ASPEK VIRUS RUBELLA

*What are Viruses?

A virus is a non-cellular
particle made up of
genetic material and
protein that can invade
living cells.

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VIROLOGICAL ASPECT OF RUBELLA
History

From Latin meaning "little red"

1881 Rubella first described by German
physicians, Friedrich Hoffmann
1941 Associated with congenital disease (Gregg)
1961 Rubella virus first isolated
1967 Serological tests available
1969 Rubella vaccines available
 CHARACTERISTIC
RNA enveloped virus
member of Rubivirus
togavirus family
Only a single serotype
Rapidly inactivated by
(chemical agents, ultraviolet light,
low pH, and heat)
Occurs primarily in children and adolescents
 PATHOPHYSIOLOGY

Transmission is by respiratory
Replication in nasopharynx and regional
lymph nodes
Viremia 5-7 days after exposure
with spread to tissues
Placenta and fetus infected during viremia
Incubation period is 2 to 3 weeks
The lytic & lysogenic Cycle

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CLINICAL MANIFESTATIONS

Malaise
Headache
Myalgias and arthralgias
Post-auricular adenopathy
Conjunctivitis
non-pruritic, erythematous,
maculopapular rash
 LABORATORY TEST

isolated from the nasopharynx, the

blood, the urine, and CSF.

Newer tests with a higher specificity

latex agglutination
fluorescence immunoassay
passive hemagglutination
hemolysis in gel
enzyme immunoassay
 LABORATORY DIAGNOSIS

Diagnosis of acute infection

Rising titres of antibody (mainly IgG)
Presence of rubella-specific IgM

Immune Status Screen

latex agglutination are routinely used
15 IU/ml is regarded as the cut-off for
immunity
Epidemic Rubella – United
States, 1964-1965
• 12.5 million rubella cases
• 2,000 encephalitis cases
• 11,250 abortions
(surgical/spontaneous)
• 2,100 neonatal deaths
• 20,000 CRS cases
• deaf - 11,600
• blind - 3,580
• mentally retarded - 1,800
 TREATMENT

No specific treatment of rubella exists.

The disease is usually self-limited.
Rest and oral fluids are appropriate.
 PREVENTION
The best protection is vaccination
Given with the measles and mumps vaccine
(MMR) at age 12-15 months and again at
school entry at 4-6 years.
One injection usually imparts lifelong immunity.
CONTRAINDICATIONS TO VACCINATION

Pregnant women
Patients receiving immunoglobulin
Patients who are seriously ill
Patients with severe altered immunity
Patients on immunosuppressive therapy
Patients with HIV
ADVERSE REACTIONS TO VACCINATION
Fever 5%-15%
Rash 5%
Joint symptoms 25%
Thrombocytopenia <1/30,000 doses
Parotitis rare
Deafness rare
Encephalopathy <1/1,000,000 doses
 COMPLICATION
Congenital Rubella Syndrome (CRS) is the
most severe and important complication
the severity depends on how early the
infection occurs.

The most common abnormalities

ophthalmologic (cataracts, retinopathy).
Cardiac (patent ductus arteriosus,
pulmonary stenosis)
Auditory ( sensineural deafness)
 COMPLICATION
Neurologic disorders
(meningoencephalitis, mental retardation
with behavioral disorders)
 RISK OF CONGENITAL RUBELLA

%50
45
40
35
30
25
20
15
10
5
0
1-4 wks 5-8 wks 9-12 wks > 12 wks
 MANIFESTATIONS OF CONGENITAL
RUBELLA
%80
70
60
50
40
30
20
10
0
Deafness Eye CNS Cardiac
*The Lytic Cycle
*The Lysogenic Cycle