Rubella and Rubeola

Infection
Albert Benni C. Doloiras, RMT
Rubella
Etiology

• First isolated in 1962

• Also known as German Measles or 3-day measles
• Enveloped, ssRNA virus
• Togaviridae
• Transmitted through respiratory secretions
• Usually occurred in childhood, although it also affected adults
Epidemiology

• Before the development of vaccine, rubella caused epidemics of

congenital rubella syndrome and stillbirths in the US
• Contracting the infection and vaccination are the only routes to
developing immunity against rubella
• Previous infection or successful vaccination confers permanent
immunity to rubella, except in cases of congenital rubella
• Only proof of immunity is positive serologic test for rubella
antibodies
Epidemiology

• Individuals requiring rubella immune status determination:

• Pre-school and school-age children
• All females at or just before childbearing age
• Women about to be married
• Married women
Signs and Symptoms

• Diagnosis of acquired rubella is not based solely on clinical

manifestations
• Widely vary from person to person
Acquired Rubella Infection

• Incubation period lasts from 10-21 days

• Acute infection lasts from 3-5 days
• Clinical manifestations
• Begins with a prodromal period of catarrhal symptoms
• Emergence of maculopapular rash on the face and then on the neck and
trunk
• Temperature of less than 34.4 is usually present
• In older children and adults – self-limiting arthralgia and arthritis are
common
Congenital Rubella Infection

• Mild, self-limiting disease with only rare complication in children and

adults
• In pregnant women, rubella can have devastating effects on the fetus
• In-utero infection can result in fetal death or congenital defects
• Rubella syndrome – encephalitis, hepatomegaly, bone defects,
mental retardation, cataracts, thrombocytopenic purpura,
cardiovascular defects, splenomegaly, microcephaly
Immunologic Manifestations

• Acquired Rubella Infection

• IgG and IgM antibodies is associated with the appearance of clinical signs and
symptoms
• IgM – recently experience a rubella infection
• IgG – remain present and protects indefinitely
• Congenital Rubella Syndrome
• IgG – not efficient since IgG can cross the placenta
• IgM – diagnostic of CRS
Diagnostic Evaluation

• Screening methods – TORCH

• Toxoplasma, other viruses, Rubella, CMV, Herpes
Rubeola
Overview

• Rubeola is referred to as measles

• Caused by rubeola virus
• ssRNA, genus Morbillivirus, Paramyxoviridae
Prevention

• MMR (measles, mumps, rubella) Vaccine administered to 12- to 15-

month old children, with revaccination between 4 and 12 years of
age
• Vaccine is comprised of a live attenuated virus – should not be used
in pregnant women or those with significant immunosuppression
Laboratory Testing

• Detection of IgM anti-measles

• Isolation of measles virus
• Detection of measles virus RNA by molecular techniques
• Serum testing:
• IgM and IgG serial testing – acute infection
• IgG – seroconversion
• CSF IgM and IgG – identify subacute sclerosing panencephalitis
• Viral Culture
• Nasopharyngeal and blood culture – most sensitive if collected during
prodrome