1. COMMUNICABLE DISEASES
German Measles
(Rubella)
Professor
Qayser Sahib Al Habeeb
Specialist in
Internal and Community Medicine
Department of Family and Community Medicine
College of Medicine
University of Duhok

2. By the end of the lecture, the students should be able to describe:
CDC LECTURES:
Learning Objectives:
By the end of the lecture, the students should be able to describe:
1- The disease, its occurrence and susceptibility.
2- Causative agent, incubation period and communicability.
3- Mode of transmission , reservoir of infection and carrier state if any.
4- Principles of management(Dx and treatment).
5- Main preventive and control measures

3. German Measles
Rubella
--- It is an acute viral infection caused by rubella virus
Genus : Rubivirus
Family : Togaviridae
--- Generally it is a mild viral infection that occurs most often in children and young adults.

4. --- Rubella infection in pregnant women may cause fetal death or congenital defects known as congenital rubella syndrome (CRS).
--- Worldwide, over babies are born with CRS every year.
--- There is no specific treatment for rubella but the disease is preventable by vaccination.

6. I.P : 2 – 3 weeks
MOT : droplets
--- contact ( direct and indirect)
C.P : 7 days before
to 5-7 days after rash onset
Reservoir : --- humans
--- up to 50% of infections may be subclinical or asymptomatic

7. The disease starts with
Clinically:
The disease starts with
--- fever,
--- mild upper respiratory symptoms,
--- punctate macular rash (50–80% of cases) resembling measles or scarlet fever and lasts 1– days .
--- lymphadenopathy

8. Lymphadenopathy
usually affects
posterior cervical,
post auricular
& sub occipital groups.
-- It is the most characteristic clinical feature It precedes the rash by 5–10 days.
-- It can be generalized.

9. The disease is usually mild but infection with rubella
during the “1st trimester of pregnancy”
is associated with a high risk of
Congenital Anomalies
(Destruction of cells and mitotic arrest)

10. Fetuses infected early are at greatest risk of
■ intrauterine death
■ spontaneous abortion
and
■ congenital malformations
of major organs (single or combined defects)

11. Common Defects are: cataract , deafness, cardiac defects,
microphthalmia & microcephaly
other lifelong disabilities,
include
autism, diabetes mellitus and thyroid dysfunction.

12. Complications: 1- Idiopathic thrombocytopenic purpura.
….. usually transient, lasting 1-3 weeks.
2- Encephalitis
….. occurs in 1 / 5000 cases and is variable
in severity.

13. Reported rubella and CRS: United States, 1966-2004
Meissner, H. C. et al. Pediatrics 2006;117:
Copyright ©2006 American Academy of Pediatrics

14. Face of adult with rubella
CDC

15. This patient presented with a generalized rash on the abdomen caused by German measles (rubella). The rash usually lasts about 3 days, and may be accompanied by a low-grade fever.

16. Distribution is similar to that of measles but
Rash of rubella
on skin of
child's back.
Distribution is similar to that of measles but
the lesions are less
intensely red.

17. This adolescent presented with a 2-day history of fever, malaise, rash, and lymphadenpathy, including these post auricular lymph nodes.

18. Post-auricular lymphadenopathy in a 17-year old with rubella.

19. severe mental retardation, deafness, blindness
This infant has the rash of congenital rubella These infants are at great risk for
severe mental retardation, deafness, blindness
(atrophic eyes, cataracts and chorioretinitis)
as well as
congenital heart disease and other abnormalities

20. Newborn with congenital rubella rash.

21. Baby born with rubella:
Thickening of the lens of the eye that causes blindness (cataracts) 
CDC.

22. congenital rubella syndrome with
A 4 year - old boy with
congenital rubella syndrome with
unilateral microphthalmos and cataract formation in the left eye.

23. A 4 year - old female with congenital rubella with micro cephaly.

24. Differential Diagnosis:
--- measles,
--- human parvovirus infection (‘slapped cheek’)
--- human herpes virus 6 (roseola)
--- large number of other rashes of varied etiology.

25. Diagnosis: ► clinical suspicion ► confirmation by specific IgM Abs
or rising titer
(4 fold rise in paired sera)
► virus isolation might also be done.
► detection of rubella specific RNA fragments using PCR.

26. Congenital Rubella Syndrome (CRS)
◘ Occurs in up to 90% of infants born to women infected during the 1st trimester.
◘ The risk of a single congenital defect falls to
~ 10%–20% by the 16th week.
◘ The risk is minimal in the 3rd trimester.
◘ Congenital malformations and fetal death may occur following inapparent maternal rubella.

27. infants with congenital rubella syndrome might shed the virus
Management
Antenatal mothers < 16 weeks pregnant with rubella are best advised to terminate pregnancy.
Note:
infants with congenital rubella syndrome
might shed the virus
through nasopharyngeal secretion & urine
FOR LONG TIME

28. Prevention and Control Measures:
♦ Active immunization (LAV)
CI in pregnancy & immuno suppression
♦ If exposed during pregnancy,
---- counsel the family
---- consider abortion.

29. ♦ Contact isolation of the patients in hospitals and institutions
♦ Contact isolation of the patients in hospitals and institutions. Affected infants should be considered contagious until at least they are one year old.
♦ Exclusion from school for at least 7 days after the onset of rash.

30. ♦ Investigation of contacts and source of infection:
Identify pregnant female contacts, especially those in the first trimester. Such contacts should be tested serologically for susceptibility or early infection (IgM antibody) and advised accordingly.
♦ Educate the general public on transmission modes and stress the need for rubella immunization Health care providers must be aware of the risk of rubella in pregnancy.