Last Updated: 2020-11-18
Rubella, Three-day measles.
- Mainly occurs in spring.
- Especially unvaccinated young people are affected.
- Transmission: droplet infection.
- Incubation period: 2-3 weeks.
- 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.
- 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
- > 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
Instructions for use (see package/ technical information)
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
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
- 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).
- 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.
- 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.
- Dukes C. ON THE CONFUSION OF TWO DIFFERENT DISEASES UNDER THE NAME OF RUBELLA (ROSE-RASH). The Lancet 1900;156:89-95.
- Rosa C. Rubella and rubeola. Seminars in Perinatology 1998;22:318-22.
- Vander Straten MR, Tyring SK. Rubella. Dermatologic Clinics 2002;20:225-31.
- Velangi, Tidman. Gianotti-Crosti syndrome after measles, mumps and rubella vaccination. British Journal of Dermatology 1998;139:1122-3.
- 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