II. Etiology

  1. Rubivirus (Togaviridae, pleomorphic RNA virus)

III. Epidemiology

  1. Incidence of Rubella cases
    1. U.S. Cases in 1964-5: 12 million cases
    2. U.S. Cases in 2000: 176 cases
  2. Incidence of congenital Rubella cases
    1. U.S. Cases in 1964-5: 20,000 cases
    2. U.S. Cases in 2000: 9 cases
    3. U.S. Cases in 2015: 6 cases

IV. Pathophysiology: Transmission

  1. Person to person via oral droplets
  2. Vertical transmission (transplacental) results in congenital Rubella (90% risk in first trimester)
  3. Up to 60% transmission in susceptible family

V. Symptoms

  1. Subclinical in 50% of cases
  2. Known also as "Three Day Measles" for the shorter, more mild course
  3. Mild Upper Respiratory Infection symptoms
  4. Fever
  5. Pharyngitis
  6. Headache

VI. Signs

  1. Mild Fever
  2. Significantly tender Lymphadenopathy
    1. Retroauricular, posterior auricular, Occipital Lymphadenopathy
  3. Rash
    1. Initially, exanthem may cover Soft Palate and face
    2. Later, rash begins on face and spreads to cover trunk
    3. Maculopapular rash with areas of confluence, Flushing
    4. Mild Pruritus
    5. Rash usually clears by Day 3 (hence the name: Three Day Measles)

VII. Differential Diagnosis

VIII. Complications

  1. Encephalitis (1 case per 6,000 Rubella infections)
    1. Mortality from Encephalitis approaches 20%
  2. Arthritis (immune complex)
  3. Thrombocytopenia (1 case per 3000 Rubella infections)
  4. Immune-complex mediated Arthritis
  5. Congenital Rubella Syndrome
    1. Rubella is one of the TORCH Viruses
    2. Pregnant women should avoid Rubella exposure
      1. Avoid throughout pregnancy (especially early)
      2. Avoid exposure to infants with congenital Rubella
        1. Very high risk due to prolonged shedding

IX. Management: High risk exposure occurs early in pregnancy

  1. Consider therapeutic abortion
  2. Give Rubella Immunoglobulin

X. Prevention

  1. Primary Series
    1. Immunization at Ages 12-15 months, and 4-6 years
  2. Preconception Counseling
    1. Test Rubella Immunity
    2. Vaccinate women not immune to Rubella

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Related Studies

Ontology: Rubella (C0035920)

Definition (MSHFRE) Maladie infectieuse aiguë, généralement bénigne, due au virus de la rubéole. Elle affecte principalement les enfants ainsi que les jeunes adultes non immunisés. Le virus se transmet par voie respiratoire par l'intermédiaire de gouttelettes salivaires puis il gagne le système lymphatique. (Extr. Dorland, 27ème éd.)
Definition (MSH) An acute infectious disease caused by the RUBELLA VIRUS. The virus enters the respiratory tract via airborne droplet and spreads to the LYMPHATIC SYSTEM.
Definition (MEDLINEPLUS)

Rubella is an infection caused by a virus. It is usually mild with fever and a rash. About half of the people who get rubella do not have symptoms. If you do get them, symptoms may include

  • A rash that starts on the face and spreads to the body
  • Mild fever
  • Aching joints, especially in young women
  • Swollen glands

Rubella is most dangerous for a pregnant woman's baby. It can cause miscarriage or birth defects.

Rubella spreads when an infected person coughs or sneezes. People without symptoms can still spread it. There is no treatment, but the measles-mumps-rubella (MMR) vaccine can prevent it.

Centers for Disease Control and Prevention

Definition (NCI) A viral infection caused by the rubella virus. It is initially manifested with flu-like symptoms that last one or two days, followed by the development of a characteristic red rash which lasts from one to five days. The rash first appears in the neck and face. It subsequently spreads to the rest of the body.
Definition (CSP) acute infectious disease caused by the rubella virus and most often affecting children and nonimmune young adults, in which the virus enters the respiratory tract via droplet nuclei and spreads to the lymphatic system; usually benign; however transplacental infection of the fetus in the first trimester can cause death or severe developmental abnormalities (congenital rubella syndrome).
Concepts Disease or Syndrome (T047)
MSH D012409
ICD9 056
ICD10 B06 , B06.9
SnomedCT 266192003, 154343004, 36653000
LNC LA10502-5
English Measles, German, Rubellas, rubella (diagnosis), rubella, rubella (German measles), Rubella NOS, Rubella [German measles], Rubella [Disease/Finding], Three Day Measle, Three Day Measles, Measles, Three Day, Measle, Three Day, third disease, german measle, german measles rubella, three-day measles, german measles, Rubella Infection, German Measles, Three day measles, German measles, Rubella (disorder), Rubella, NOS, Rubella
Dutch rubella, Rode hond, rodehond, Rubella [rodehond], Rodehond, Rubella
Italian Morbillo tedesco, Rosolia
Spanish Sarampión alemán, Sarampión Alemán, rubéola (trastorno), rubéola, sarampión alemán, Rubéola, Rubéola (Sarampión Alemán)
Swedish Röda hund
Japanese フウシン, ドイツ麻疹, 風疹, 三日はしか, 三日麻疹, 流行性バラ疹, 麻疹-ドイツ
Czech zarděnky, Rubeola, Zarděnky, rubeola
Finnish Vihurirokko
German Roeteln [Rubeola] [Rubella], Roeteln, Measles, German, Röteln
Korean 풍진 [독일홍역]
Croatian RUBEOLA
Polish Różyczka
Hungarian Rózsahimlő, rubeola
Norwegian Rubella, Røde hunder
Portuguese Rubéola, Rubéola (Sarampo Alemão), Sarampo Alemão
French Rubéole