health