Rubella

Last Updated: 2020-11-18

Author(s): Anzengruber, Navarini

Rubella, Three-day measles.

  • Mainly occurs in spring.
  • Especially unvaccinated young people are affected.
  • Transmission: droplet infection.
  • Incubation period: 2-3 weeks.

 

  • Contagiousness
  • 6 days before until 8 days after the start of the exanthema.
  • Contagiousness lower than for measles.
  • 50-100 nm RNA togavirus. Infection gateway is the respiratory mucosa from where haematogenic spread occurs.
  • Affected persons are contagious 1 week before and 1 week after the outbreak of exanthema.
  • Obligation to notify in case of connatal infection.
  • Often asymptomatic course.

 

  • Prodramal stage: Reduced general condition, subfebrile and febrile temperatures (up to 38.0°C) and other flu-like symptoms with arthralgia and arthritis. In most cases, a butterfly-shaped exanthema in the face initially appears, which spreads to the retroauricular area.

 

  • Stage of exanthema: In the course of the disease a non-confluent, small spotted or papular exanthema develops on the entire integument with spontaneous remission after 3 days. Cervical swelling of the lymph glands (Theodor gland) becomes apparent. In some cases splenomegaly and arthralgia.
  • Clinical features.
  • Blood count (leukopenia, eosinophilia), ESR (elevated), ASO titer (elevated) (after 1-2 weeks).
  • Erasure phenomenon: coin-sized exanthema recess after i.c.-Inj. of a scarlet convalescent or antistreptococcal serum.
  • Bacterial smear (throat)
  • The haemagglutination inhibition test (HAI) is used to detect specific IgM antibodies (only 3-7 after exanthema outbreak). A 4-fold increase (2 levels) in the titer after 2 weeks is indicative of a measles infection.
  • Direct detection is possible by PCR.
  • Encephalitis
  • Gregg syndrome or miscarriage in pregnancy
  • Blande external therapy.
  • Isolation (up to 1 week after the onset of exanthema).
  • In the case of connatal rubella, a longer isolation period must be observed (excretion of the virus up to 1 year is possible).
  • School ban up to 1 week after cutaneous symptomlessness.
  • Bed rest
  • Antipyretic measures
  • Calf compression wrap
  • #Paracetamol
  • Application:
  • > 12 Y. (>40 kg): Single dose (SD): 500-1000 mg, max. daily dose (DD): 4 g.
  • 9-12 Y. (30-40 kg): SD: 500 mg, max. DD: 2 g.
  • 6-9 Y. (22-30 kg): SD: 250-500 mg, max. DD: 750 mg.
  • Contraindications: Liver damage, renal failure, acute hepatitis, Meulengracht's disease, pregnancy, lactation.
  • Topical therapy
  • Zinc-containing Externa
  • #Lotio alba

 

  • Vaccination recommendation
  • 1st vaccination: MMR (Measles-Mumps-Rubella) from the age of 11 months. The follow-up vaccination should start at 1 ½ until 3 months after that.
  • In case of exposure to rubella virus, a pregnant woman and an immunosuppressed patient can be treated with intravenous immunoglobulins within 3 days.
  • Intravenous immunoglobulins (#Privigen®) i.v. 250-400 mg/kg bw daily for 3-5 days every 3-4 weeks
  • Initial dose: 0.4-0.8 g/kg bw
  • In the course of: 0.2 g/kg bw every 3 to 4 weeks.
  • Always determine the IgG serum level immediately before the next infusion!
  • An IgG valley level of at least 5 to 6 g/l should be reached before the next infusion.

 

  • Lifelong immunity

Vaccination against

 Category 

 Indication

Instructions for use (see package/ technical information)

Rubella

I

Unvaccinated women or women of childbearing age with unclear vaccination status

Women of childbearing age once vaccinated

Two dose vaccinations with a MMR vaccine

 

 

Single dose vaccination with a MMR vaccine

 

B

Unvaccinated persons or persons with unclear vaccination status in pediatric, obstetric and prenatal care or in community facilities

Single dose vaccination with an MMR vaccine

I: Indicative vaccinations for risk groups with individually (non-occupational) increased risk of exposure, disease or complications and for the protection of third parties

B: Vaccinations due to an increased occupational risk, e.g. following a risk assessment in accordance with the Occupational Health and Safety Act/Bioactive Substances Ordinance/ Ordinance on Occupational Medical Precautions (ArbMedVV) and/or for the protection of third parties in the context of occupational activity

Robert Koch Institute, Epidemiological Bulletin No. 34 (2015). Rki.de. Retrieved 10 May 2016, from https://www.rki.de/DE/Content/Infekt/EpidBull/Archiv/2015/Ausgaben/34_15.pdf?__blob=publicationFile

  1. Control and Prevention of Rubella: Evaluation and Management of Suspected Outbreaks, Rubella in Pregnant Women, and Surveillance for Congenital Rubella Syndrome.  PsycEXTRA Dataset: American Psychological Association (APA).
  2. Cherry JD, Bobinski JE, Comerci GD. A clinical trial with live attenuated rubella virus vaccine (Cendehill 51 strain). The Journal of Pediatrics 1969;75:79-86.
  3. Davidkin I, Valle M, Peltola H, et al. Etiology of Measles‐ and Rubella‐like Illnesses in Measles, Mumps, and Rubella–Vaccinated Children. The Journal of Infectious Diseases 1998;178:1567-70.
  4. Dukes C. ON THE CONFUSION OF TWO DIFFERENT DISEASES UNDER THE NAME OF RUBELLA (ROSE-RASH). The Lancet 1900;156:89-95.
  5. Rosa C. Rubella and rubeola. Seminars in Perinatology 1998;22:318-22.
  6. Vander Straten MR, Tyring SK. Rubella. Dermatologic Clinics 2002;20:225-31.
  7. Velangi, Tidman. Gianotti-Crosti syndrome after measles, mumps and rubella vaccination. British Journal of Dermatology 1998;139:1122-3.
  8. Robert Koch Insitut, Epidemiologisches Bulletin Nr. 34. (2015). Rki.de. Retrieved 10 May 2016, from https://www.rki.de/DE/Content/Infekt/EpidBull/Archiv/2015/Ausgaben/34_15.pdf?__blob=publicationFile