German measles,
or rubella, is a mild, systemic infection of childhood.
It is a
pleomorphic RNA virus in the Togaviridae family of the genus Rubivirus.
In
older children and adults, especially women, it may be more severe,
with joint involvement and purpuric rash.
Except for superficial similarity in the name, the
rubella virus is not related to the
measles (rubeola)
virus.
A worldwide disease, rubella is
characterized by measles-like rash, low-grade fever, and swollen
posterior auricular and occipital lymph nodes.
The congenital
rubella syndrome (CRS) involves multiple organ systems and has a long
period of active infection and virus shedding in the postnatal period.
Subclinical
infections are common.
The incubation period is 12 to 21 days, and the
mild rash and other symptoms resolve within 3 days.
Initially,
swollen, nontender posterior auricular and occipital lymph nodes
appear.
A day or two later the nonpruritic rash begins on the face and
rapidly spreads over the rest of the body, sparing the palms and
soles.
The virus is
very contagious and is shed from the nasopharynx .
The virus is also
transmitted through the placenta, and rubella infections in pregnant
women are a serious public health concern, because intrauterine
infection causes spontaneous abortion, fetal death
and a variety of congenital abnormalities.
Infection
during the first trimester is most serious.
The classic triad
of congenital rubella includes ocular abnormalities, heart disease,
and deafness.
The principal congenital
abnormalities are patent ductus arteriosus, pulmonary and aortic
stenosis, coarctation of the aorta, defects of the atrial or
ventricular septum, ocular lesions (cataracts, glaucoma, and
chorioretinitis), deafness, microcephaly, mental retardation, and
retarded growth.
Congenital
rubella produces a classic salt-and-pepper pigmentation of the fundus.
Image Link
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Rubella and
congenital rubella syndrome: global update.Rev
Panam Salud Publica. 2003 Nov;14(5):306-15.
Worldwide, it is
estimated that there are more than 100.000 infants born with
congenital rubella syndrome (CRS) each year. In 1998, standard
case definitions for surveillance of CRS and rubella were
developed by the World Health Organization (WHO). In 2001, 123
countries/territories reported a total of 836.356 rubella cases.
In the future more countries are expected to report on rubella as
a global measles/rubella laboratory network is further developed
under the coordination of WHO. Operational research is being
conducted to improve rubella surveillance. This includes projects
on initiating CRS surveillance, comparative studies on diagnostic
laboratory methods, and molecular epidemiology research to expand
the global understanding of patterns of rubella virus circulation.
In 1996 a WHO survey found that 78 od 214 reporting
countries/territories (36%) were using rubella vaccine in their
routine immunization services. By the en of 2002 a total of 124 of
the 214 counties/territories (58%) were using rubella vaccine.
Rubella vaccine use varies by stage of economic development: 100%
for industrialized countries, 71% for countries with economies in
transition, and 48% for developing countries. A safe effective
rubella vaccine is available, and there are proven vaccination
strategies for preventing rubella and CRS. A WHO position paper
provides guidance on programmatic aspects of rubella vaccine
introduction. The introduction of rubella vaccine is
cost-effective and cost-beneficial but requires ongoing
strengthening of routine immunization services and surveillance
systems. |
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