Infectious Disease: Rubella

Question 1

Defintion

Answer 1

Rubella (German measles) is a viral illness caused by infection with a togavirus
Rubella is spread via direct contact with infected body fluid or by droplet contact

Question 2

Epidemiology

Answer 2

Since the introduction of the MMR vaccine, rubell remains a rare condition in the UK
- close contact with infected person
- absence/incomplete MMR vaccination record

Question 3

Pathophysiology

Answer 3

The incubation period for rubella is 14-21 days and individuals are infectious from 7 days before the onset of symptoms until approximately four days after the onset of the rash.
Once contracted, the virus replicates in the nasopharynx and regional lymph nodes and spreads to lymphoid tissue before haematogenous dissemination (including to the placenta and foetus if pregnant).

Question 4

Rubella in pregnancy complication

Answer 4

Unvaccinated pregnant women (MMR) who contract rubella -> miscarriage or congenital rubella syndrome (CRS) can occur.
CRS can lead to a number of problems including fetal defects such as:
- sensorineural deafness,
- optic abnormalities,
- growth and cardiac defects

Question 5

Signs

Answer 5

• Maculopapular rash: starts on the face and neck before spreading down the body and becoming generalised
• Lymphadenopathy: suboccipital postauricular and cervical lymphadenopathy. May precede rash and last for 2 weeks after the rash resolves

Question 6

Symptoms

Answer 6

• Rash
• Arthralgia
• Non-specific symptoms:
  = low-grade fever
  = headache
  = malaise
  = coryza

Question 7

Diagnosis

Answer 7

FIRST LINE = Oral fluid (OF) sample

Question 8

Treatment

Answer 8

Non pregnant:
- conservative management
- school/work absence: min 5 days after the initial development of the rash
- Notification to health protection team
Pregnant:
- Gestation ≤ 20 weeks : referred urgently to obstetrics for assessment. The risk of CRS is highest at earlier gestation. Human Normal Immunoglobulin may be considered in secondary care
If over 20 weeks pregnant : patients can be reassured that there have been no reported cases of CRS after this gestational age. Rubella immunisation should not be administered in pregnancy but may be given post-partum if non-immune
The MMR vaccine, like other live vaccines, are contraindicated in pregnancy

Question 9

Complications

Answer 9

Arthralgia
Thrombocytopenia
Neurological encephalitis
Obstetrics complications:
- Miscarriage
- Stillbirth
- Congenital rubella syndrome (CRS)