EPIDEMIOLOGY
OF
RUBELLA
(GERMAN
MEASLES)
DR. MAHESWARI JAIKUMAR.
maheswarijaikumar2103@gmail.
RUBELLA
VIRU
S
RUBELLA
VIRU
S
RUBELLA/GERMAN
MEASLES
• German measles is an acute
childhood infection, usually
mild, of short duration (3
days).
• Rubella is accompanied
by low
grade fever,
lymphadenopathy and a
maculopapular rash.
• Infection in early pregnancy
may result in serious
congenital defects
including death of the
fetus.
AGEN
• Rubella isTcaused by an
RNA virus of the
TOGAVIRUS family. The
virus can be propagated in
cell culture.
SOURCE OF
INFECTION
• Clinical
or subclinical case
of cases of rubella. ( A
large number of rubella
infections are subclinical.
This is one of the major
differences between
measles and rubella)
PERIOD OF
COMMUNICABIL
ITY
• Rubella is much less
communicable than measles
(due to absence of coughing).
• The period of
communicability probably
extends from a week
before symptoms to about
a week after rash appears.
Infectivity is greatest when
the rash is erupting.
AG
E of
• Mainly a disease
childhood.
• Usually affects children
between 3 & 10 Years.
IMMUNIT
Y results in
• One attack
lifelong immunity.
• Secondary attacks are
rare.
• Disease usually
occurs in a seasonal
pattern.
• In temperate zones during
the late winter and
spring, with epidemics
every 4-9 years.
TRANSMISSI
• TheON
virus is transmitted
directly from person to
person by droplets from
nose and throat and
droplet nuclei (aerosols)
from one week before the
onset of rashes to one
week after it has faded.
• The portal of entry is
through respiratory tract.
• The virus can cross
placenta (vertical
transmission).
INCUBATION
PERIOD
2 To 3 weeks; average 18
days.
CLINICAL
• AFEATURES
large percentage of
infections are
asymptomatic.
• However in a typical case,
the clinical features
compromise the following.
PRODROM
AL
• The prodromal
symptoms
are coryza, sore throat,
low-grade fever mark the
of viraemia.
LYMPHADENOPA
• InTHY
susceptible individuals,
the enlargement of
the
post auricular and posterior
cervical lymph node
appears as early as 7 days
before the appearance of
the rash.
• The enlarged glands may be
found 10-14 days after the
rash.
RAS
• The rash is H
often the first
indication of the disease in
children.
• It appears first on the face,
usually within 24 hours of the
onset of prodromal
symptoms.
• It is a minute, discrete,
pinkish, macular rash and
not confluent as the rash
of measles.
• Conjunctivitis may occur.
• The rash spreads rapidly to
the trunk and extremities,
by which time it is often no
longer apparent on the
face.
• The rash spreads much
faster and clears more
• It disappears altogether by
the third day.
• The rash is an inconstant
feature of the disease.
• It is absent in subclinical
cases.
COMPLICATIO
NSinstances arthralgia
• In rare
may occur in several joints
in adults.
• Thrombocytopenic purpura
has also been observed as
a complication.
DIAGNOS
• Due to itsIS
mildness and
variability of symptoms, the
disease can go unrecognized
unless it is an epidemic.
• A definitive diagnosis of rubella
is possible only through virus
isolation and serology.
• Throat swabs should be
cultured for virus isolation;
it takes longer
than
serological diagnosis.
• The most widely used
serological test is the
heamagglutination
• Two blood samples are
taken , the first sample
within 5 days after the onset
of illness, and the second 2
weeks later.
• More sensitive serological
test include the ELISA
test and
CONGENITAL
RUBEL
• Congenital Rubella
Syndrome
(CRS)
refers
to
LA
infants born with defects
secondary to intrauterine
infection or who manifest
symptoms or signs of
intrauterine infection
sometime after birth.
• Rubella infection inhibits
cell division and this is
probably the reason for
congenital malformations
and low birth weight.
• The classical triad of
congenital defects are
deafness, cardiac
malformations and
cataracts.
• Other resulting defects
include glaucoma,
retinopathy, microcephalus
cerebral palsy,
• These defects occurring
singly or in combination
have become
known as “Congenital
rubell
a Syndrome”.
• The first trimester of
pregnancy is crucial and
disastrous for the foetus
as the organogenesis
takes place. Maternal
infection during this time
is directly associated with
congenital abnormalities.
PREVENTI
• ActiveON
immunization is
available.
• RUBELLA VACCINE : RA
27/3 vaccine, produced in
human diploid fibro-blast
is recommended for
• RA 27/3 vaccine is
administered in a single
dose of 0.5ml
subcutaneously.
• It may provoke some mild
reactions in some subjects
such as malaise, fever,
mild rash and transient
• Rubella vaccine is also
available as combined
Measles, Mumps and
Rubella (MMR).
• It is equally effective.
VACCINATION
STRATEGY
• MMR vaccination is given
to infants on completing 9
months of age. (in the
national immunization
schedule in India)
• In general the priority being to
protect women of child
bearing age (15-34 or 39 years
of age) and then to interrupt
transmission of rubella by
vaccinating all children in the
community aged 1-14 years
and subsequently all children
at one year of age.
THANK
YOU