Rubella

Rubella is a mild viral infection, which in an unprotected pregnant woman during her first trimester of pregnancy can cause abortion, stillbirth or a set of serious birth defects knows as congenital rubella syndrome (CRS). Rubella disease is caused by infection by a Toga virus (RNA virus).

Symptoms

• Maculopapular rash and fever are the primary symptoms, where the prodromal phase is less symptomatic as compared to measles, but with the same average incubation period of ~14 days.
• The virus is transmitted via the respiratory route, and symptoms usually appear 2–3 weeks after exposure.
• In children, the disease is usually mild, with low fever, nausea and a transient rash. Adults may develop arthritis, lymphadenitis and pain in the joints.
• Although the clinical manifestations are less severe than measles, characteristic lymphadenopathy and arthritis / arthralgia that is more pronounced in adults are the hallmarks of rubella disease.
• The infectious period in the natural history of illness is 7 days before to 7 days after onset of rash, which disappears after 7–10days.
• Infections in children are less severe and believed to provide lifelong immunity.

Congenital Rubella Syndrome

• When rubella infection occurs during early pregnancy (first trimester), the virus during primary viraemia infects the placenta along with the fetus, causing fetal pathology due to tissue necrosis involving multiple organ systems at the developmental stage. This infection then can lead to congenital anomalies that may cause death or premature delivery of the fetus resulting in either spontaneous abortions or stillbirths.
• The post- rubella congenital anomalies are usually a complex set of multi-organ involvement known as congenital rubella syndrome (CRS).
• CRS usually manifests with congenital cataract, congenital glaucoma, congenital deafness, congenital cardiac defects like ventricular septal defects, atrial septal defects, patent ductus arteriosus, hepatosplenomegaly, microcephaly, haematological disorders like purpura and often having mental retardation due to suboptimal brain tissue development.

Management

There is no specific treatment for rubella and the disease can be only prevented through immunization.

Source: Introduction of measles-rubella vaccine and national operational guidelines 2017