Rubella overview
Synonyms: German measles; 3 day measles

# Overview
Rubella is a common childhood infection usually with minimal systemic upset although transient arthropathy may occur in adults. Serious complications are very rare. If it were not for the effects of transplacental infection on the developing fetus, rubella is a relatively trivial infection.

# Historical Perspective
The clinical picture resembling rubella was described for the first time in 1814 and its role in causing congenital anomalies was identified in 1942. The virus was isolated for the first time in 1962 by two independent groups in tissue culture.

# Pathophysiology
The pathophysiology of rubella is not completely understood. Viral replication in the respiratory epithelium occurs following transmission of the virus via contact with droplet secretions from an infected person. Viremia subsequently ensues, with the onset of the rubella rash occurring at the peak of viremia.

# Causes
The disease is caused by rubella virus, a togavirus that is enveloped and has a single-stranded RNA genome. The virus is transmitted by the respiratory route and replicates in the nasopharynx and lymph nodes. The virus is found in the blood 5 to 7 days after infection and spreads throughout the body. It is capable of crossing the placenta and infecting the fetus.

# Differentiating Rubella from other Diseases
Rubella infection must be differentiated from diseases presenting with features of skin rash, fever and lymphadenopathy such as measles, coxsackievirus infection and infectious mononucleosis.

# Epidemiology and Demographics
In the United States, endemic rubella virus transmission has been eliminated since 2001. From 2004 to 2013, 10 cases of rubella infection were diagnosed in the immigrants.

# Risk Factors
The risk factors predisposing for rubella infection include: contact with infected patient and not receiving immunization according to the standard schedule.

# Screening
There are no standard screening test recommended for rubella infection, however pregnant women with suspected rubella infection must be investigated to confirm the diagnosis to prevent fetal anomalies.

# Natural History and Complications
Rubella is transmitted by direct contact and presents with a fever, rash and lymphadenopathy. It is usually a self limiting infection and resolves without any complications. Few patients might develop complications such as arthritis which needs symptomatic treatment. The prognosis is good in adults with complete resolution of symptoms in a week.

# Diagnosis

## History and Symptoms
Patients with rubella infection present with a fever, skin rash and cervical lymphadenopathy. Malaise and anorexia precede the development of fever and rash.

## Physical Examination
Rubella infection in adults presents with low grade fever and a maculopapular rash starting on the face and spreads caudally. Cervical lymphadenopathy is present in majority of the patients.

## Laboratory Diagnosis
All patients with suspected rubella infection must be investigated further to confirm the diagnosis. Serological tests to look for the presence of rubella specific IgG antibodies and IgG avidity and RT-PCR should be done to confirm the diagnosis.

# Treatment

## Medical Therapy
There is no specific antiviral therapy for rubella infection. Symptomatic therapy and reporting the infection to local disease control agencies is recommended.

## Surgical Therapy
Surgical intervention is not recommended for the management of rubella infection.

# Prevention

## Primary Prevention
Rubella infections are prevented by active immunization programs using live, disabled virus vaccines. Two live attenuated virus vaccines, RA 27/3 and Cendehill strains, are effective in the prevention of adult disease

## Secondary Prevention
All the patients with confirmed rubella infection must be vaccinated. Pregnant women should be vaccinated after delivery of the baby.