German Measles (Third Disease, Rubella)
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- Rubella derived from Latin, meaning “little red.”
- Disease initially considered variant of measles
- Viral infection characterized by mild symptoms (often subclinical), with an erythematous rash progressing from head to toes
- Congenital rubella syndrome can be devastating.
- Spread person to person via airborne transmission; worldwide infection
- Infection most contagious when rash is erupting. However, virus may be shed beginning 7 days before rash to 14 days after.
- Infants with congenital rubella syndrome may shed virus for up to 1 year.
- In temperate regions, peaks in late winter and early spring
- Infection occurs equally in following age groups: <5 years, 5 to 19 years, and 20 to 39 years.
- In prevaccine era, annual incidence of infection in the United States was ∼58 per 100,000 population.
- 2004: no longer endemic in the United States
- 2004 to 2012: 79 reported cases, mostly in unvaccinated individuals born overseas
- Congenital rubella syndrome
- 1964: 20,000 newborns
- 1980s: reported rarely, with <5 cases annually
- 1990 to 1991: ∼30 cases reported annually
- 2004 to 2012: total of 6 cases reported to Centers for Disease Control and Prevention (CDC), only 1 with mother born in the United States
- Prevention of congenital rubella syndrome is main objective of vaccination programs.
- Rubella vaccine
- Current strain of vaccine (RA 27/3, developed at the Wistar Institute in Philadelphia) was licensed in 1979 and has replaced all other strains.
- Given as part of MMR vaccine at 12 to 15 months and again at 4 to 6 years
- Immunity occurs in 95% of those vaccinated and is thought to be lifelong.
- Important to ensure full vaccination for preschool-aged children
- Vaccine virus is not communicable: Pregnant women and persons who are immunodeficient (except asymptomatic HIV infection) should not receive vaccine, but household contacts should.
- Pregnant women should avoid contact with source patient.
- Postnatal: Droplet precautions and/or school exclusion is indicated for 7 days after onset of rash.
- Congenital: contact isolation until first birthday or until two nasopharyngeal and urine cultures consecutively negative
- Respiratory transmission
- Replication in nasopharynx and regional lymph nodes
- Viremia 5 to 7 days after exposure, with spread of virus throughout body
- In congenital rubella syndrome, transplacental infection of fetus occurs during viremia.
- Classified as a Rubivirus in the Togaviridae family
- RNA virus with single antigenic type
- First isolated in 1962 by Parkman and Weller