• This infection caused by the Rubella virus is also called "3-day measles" or "German measles".
• Rubella is an RNA virus. The disease is transmitted by droplet or transplacental route.
• During acute illness, virus is found in nasopharyngeal secretions, blood, stool and urine from 1 week before to 2 weeks after rash. Children with congenital rubella infection spread the virus for months.
• Active rubella infection provides permanent immunity. Antibodies passed from the mother provide passive immunization of the baby in the first 6 months postnatal period.
Clinic
• The incubation period of the disease is 14-21 days. It is contagious between 5 days before and 6 days after the rash.
• In rubella, there is a prodromal period characterized by mild catarrhal symptoms and often unnoticed. In children, this prodromal period is not usually seen.
The characteristic symptoms and signs of rubella are:
• Lymphadenopathy occurs 24 hours before the rash and persists for days. Posturicular, posterior cervical, and suboccipital lymphadenopathy are usually prominent. Sometimes one of these lymphadenopathies becomes large (Theodor phenomenon).
• Forscheimer's spots (petechial), especially observed on the soft palate.
• The rash is maculopapular and prone to coalescence. It starts on the face and spreads rapidly to the trunk and extremities within 24 hours. The rash does not itch and is like lace. On the 2nd day, the rash is pinhead-shaped and more discrete, red-like. On the 3rd day, it disappears leaving a slight desquamation.
• Polyarthritis
• Mild fever
Complications
• Arthralgia-arthritis
• Encephalitis
• Progressive Rubella Panencephalitis (PRP): It causes a picture similar to SSPE in measles.
• Thrombocytopenia
• Orchitis
• Myocarditis
NOTE: It does not cause bronchopneumonia.
Protection
• For protection, MMR vaccine is given in the 12th month and in the first grade of primary education. Passive immunization is not recommended except for pregnant women.
• When pregnant women make suspicious contact:
- Rubella IgG determination is made immediately, if it is negative, it is repeated after 2-3 weeks, if it is negative, it is repeated after 6 weeks.
- If all are negative, there is no infection. If the 2nd and 3rd titers are positive, it indicates acute infection and is a therapeutic abortion indication.
- If the family does not accept abortion, immunoglobulin should be given.