CD-ROM Today 1996 January/CD-ROM Today 1996 January.iso/dp/0419/04199.txt

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$Title{Rubella}
$Subject{Rubella German Measles Three-Day Measles }
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Copyright (C) 1986, 1989 National Organization for Rare Disorders, Inc.

274:
Rubella

** IMPORTANT **
It is possible the main title of the article (Rubella) is not the name
you expected.  Please check the SYNONYMS to find the alternate names and
disorder subdivisions covered by this article.

Synonyms

     German Measles
     Three-Day Measles

General Discussion

** REMINDER **
The information contained in the Rare Disease Database is provided for
educational purposes only.  It should not be used for diagnostic or treatment
purposes.  If you wish to obtain more information about this disorder, please
contact your personal physician and/or the agencies listed in the "Resources"
section of this report.


Rubella is a contagious viral disease characterized by swelling of lymph
glands and a rash.  A pregnant woman infected with Rubella during the early
months of pregnancy may develop an abortion, stillbirth or congenital defects
in the infant.  (For more information, see the article "Rubella" in the
Prevalent Health Conditions/Concerns area of NORD Services.)

Symptoms

Rubella has a 14- to 21-day incubation period and a 1- to 5-day preliminary
phase in children.  The preliminary phase may be minimal or absent in
adolescents and adults.  Tender swelling of the glands in the back of the
head, the neck and behind the ears is characteristic.  The typical rash
appears days after onset of these symptoms.

The Rubella rash is similar to that of measles, but it is usually less
extensive and disappears more quickly.  It begins on the face and neck and
quickly spreads to the trunk and the extremities.  At the onset of the
eruption, a flush similar to that of scarlet fever may appear, particularly
on the face.  The rash usually lasts about three days.  It may disappear
before this time, and rarely there is no rash at all.  A slight fever usually
occurs with the rash.  Other symptoms such as headache, loss of appetite,
sore throat and general malaise, are more common in adults and teenagers than
in children.

After-effects of Rubella are rare among children, although there have
been cases of joint pain (arthralgia), sleeping sickness and blood clotting
problems.  Adult women who contract Rubella are often left with chronic joint
pains.  Encephalitis is a rare complication that has occurred during
extensive outbreaks of Rubella among young adults serving in the armed
services.  Transient pain in the testes is also a frequent complaint in adult
males with Rubella.

Causes

Rubella is caused by an RNA virus of uncertain classification (probably a
toga-virus), and is spread by airborne droplet clusters or by close contact
with an infected person.  A patient can transmit the disease from 1 week
before onset of the rash until 1 week after it fades.  Congenitally infected
infants are potentially infectious for a few months after birth.  Rubella is
apparently less contagious than measles, and many persons are not infected
during childhood.  As a result, 10% to 15% of young adult women are
susceptible if they have not been vaccinated against the disorder.  Many
cases are misdiagnosed or go unnoticed.

Before the Rubella vaccine was developed, epidemics occurred at regular
intervals during the spring.  Major epidemics occur at about 6- to 9-year
intervals.  Once infected by Rubella, immunity appears to be lifelong.

Related Disorders

Measles, scarlet fever (scarlatina), secondary syphilis, drug rashes,
erythema infectiosum (fifth disease), infectious mononucleosis, and echo-,
coxsackie- and adenovirus infections must be considered in the differential
diagnosis.

Rubella is clinically differentiated from measles by the milder rash that
disappears faster, and by the absence of the small, irregular, bright red
spots (Koplik's spots) on the mucous membranes inside of the cheeks and on
the tongue, a running nose (coryza), the aversion to light and a cough.  A
patient with measles appears more sick and the illness lasts longer.

With even mild scarlet fever (scarlatina) there are usually more
constitutional symptoms than in Rubella, including a severely red, sore
throat.  The white blood cell count is elevated in scarlet fever, but is
usually normal in Rubella.

The rash and swollen lymph nodes (adenopathy) of Rubella can be simulated
by secondary syphilis.  However, the lymph nodes are not tender in syphilis
and the rash appears bronze-like.  If there is doubt, a quantitative
serologic test for syphilis can be performed.

Infectious mononucleosis may also cause a Rubella-like swelling of lymph
nodes and a skin rash, but can be differentiated by the initial lack of white
blood cells (leukopenia) followed by an increase in white blood cells
(leukocytosis).  Many typical mononuclear cells appear in the blood smear,
with appearance of antibodies to the Epstein-Barr virus.  In addition, the
sore throat of infectious mononucleosis is usually prominent, and malaise is
greater and lasts much longer than in Rubella.

A clinical diagnosis of Rubella is subject to error without laboratory
confirmation, especially since many viral rashes closely mimic Rubella.
Acute and convalescent serum should be obtained, if possible, for serologic
testing.  A 4-fold or greater rise in specific hemagglutination inhibiting
antibodies confirms the diagnosis of Rubella.

Therapies:  Standard

Prevention:  The purpose of Rubella immunization programs is to prevent some
of the catastrophes associated with congenital Rubella.  All children between
the ages of 15 months and puberty should be routinely vaccinated against
Rubella.  Women of childbearing age whose blood tests negative for
hemagglutination inhibiting antibodies should be immunized.  Conception
should be prevented for at least 3 months after immunization.

Rubella requires little or no treatment.  Middle ear infection (otitis
media), a rare complication, is usually treated with penicillin G or V in
patients over 8 years of age, and with ampicillin for those under 8.

Therapies:  Investigational

This disease entry is based upon medical information available through
September 1989.  Since NORD's resources are limited, it is not possible to
keep every entry in the Rare Disease Database completely current and
accurate.  Please check with the agencies listed in the Resources section for
the most current information about this disorder.

Resources

For more information on Rubella, please contact:

     National Organization for Rare Disorders (NORD)
     P.O. Box 8923
     New Fairfield, CT  06812-1783
     [phone]

     NIH/National Institute of Allergy and Infectious Diseases
     9000 Rockville Pike
     Bethesda, MD  20892
     [phone]

     Centers for Disease Control
     1600 Clifton Road, N.E.
     Atlanta, GA 30333
     [phone]

References

Rubella:  Public Health Education Information Sheet:  March of Dimes Birth
Defects Foundation (1984).