Rubella

Question 1

RUBELLA

what type virus

Answer 1

• RNA virus

Question 2

RUBELLA

how infection acquired & incubation period

Answer 2

• Acquired by respiratory droplet exposure Incubation period 2-3 weeks

Question 3

RUBELLA

Symptoms

Answer 3

• Symptoms: fever, rash, arthralgia, postauricular
and suboccipital lymphadenopathy
(only 50-75% of infected patients are symptomatic)

Question 4

RUBELLA

Vaccination

Answer 4

• Vaccination: Results in long term (not life long) immunity in 95% of those vaccinated.

Question 5

RUBELLA

Diagnosis

Answer 5

• Diagnosis: Clinical diagnosis unreliable. Need to demonstrate seroconversion in susceptible
women (presence of rubella IgM in sample taken 3 weeks after contact).

Question 6

Congenital rubella syndrome:

Answer 6

Typically affects:
1) Eyes: cataract, retinopathy, glaucoma & microophthalmia
2) Heart: PDA, pulmonary valvular and artery stenosis, coarctation of aorta, VSD and ASD
3) Ear: bilateral and progressive hearing loss
4) IUGR and oligohydramnios
5) Neonatal hepatosplenomegaly, purpura, jaundice, meningoencephalitis & thrombocytopaenia also occur!
•6) Increased risk of diabetes mellitus, thyroid disease and rarely growth hormone deficiency

Question 7

• Risk of fetal RUBELLA infection:

Answer 7

over 90% in the first trimester;
25% in early second trimester
No case of congenital rubella syndrome as a result of immunisation has been documented.

Question 8

Fetal viremia in RUBELLA

Answer 8

• Fetal viraemia continues throughout pregnancy and the infant may continue to excrete virus for up to a year

Question 9

Management OF RUBELLA

Answer 9

• Universal vaccination
• Universal screening in pregnancy
• Screening & vaccination of all women planning pregnancy
• No evidence that vaccine is terratogenic therefore TOP not indicated if pregnant woman is vaccinated
• If fetal infection is suspected, fetal blood sampling and PCR may be used to confirm fetal infection.

However, counselling based on gestational age at infection alone is as useful as invasive testing.

Question 10

Offer TOP in RUBELLA if:

Answer 10

Offer TOP if:
infection occurs in the first trimester
• Maternal infection at < 11 weeks.. 90% of fetuses affected; 11-12 weeks (33% affected),
no fetuses affected after 20 weeks