rubella
(roo-bel'ă 
)
[L. rubellus, reddish]
A mild, febrile, highly infectious viral disease formerly common in childhood before development of an effective vaccine.
Incidence: Before the era of routine vaccination, more than 50,000 cases of rubella were reported annually in the U.S. Currently less than 200 children develop rubella on average each year. The disease still occurs in sporadic outbreaks among nonimmunized children and young adults, esp. in cities of underdeveloped regions where epidemics of the disease occur every 4 to 8 years.
Causes: Rubella is caused by an RNA virus in the Toga virus family. The virus is transmitted through contact with nasopharygeal secretions, blood, urine, and stool of infected people, and , possibly, by contact with contaminated clothing, tissues, etc. Humans are the only known host. The disease is contagious from about 10 days before appearance of the rash until about 5 days after its disappearance.
Symptoms and Signs: A 1- to 5-day prodromal period of drowsiness, mild elevation of temperature, slight sore throat, Forschheimer spots (pinpoint reddish areas on the palate), and postauricular, postcervical, and occipital lymphadenopathy commonly precedes the rash and is the hallmark of the disease. The maculopapular rash resembles that of measles or scarlet fever, begins on the forehead and face, spreads downward to the trunk and extremities, and lasts about 3 days, accompanied by fever. The rash appears in only about 50% of infections.
Rubella occurring during the first trimester of pregnancy has devastating consequences for the developing fetus. It is one of the TORCH viruses, a group of viruses associated with a wide variety of severe congenital malformations.
Incubation: Infection occurs approx. 14 to 23 days before the advent of symptoms.
Complications: Complications seldom occur in children. Older patients may experience generalized lymphadenopathy and splenomegaly. A transient polyarthritis (of the wrist, finger, knee, toe, and ankle joints) may occur within 5 days of the rash but usually lasts less than 2 weeks. Encephalomyelitis is rare and usually self-limiting.
SEE: congenital rubella syndrome.
Prevention: Prophylaxis consists of childhood immunization with a combination measles, mumps, rubella (MMR) vaccine, usually administered between 12 and 15 months of age and repeated at age 4 to 6 years. Preconception care includes updating immunizations at least 3 months before attempting conception (rubella and other needed vaccines).
Administration of live virus vaccines is contraindicated during pregnancy.Treatment: There is no specific therapy for rubella; treatment consists of alleviating discomfort. Treatment of newborns is focused on managing complications.
Patient Care: Injection Site: For 30 min after receiving the vaccine, the patient is observed for indications of anaphylaxis, and epinephrine 1:10,000 is kept readily available. Warmth should be applied to the injection site for 24 hr following immunization to aid absorption. If swelling persists beyond the initial 24 hr, cold should be applied to promote vasoconstriction and prevent antigenic cyst formation. Acetaminophen (for children) or aspirin (for adults) can be taken for relief of fever.
Parents need to be taught about respiratory (droplet) isolation and why it is necessary; the need to prevent exposure of pregnant women to rubella must be emphasized.
Children with rubella virus should be made as comfortable as possible, allowed to occupy themselves with books, games, and television. Adolescent or adult patients may have fever and joint pain. If medication is needed for symptomatic relief, adults may use aspirin, but children and adolescents under the age of 19 should use acetaminophen to lessen the risk of Reye syndrome.
If a pregnant, unimmunized woman develops rubella in her first trimester, she must be informed of the potential for fetal infection and its serious consequences. Generally speaking, the earlier the infection occurs during the pregnancy, the more severe the damage to the fetus. The combination of cataracts, deafness, and cardiac disease defines congenital rubella syndrome (CRS). Low birth weight, microcephaly, and mental retardation are also common. Many developing fetuses do not survive rubella contracted during pregnancy. Miscarriage and stillbirth are common complications of the disease. Appropriate immunoglobulin laboratory studies determine the presence of fetal infection. Counseling is offered regarding the woman's choice for family planning, and the patient is supported in her decision.
Infants born with congenital rubella require contact isolation until they no longer excrete the virus. The duration of the viral excretion is variable, usually several months to a year. Parents are taught that congenital rubella is a lifelong disease, that many related disorders may not appear until later in life, and that cataract and cardiac surgery may be required. Emotional support is offered to parents of an affected child. A referral to social service agencies guides parents to appropriate community resources and organizations. A mental health referral may help them deal with their grief, frustration, and anxiety. Confirmed cases of rubella and congenital rubella syndrome should be reported to the local public health department. SYN: German measles ; third disease; three-day measles .