Rubella Flashcards
True or false: rubella is nationally notifiable?
True - routine.
Which organism causes rubella?
Rubella virus
Also called German measles or 3 day measles.
Rubella etymology - latin = “little red”
How is rubella transmitted?
Person-person:
* Respiratory droplets
* Direct contact secretions
* Vertical
What are the clinical features of rubella?
Spectrum
* Asymptomatic
* Prodrome - headache, malaise, coryza
* Febrile illness with diffuse rash
* Cervical lymphadenopathy
What are the clinical complications of rubella?
- Polyarthralgia
- Encephalitis
- Adverse pregnancy outcomes (stillbirth, miscarriage, CRS) - rare if infected after 20 weeks
CRS = congenital rubella syndrome
What is congenital rubella syndrome?
- Opthalmic (cataracts, congenital glaucoma)
- Auditory - SNHL
- Neurological - microcephaly, meningo-encephalitis
- Cardiac - PDA, pulmonary stenosis
- IUGR
- Pneumonitis
- Hepatosplenomegaly
- Thrombocytopaenia
- Radioluscent bone disease
Which groups are high-risk for rubella?
Pregnant women
What are the case definitions for rubella?
Rubella:
* Confirmed: Isolation/detection/seroconversion
* Probable - IgM + clinical/epi
Rubella congenital - confirmed and probable
CRS - confirmed and probable
How is rubella diagnosed?
Culture or PCR from NPA, urine, saliva, amniotic fluid, blood
Serology
What is the incubation period for rubella?
14 - 17 days (up to 21 d)
What is the infectious period for rubella?
7 days before to 4 days after rash onset.
Infants with CRS shed for months or longer.
What is the outbreak definition of rubella?
Eliminated in Australia therefore observed > expected.
How are outbreaks of rubella managed?
How is rubella prevented?
Vaccination - 2 doses on NIP at 12mo (MMR) and 18 mo (MMRV)
What type of vaccine is the rubella vaccine?
MMR / MMRV is a live-attenuated vaccine.
Apart from those indicated on the NIPS, who should receive the rubella vaccine?
- All adults and adolescents without prior doses especially HCW, ECE
- Seronegative WCBA
Seronegative WCBA shoyld have repeat serology 6-8 weeks post vaccine (avoid pregnancy 28 days)
True or false: the rubella vaccine confers lifelong immunity?
True.
What resources are available for public health management of rubella?
No SoNG.
DH protocol.
How are cases of rubella managed?
- Interview: DRSVECT - sx, vax, antenatal screening if CRS, contact with pregnant women while infections
- Treatment - clinician
- Isolation/exclusion - exclude W/S/CC other settings with children and pregnant women for 4 days from rash onset.
- Educate re transmission, importance of immunisation
Who are considered contacts of rubella cases?
- HH
- Same calss
- Same social function
- Work in same area
Who are high-risk contacts of rubella cases?
Pregnant women.
How are contacts of rubella managed?
Susceptible (non-immune) - MMR vaccine (though unlikely to reduce risk of infection)
Pregnant women
* Urgent serology, obstetric referral for Mx/counselling
* Avoid contact with case and other contacts for 6 weeks
* Consider NHIg
Systematic approach:
* Treatment - vax, pregnant women as above
* Isolation / Exclusion - HCWs - if no immunity exclude from work for 21 days post exposure
* Monitor -
* Education - Sx, avoid contact with high-risk until 21d after exposure
What environmental management is required for rubella?
Nil
True or false: rubella is common in Australia?
False. Eliminated in Australia (2018) due to widespread vaccination.
Previously common and major cause of congenital abnormalities and deafness.
Why are rubella cases still detected in Australia?
Imported from overseas.
