Rubella B06.99

Author: Prof. Dr. med. Peter Altmeyer

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

Our authors

Last updated on: 29.10.2020

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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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The Rubella virus is a virus with a positive-stranded RNA genome from the family oftogaviruses (Togaviridae). The genus Rubivirus in the family of Togaviridae knows only one species, the Rubella virus.

Etiopathogenesis
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Transmission by droplet infection. Contagiosity is lower than that of measles. Diaplacental transmission is possible. After initial replication in the lymphoid tissues of the nasopharynx, it spreads to the regional lymph nodes. After a further replication phase, which leads to clinically perceptible lymphadenopathy, the virus appears in the blood about 8 days after the primary infection. The virus is excreted in 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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Clinically silent infections are present in 40-50% of cases. Incubation period: 2-3 weeks.

  • In 40-50% of the cases clinically silent infections are present.
  • Prodromi: "flu-like symptoms" with slight temperature increase and catarrh. Symptoms. Often before the onset of the exantem lymph node swelling cervical and occipital (possibly also in the crook of the arm), occasionally spleen swelling.
  • Discrete enanthema of the oral mucosa is possible, but is of no diagnostic importance.
  • Integument: Development of exanthema variable. 50% of children show no or only a very discreet exanthema. Typical is a pale red, spot-like exanthema with craniocaudal spread: beginning in the face, spreading to retroauricular regions, trunk, extremities. The exanthema subsides after 3-4 days in the above mentioned order.
  • Extracutaneous manifestations: In 30-50% of patients (even after vaccination possible in 3% of cases in children, in about 13% of cases in adults) arthritis (mostly polyarthritis) may develop, which can last for months. In older children the arthritis can be accompanied by fever episodes. 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 about 1/3 of cases with rubella contact in 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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Please ask your physician for a reliable diagnosis. This website is only meant as a reference.