Information about Rubella

Rubella
Classification & external resources

ICD-10	B06.
ICD-9	056
DiseasesDB	11719
MedlinePlus	001574
eMedicine	emerg/388  peds/2025 derm/259

Rubella virus
Virus classification
Group: Group IV ((+)ssRNA) Family: Togaviridae Genus: Rubivirus Species: Rubella virus

Rubella, commonly known as German measles, is a disease caused by the rubella virus. It is often mild and an attack can pass unnoticed. However, this can make the virus difficult to diagnose. The virus usually enters the body through the nose or throat. The disease can last 1-5 days. Children recover more quickly than adults. Like most viruses living along the respiratory tract, it is passed from person to person by tiny droplets in the air that are breathed out. Rubella can pose a serious risk as it can also be transmitted from a mother to her developing baby through the bloodstream via the placenta. If the mother is infected within the first 20 weeks of pregnancy, the child may be born with congenital rubella syndrome, which includes a range of birth defects. The virus has an incubation period of 2 to 3 weeks during which it becomes established.

Symptoms

Symptoms of rubella include:

Children: Low grade fever, swollen glands, joint pain, headache, conjunctivitis, rash

Adults and children:

• swollen glands or lymph nodes (may persist for up to a week)
• fever (rarely rises above 38 degrees Celsius [100.4 degrees Fahrenheit])
• rash (Appears on the face and then spreads to the trunk and limbs. It appears as pink dots under the skin. It appears on the first or third day of the illness but it disappears after a few days with no staining or peeling of the skin)
• Forchheimer's sign occurs in 20% of cases, and is characterized by small, red papules on the area of the soft palate
• flaking, dry skin
• nerves become weak and numb (very rare)

Risks

Rubella can affect anyone of any age and is generally a mild disease. However, rubella can cause congenital rubella syndrome in the fetus of an infected pregnant woman. Usually occurs between 14 - 21 weeks of pregnancy.

Prevention and treatment

Symptoms are usually treated with paracetamol until the disease has run its course. There is no treatment available for congenital rubella.

Fewer cases of rubella have occurred ever since a vaccine became available in 1969, although decreased uptake of the MMR vaccine (e.g. in the UK) is expected to lead to a rise in incidence. In most Western countries, the vast majority of people are vaccinated against rubella as children at 12 to 15 months of age. A second dose is required before age 11. The vaccine may give lifelong protection against rubella. A side-effect of the vaccine can be transient arthritis.

The immunization program has been quite successful with Cuba declaring the disease eliminated in the 1990s. In 2004 the Centers for Disease Control and Prevention announced that both the congenital and acquired forms of rubella had been eliminated from the United States.^[1][2]

History

Friedrich Hoffmann made a clinical description of rubella in 1740.^[3] Later descriptions by de Bergen in 1752 and Orlow in 1758 supported the belief that this was a derivative of measles. In 1814, George de Maton first suggested that it be considered a disease distinct from both measles and scarlet fever. All these physicians were German, and the disease was known medically as Rötheln (from the German name Röteln), hence the common name of "German measles".^{[3][4][5][6][7][8]}

English Royal Artillery surgeon, Henry Veale, observed an outbreak in India. He coined the euphonious name "rubella" (from the Latin, meaning "little red") in 1866.^[7] It was formally recognized as an individual entity in 1881, at the International Congress of Medicine in London.^[8] In 1914, Alfred Fabian Hess theorised that rubella was caused by a virus, based on work with monkeys.^[9] In 1938, Hiro and Tosaka confirmed this by passing the disease to children using filtered nasal washings from acute cases.^[6]

In 1940, there was a widespread epidemic of rubella in Australia. Subsequently, opthalmologist Norman McAllister Gregg found 78 cases of congenital cataracts in infants and 68 of them were born to mothers who had caught rubella in early pregnancy.^[4][6] Gregg published an account, Congenital Cataract Following German Measles in the Mother, in 1941. He described a variety of problems now know as congenital rubella syndrome (CRS) and noticed that the earlier the mother was infected, the worse the damage was.^[8] The virus was isolated in tissue culture in 1962 by two separate groups led by physicians Parkman and Weller.^[7][4]

There was a pandemic of rubella between 1962 and 1965, starting in Europe and spreading to the United States.^[7] In the years 1964-65, the United States had an estimated 12.5 million rubella cases. This led to 11,000 miscarriages or therapeutic abortions and 20,000 cases of congenital rubella syndrome. Of these, 2,100 died as neonates, 12,000 were deaf, 3,580 were blind and 1,800 were mentally retarded. In New York alone, CRS affected 1% of all births.^[8]

In 1969 a live attenuated virus vaccine was licensed.^[6] In the early 1970s, a triple vaccine containing attenuated measles, mumps and rubella (MMR) viruses was introduced.^[7]

Rubella in popular culture

• Agatha Christie's The Mirror Crack'd from Side to Side features a plot, possibly based on real life, in which a girl is shut in quarantine for a minor illness but climbs out of the window to meet a actress (Gene Tierney). The actress (Tierney) is pregnant and unknowingly catches rubella resulting in a child with congenital rubella syndrome. However, as this is the fan's favourite anecdote, when she meets the actress (Tierney) years later she tells her the story and the actress realises that her baby's syndrome was caused by this fan. Tierney described the event in her autobiography (Self-Portrait, 1979), but it had been publicized for years previously. The incident, as well as the circumstances under which the information is imparted to the actress is repeated almost verbatim in the story.

References

External links

• Rubella at Wong's Virology.
• Immunization Action Coalition: Rubella
• DermNet viral/rubella

•  • [ e] Viral diseases (A80-B34, )
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•  • [ e] Exanthema
Measles (1st disease) - Scarlet fever (2nd disease) - Rubella (3rd disease) Duke's disease (4th disease) - Slap cheek (5th disease) - Roseola (6th disease)