rubella

see also:

• viruses
• paediatric exanthems

• once an extremely common exanthem of childhood, now quite rare in vaccinated regions
• whilst the viral illness is generally mild, it does pose a major risk to the fetus if pregnant mothers become infected
• the rubella virus is a member of the Rubivirus genus of the family Togaviridae
• transmission is respiratory route
• Australia declared Rubella-free by the W.H.O. in late 2018. Recent history shows 22 reported cases in Victoria in 2010 falling to 2 in 2017.

• incubation 14-21 days
• prodrome lasting 1-5 days prior to rash:
  • unusual in children but more common in adults
  • painful eyes on sup/lat. gaze
  • conjunctivitis
  • sore throat
  • headache
  • low grade fever
  • tender lymphadenopathy - esp. post. auricular and suboccipital nodes
  • 20% develop petechiae on the palate during prodrome (Forchheimer sign)
• rash phase:
  • 1-4mm dicrete pink m/p rash lasting 3 days
  • rash starts on face and neck and spreads downwards over 24hrs and starts to fade in same manner on day 2
  • may be pruritic in adults
  • fever up to 38.5degC
  • enlarged post. auricular and suboccipital nodes
  • +/- Forchheimer sign

• sensorineural hearing loss (if infected in 1st 16wks pregnancy) which may not become apparent until 2yrs age
• cataract
• infantile glaucoma
• pigmentary retinopathy - usually benign
• patent ductus arteriosus (PDA) (if infected in 1st 10wks pregnancy)
• pulmonary artery stenosis (if infected in 1st 10wks pregnancy)
• IUGR
• prematurity
• stillbirth
• miscarriage
• mental retardation
• CNS disorders
• hepatosplenomegaly
• hepatitis
• skin lesions such as blueberry muffin spots
• bone lesions
• anaemia
• thrombocytopenia
• diabetes mellitus or thyroid disease in young adults

• vaccination of infants
• serologic testing of immunity for prenatal women