Rubella (German measles )

Mrs.G.Manibharathi, Msc(N),
Associate professor
 INTRODUCTION

• Rubella, commonly known as German

measles, is a disease caused by Rubella virus.
The name is derived from the Latin, meaning
little red.
• Rubella is also known as German measles
because the disease was first described by
German physicians, Friedrich Hoffmann, in
the mid-eighteenth century.
 Definition
• Rubella is a disease caused by the rubella
virus.
• Also known as German Measles or 3 day
measles
• Rubella is usually a mild illness belongs to
Family Togaviridae.
 Rubella virus
• Rubella virus is single
stranded RNA virus
• Diameter 50 – 70 nm
• Enveloped Spherical
• Virus multiply in the
cytoplasm of infected cell
 Mode of transmission

Mode of transmission : Airborne droplets when infected

people sneeze or cough.
Incubation period : 14-21 days.
 CAUSES
• AGE •Disease of childhood (3-10 years)
• Disease usually occurs in a seasonal pattern
i.e. in temperate zones during the later winter
and spring, with epidemics of every 4-9 years
 Mode of transmission
• The virus is transmitted directly from person
to person by droplet nuclei from nose and
throat.
• The portal of entry is via the respiratory route.
• The virus can cross the placenta and infect the
foetus in uterus, leading to congenital rubella
in new born
Mode of transmission
Mode of transmission
 Pathophysiology

• Respiratory transmission of virus Spread by

respiratory droplets.
•Replication in nasopharynx and regional lymph nodes.

•Viremia 5-7 days after exposure with spread to tissues.

Placenta and foetus infected during viremia. 
 Clinical Features
• Incubation period 18 days (range 14-21 days)
• Prodrome of low grade fever
• Lymphadenopathy in second week
• Maculopapular rash 14-17 days after exposure
 SIGNS AND SYMPTOMS
• RASH- After an incubation period of 14-21 days, the
primary symptom of rubella virus infection is the
appearance of a rash (exanthema) on the face which spreads
to the trunk and limbs and usually fades after three days
with no staining or peeling of the skin.The skin
manifestations are called "blueberry muffin lesions.“
• LYMPH NODE- Tender lymph adenopathy (particularly
posterior auricular and sub occipital lymph nodes) persist
for up to a week.
• TEMPERATURE-Fever rarely rises above 38 oC(100.4 oF)
20
 SIGNS AND SYMPTOMS
•  Eye pain on lateral and upward eye movement (a particularly
troublesome complaint)
• Conjunctivitis
• Sore throat
• Headache
• General body aches
• Low-grade fever
• Chills
• Anorexia
• Nausea
• Forchheimer sign
Clinical features
Clinical features
Clinical features
Clinical features
 Congenital rubella syndrome
• Congenital rubella syndrome (CRS) refers to
infants born with defects secondary to
intrauterine infection.
• It occurs if the infant has IgM rubella
antibodies shortly after birth or IgG antibodies
persist for more than 6 months, by the time
maternally derived antibodies would have
disappeared.
 Clinical Findings Of CRS
• the most common and major defects are
deafness, cardiac malformations and cataracts.
 Other defects CRS
• Glaucoma
• Retinopathy
• Microcephalus
• Cerebral palsy
• Intrauterine growth retardation
• Hepato-splenomegaly
• Mental and motor retardation
 Diagnosis
• Nasopharyngeal or throat swabs taken 6 days prior or after
appearance of rash is a good source of Rubella virus.
• Using cell cultured in shell vial antigens can be detected by
Immuno fluorescent methods .
• Hemagglutination inhibition test for Rubella is of Diagnostic
significance.
• ELISA tests are greater importance.
• A raise in Antibody titer must be demonstrated between two
serum samples taken at least 10 days apart .
• Fourfold rise in IgG titer between acute and convalescent
serum specimens in mother.
 Treatment
• Acetaminophen for symptomatic relief
• CDC recommends limiting use of immunoglobulin to
women with known rubella exposure who decline
pregnancy termination.
• Glucocorticoids, platelet transfusion and other supportive
measures for complications.
 Prevention
 Rubella vaccine is given to children at 15 months of age
as a part of the MMR (measles-mumps-rubella)
immunization.
 The vaccine is live and attenuated and confers lifelong
immunity.
 Given to children 12 and 15 months and again between
3- 6 years of age.
 Vaccination after exposure will not prevent infection.
 Counsel about maternal-foetal transmission and offered
pregnancy termination, especially prior to 16 weeks
gestation.
 NURSING CARE
• Isolation: Emphasize the need for immediate isolation
when early catarrhal symptoms appear.
• Skin care: keep the patient’s nails short, encourage long
pants and sleeves to prevent scratching, keeping skin
moist with health care provider recommended lotions,
and avoiding sunlight and heat.
 NURSING CARE

• Eye  care: Treat conjunctivitis with warm saline when

removing eye secretions and encourage patient not to rub
eyes; protect the eyes from the glare of strong light.
• Hydration: Encourage oral hydration; medical literature
encourages the use of oral rehydration solution.
• Temperature control: Antipyretics should be administered
• Remind parents not to administer Aspirin due to the risk of
Reye’s syndrome.