Rubella

Question 1

What is rubella?

Answer 1

Single stranded RNA virus

Question 2

How is rubella transmitted?

Answer 2

Airborne droplets between close contacts

Question 3

How has the incidence of rubella decreased in the UK?

Answer 3

Introduction of the MMR vaccination programme

Question 4

When did rubella stop being screened for and why?

Answer 4

2016 - due to the success of the MMR vaccination programme

Question 5

List the clinical features of maternal rubella

Answer 5

Asymptomatic 
Non specific
Malaise
Headache
Coryza
Lymphadenopathy 
Fine diffuse maculopapular rash

Question 6

What is the incubation period of rubella?

Answer 6

14-21 days

Question 7

What investigations should be done when rubella is suspected in pregnancy

Answer 7

ELISA - rubella specific IgG and IgM
IgM- acute infection
IgG - infection or vaccination

Question 8

Describe the management of rubella in pregnancy

Answer 8

Refer to foetal medicine specialist

Maternal - self limiting, no treatment, antipyretics.

Foetal - Management depends on gestation

Question 9

Describe the infective period of rubella

Answer 9

Infective for 7 days prior to onset of symptoms and 4 days after

Question 10

What is the risk of vertical transmission and congenital rubella syndrome is determined by?

Answer 10

gestational age at time of infection

Question 11

What management is suggested for rubella infection <12weeks gestation?

Answer 11

Termination of pregnancy considered

Question 12

What management is suggested for rubella infection 12-20 weeks gestation?

Answer 12

Prenatal diagnosis of foetal rubella - RT-PCR on amniotic fluid samples
If confirmed, then termination of pregnancy or ultrasound surveillance to identify features of congenital rubella syndrome

Question 13

What management is suggested for rubella infection >20 weeks gestation?

Answer 13

None

Question 14

What does the risk of vertical transmission depend on?

Answer 14

Gestation

Question 15

What is the risk of vertical transmission and the risk of congenital rubella syndrome in a <12weeks gestation?

Answer 15

90% risk of transmission and congenital syndrome with high likelihood of multiple defects

Question 16

What is the risk of vertical transmission and congenital rubella syndrome in a 12-26 weeks gestation?

Answer 16

55% transmission

20% with single defects common

Question 17

What is the risk of vertical transmission and risk of congenital rubella syndrome at 16-20 weeks gestation?

Answer 17

45% transmission

20% risk deafness

Question 18

What is the risk of vertical transmission and risk of congenital rubella syndrome >20 weeks gestation?

Answer 18

45% transmission

No additional risk of congenital rubella syndrome

Question 19

What is congenital rubella syndrome?

Answer 19

Neonatal manifestation of infection with rubella during pregnancy

Question 20

What clinical features of congenital rubella syndrome are present at birth?

Answer 20

Sensorineural deafness
Pulmonary stenosis, patent ductus arteriosus, ventricular septal defect
Retinopathy, congenital cataracts
Learning disabilities, microcephaly
Thrombocytopaenia, blueberry muffin appearance

Question 21

What clinical features of congenital rubella syndrome are present later?

Answer 21

Diabetes mellitus
Thyroiditis
Growth hormone abnormalities
Behavioural problems