Rubella is one of the traditional childhood exanthems.
- Superkingdom Viruses
Rubella virus causes a mild febrile illness, with a diffuse punctate and maculopapular rash. The incubation period is from 14 to 21 days, and it is contagious from one week before and 4 days after the onset of the rash. It may cause mild arthropathy. Small discrete nodes in the posterior triangle of the neck are traditionally associated with it. In healthy individuals, it is regarded as a trivial disease.
Rubella in pregnancy
However, the real reason why we are concerned about rubella is because it causes congenital rubella syndrome (CRS).
Vaccination of teenage girls with rubella vaccine reduced the number of cases; but there were still many cases as there was no herd immunity, and many women of child-bearing age had either not been vaccinated (missed out in UK, or came from elsewhere where vaccination is not offered) or had been vaccinated but not successfully immunised. Since the introduction of MMR there has been a very dramatic reduction in CRS.
Guidelines "Guidance on the management of, and exposure to, rash illness in pregnancy" is available from the HPA website.
Congenital rubella syndrome
Congenital rubella syndrom was first noted by Australian paediatrict opthalmogist Normal McAlister Gregg, who noted a high rate of cataracts in infants, and made the connection between this and their mother's rubella infections in pregnancy.
CRS causes severe fetal abnormalities or death.
Rubella infection in pregnancy can interfere with organ development. Consequently, the particular damage done will depend on which organs are developing at the time of the infection. By 20 weeks of pregnancy most organogenesis is complete, and the infection is relatively harmless.
The classic triad for congenital rubella syndrome is:
- Sensorineural deafness (58% of patients)
- Eye abnormalities—especially retinopathy, cataract, and microphthalmia (43% of patients)
- Congenital heart disease—especially pulmonary artery stenosis and patent ductus arteriosus (50% of patients)
Rubella is not the only pre-natal infection that can cause fetal abnormalities. Classically, paediatricians refer to the "TORCH" infections which "classically comprise toxoplasmosis, Treponema pallidum, rubella, cytomegalovirus, herpesvirus, hepatitis viruses, human immunodeficiency virus, and other infections, such as varicella, parvovirus B19, and enteroviruses".
There are sufficient other viral infections which produce a similar rash that definite diagnosis in populations who are mostly immunised depends on demonstrating a rise in antibodies. Usually definite diagnosis is not needed. Prior to pregnancy all women were offered determination of antibody status for Rubella, a positive test being regarded as indicating immunity. (This test was dropped in in England from 1 April 2016, in favour of increased emphasis on ensuring that all women of childbearing age who have not already received two doses of MMR vaccine do so; and that any pregnant women who have not had two doses are vaccinated postpartum.)
Rubella can be safely and effectively prevented by vaccination - in the UK, the only widely available and licensed vaccine is MMR. The rubella component of the vaccine is more effective than the mumps or measles component, and gives long-lasting protection.
There has been some discussion - stirred up by anti-vaccinationists, inevitably - about whether the use of rubella vaccine is acceptable to all religious groups' but all the major religions support the use of this vaccine, albeit with reservations - see Rubella vaccine and religious groups.
- For more information than on ganfyd, try PHE Rubella information..
- Sense charity (originally set up to support people who were deaf and blind due to congenital rubella syndrome).
- ↑ Guidelines relating to Rubella infection; HPA website or Rashes in pregnancy
- ↑ Hutton J. Does Rubella Cause Autism: A 2015 Reappraisal? Frontiers in human neuroscience. 2016; 10:25.(Epub) (Link to article – subscription may be required.)
- ↑ Neu N, Duchon J, Zachariah P. TORCH infections. Clinics in perinatology. 2015 Mar; 42(1):77-103, viii.(Link to article – subscription may be required.)
- ↑ Public Health England. "Rubella susceptibility screening in pregnancy to end in England" 2016 (last updated Jan 27) (last visited 27 Apr 2016). www.gov.uk/government/news/rubella-susceptibility-screening-in-pregnancy-to-end-in-england. States "Public Health England will end rubella (German measles) susceptibility screening in pregnancy in England on 1 April 2016" and explains why.
- ↑ Tookey P. Review of antenatal rubella susceptibility screening and the standard criteria for screening: Institute of Child Health, UCL, Undated, ?2013
- ↑ UK National Screening Committee. Rubella Susceptibility Screening in Pregnancy Policy Position Statement: UK National Screening Committee, 2015; 1-2.
- ↑ Pediatric Infectious DIsease Journal 2007;26:830-835 http://tinyurl/2fcurr )
- ↑ PHE Rubella page