Rubella B06.99

Author: Prof. Dr. med. Peter Altmeyer

Co-Autor: Dr. med. Stephan Große-Büning

All authors of this article

Last updated on: 12.02.2021

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Synonym(s)

Epidemic roseola; German measles; Rubella; rubéole

History
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Sennert, 1632

Definition
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Harmless, low-contagious viral disease in adolescents and young adults (non-named notification upon laboratory detection) with mild course and typical exanthema.

Pathogen
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Rubellavirus is a virus with a positive-stranded RNA genome from the Togavirus family(Togaviridae) that is distributed worldwide. The genus Rubivirus in the family Togaviridae knows only one species, the Rubellavirus.

Etiopathogenesis
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Transmission by droplet infection. Contagiousness is less than that of measles. Diaplacental transmission is possible. After initial replication in the lymphoid tissues of the nasopharynx, there is spread to the regional lymph nodes. After a further replication phase leading to clinically noticeable lymphadenopathy, the virus appears in the blood approximately 8 days after primary infection. With the viraemic phase, the skin is finally reached with formation of the typical exanthema. The virus is excreted in the urine during this phase.

Manifestation
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Mainly occurring in childhood (manifestation peak 5-14 years). 80-90% of adults are immunized.

Clinical features
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In 40-50% of cases there are clinically silent infections.

Incubation period: 2-3 weeks.

  • Prodromes: "flu-like symptoms" with mild temperature increase and catarrh. Appearances. Often, before the onset of the exanthema, swelling of the cervical and occipital lymph nodes (possibly also in the elbows), occasionally swelling of the spleen.
  • Discrete enanthema of the oral mucosa possible, but of no diagnostic importance.
  • Integument: Exanthema development variable. 50% of the children show no or only a very discrete exanthema. Typical is a pale red, patchy exanthema with craniocaudal spread: beginning on the face, spreading to retroauricular regions, trunk, extremities. Resolution of the exanthema after 3-4 days in the above order.
  • Extracutaneous manifestations: Arthritis (usually polyarthritis) may develop in 30-50% of patients (also possible after vaccination in 3% of children, in about 13% of adults) and may persist for months. In older children, arthritis may be accompanied by episodes of fever. As STAR-complex (sore, throat, arthritis, rash) sore throat and exanthema are added.

Laboratory
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Leukopenia, relative lymphocytosis, plasma cells 5-20%.

Diagnosis
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Exanthema, nuchal and occipital lymph node swelling.

Serology: In the hemagglutination inhibition test titre increase by 2 levels, detection of rubella-specific IgM antibodies (EIA, hemagglutination test).

Blood count.

Using RT-PCR, viral nucleic acid can be detected for prenatal diagnostics in intrauterine blood samples of children, in amniotic villi biopsy or in the amniotic fluid.

Differential diagnosis
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Complication(s)
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Gregg syndrome: Severe malformation of the fetuses in case of rubella infection of the mother in the first months of pregnancy; occurrence of rubella embryofetopathy in approx. 1/3 of cases with rubella contact during pregnancy and a titer < 1:16.

The occurrence of TEN after rubella vaccination has been described in the literature.

External therapy
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Skin care measures with e.g. Ungt. emulsif. aq., Lotio alba aq.

Internal therapy
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Normally not necessary. If necessary, antipyretic measures e.g. with paracetamol (e.g. Ben-u-ron) 4 times/day 500 mg p.o. or acetylsalicylic acid (e.g. Aspirin 500) 2-3 times/day 500 mg p.o.

Notice! Exception: In case of infection in early pregnancy genetic counselling. Prenatal rubella diagnosis from the 11th week of pregnancy. Detection of viral RNA from the amniotic fluid or from infant blood.

Specific rubella immunoglobulin is currently not available (formerly rubella immunoglobulin P Aventis).

Prophylaxis
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Vaccination with live rubella vaccine of all children in the 15th month of life (repeated vaccination between the ages of 3 and 6) and of all girls in the 12th to 14th years of age, post-pubertal in women with a titer of less than 1:16 (rubella vaccine HDC Mérieux).

Notice! Any risk of pregnancy must be excluded 2 months before and 3 months after vaccination (contraceptive treatment).

Literature
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  1. Bale JF Jr (2002) Congenital infections. Neurol Clin 20: 1039-1060
  2. Francis BH et al (2003) The impact of rubella immunization on the serological status of women of childbearing age: a retrospective longitudinal study in Melbourne, Australia. On J Public Health 93: 1274-1276
  3. Hanon FX et al (2003) WHO European Region's strategy for elimination of measles and congenital rubella infection. Euro Surveill 8: 129-138
  4. Pereira FA et al (2007) Toxic epidermal necrolysis. J Am Acad Dermatol 56: 181-200
  5. Pistol A (2003) Progress towards measles elimination in Romania after a mass vaccination campaign and implementation of enhanced measles surveillance. J Infect Dis 187: S217-222
  6. Spika JS et al (2003) Measles and rubella in the World Health Organization European region: diversity creates challenges. J Infect Dis 187: S191-197
  7. Schulz H (1989) Practically relevant pediatric skin diseases. Skin near derm: 86-95
  8. Thompson KM et al (2015) Systematic Review of Measles and Rubella Serology Studies. Risk Analdoi: 10.1111/risa.12430
  9. Sennais D (1633) Practicae medicinae liber IV: De morbis mulierum et infantium. Stoker, Wittenberg

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