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| '''For patient information click [[{{PAGENAME}} (patient information)|here]]''' | | __NOTOC__ |
| | '''For patient information click [[{{PAGENAME}} (patient information)|here]].''' |
| {{Infobox_Disease | | {{Infobox_Disease |
| | Name = Rubella | | | Name = Rubella |
| | Image = Rash of rubella on skin of child's back.JPG | | | Image = Rash of rubella on skin of child's back.JPG |
| | Caption = | | | Caption = By CDC - crop of File:Rash of rubella on skin of child's back.JPG, Public Domain, https://commons.wikimedia.org/w/index.php?curid=39884727 |
| | DiseasesDB = 11719 | | | DiseasesDB = 11719 |
| | ICD10 = {{ICD10|B|06||b|00}} | | | ICD10 = {{ICD10|B|06||b|00}} |
| | ICD9 = {{ICD9|056}} | | | ICD9 = {{ICD9|056}} |
| | ICDO = | | | ICDO = |
| | OMIM = | | | OMIM = |
| | MedlinePlus = 001574 | | | MedlinePlus = 001574 |
| | eMedicineSubj =
| | | MeshID = D012409 |
| | eMedicineTopic =
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| | eMedicine_mult =
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| | MeshID = | |
| }} | | }} |
| {{Rubella}} | | {{Rubella}} |
| {{CMG}} | | {{CMG}}; {{MJM}}, {{AKI}} |
| {{dablink|This page is for the disease. For the virus, see [[Rubella virus]].}} | |
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| | {{SK}} German measles; 3 day measles |
| ==[[Rubella overview|Overview]]== | | ==[[Rubella overview|Overview]]== |
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| ==[[Rubella pathophysiology|Pathophysiology]]== | | ==[[Rubella pathophysiology|Pathophysiology]]== |
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| ==[[Rubella epidemiology and demographics|Epidemiology & Demographics]]== | | ==[[Rubella causes|Causes]]== |
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| | ==[[Rubella differential diagnosis|Differentiating Rubella from other Diseases]]== |
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| | ==[[Rubella epidemiology and demographics|Epidemiology and Demographics]]== |
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| ==[[Rubella risk factors|Risk Factors]]== | | ==[[Rubella risk factors|Risk Factors]]== |
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| ==[[Rubella screening|Screening]]== | | ==[[Rubella screening|Screening]]== |
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| ==[[Rubella causes|Causes]]==
| | ==[[Rubella natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
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| ==[[Rubella differential diagnosis|Differentiating Rubella]]==
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| ==[[Rubella natural history|Complications & Prognosis]]== | |
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| ==Diagnosis== | | ==Diagnosis== |
| [[Rubella history and symptoms|History and Symptoms]] | [[Rubella physical examination|Physical Examination]] | [[Rubella laboratory tests|Laboratory tests]] | [[Rubella electrocardiogram|Electrocardiogram]] | [[Rubella x ray|X Rays]] | [[Rubella CT|CT]] | [[Rubella MRI|MRI]] [[Rubella echocardiography or ultrasound|Echocardiography or Ultrasound]] | [[Rubella other imaging findings|Other images]] | [[Rubella other diagnostic studies|Alternative diagnostics]] | | [[Rubella history and symptoms|History and Symptoms]] | [[Rubella physical examination|Physical Examination]] | [[Rubella laboratory findings|Laboratory Findings]] |
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| ==Treatment==
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| [[Rubella medical therapy|Medical therapy]] | [[Rubella surgery|Surgical options]] | [[Rubella primary prevention|Primary prevention]] | [[Rubella secondary prevention|Secondary prevention]] | [[Rubella cost-effectiveness of therapy|Financial costs]] | [[Rubella future or investigational therapies|Future therapies]]
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| ==Prevention==
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| {{main|MMR vaccine}}
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| Rubella infections are prevented by active immunization programs using live, disabled virus [[vaccine]]s. Two live attenuated virus vaccines, RA 27/3 and Cendehill strains, were effective in the prevention of adult disease. However their use in prepubertile females did not produce a significant fall in the overall incidence rate of CRS in the UK. Reductions were only achieved by immunisation of all children.
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| The vaccine is now given as part of the [[MMR vaccine]]. The [[WHO]] recommends the first dose is given at 12 to 18 months of age with a second dose at 36 months. Pregnant women are usually tested for immunity to rubella early on. Women found to be susceptible are not vaccinated until after the baby is born because the vaccine contains live virus.<ref name="pmid9639369">{{cite journal
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| |author=Watson JC, Hadler SC, Dykewicz CA, Reef S, Phillips L
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| |title=Measles, mumps, and rubella--vaccine use and strategies for elimination of measles, rubella, and congenital rubella syndrome and control of mumps: recommendations of the Advisory Committee on Immunization Practices (ACIP)
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| |journal=MMWR Recomm Rep
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| |volume=47
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| |issue=RR-8
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| |pages=1–57
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| |year=1998
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| |pmid=9639369
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| |doi=
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| }}</ref>
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| The [[Immunization (medicine)|immunization]] program has been quite successful with Cuba declaring the disease eliminated in the 1990s. In 2004 the [[Centers for Disease Control and Prevention]] announced that both the congenital and acquired forms of rubella had been eliminated from the [[United States]].<ref>{{cite journal |author=Dayan GH, Castillo-Solórzano C, Nava M, ''et al'' |title=Efforts at rubella elimination in the United States: the impact of hemispheric rubella control |journal=Clin. Infect. Dis. |volume=43 Suppl 3 |issue= |pages=S158–63 |year=2006 |pmid=16998776 |doi=10.1086/505949}}</ref><ref>{{cite journal |author= |title=Elimination of rubella and congenital rubella syndrome--United States, 1969-2004 |url= http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5411a5.htm|journal=MMWR Morb. Mortal. Wkly. Rep. |volume=54 |issue=11 |pages=279–82 |year=2005 |pmid=15788995 |doi=}}</ref>
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| ==Treatment== | | ==Treatment== |
| Symptoms are usually treated with [[paracetamol]] until the disease has run its course. Treatment of newly born babies is focused on management of the complications. Congenital heart defects and cataracts can be corrected by surgery.<ref name="pmid17197734">{{cite journal
| | [[Rubella medical therapy|Medical Therapy]] | [[Rubella primary prevention|Primary Prevention]] | [[Rubella secondary prevention|Secondary Prevention]] | [[Rubella cost-effectiveness of therapy|Cost-effectiveness of Therapy]] |
| |author=Khandekar R, Sudhan A, Jain BK, Shrivastav K, Sachan R | |
| |title=Pediatric cataract and surgery outcomes in Central India: a hospital based study.
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| |journal=Indian J Med Sci
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| |volume=61
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| |issue=1
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| |pages=15–22
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| |year=2007
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| |pmid=17197734
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| |doi=
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| |url=http://www.indianjmedsci.org/article.asp?issn=0019-5359;year=2007;volume=61;issue=1;spage=15;epage=22;aulast=Khandekar
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| }}</ref> Management for ocular CRS is similar to that for age-related macular degeneration, including counseling, regular monitoring, and the provision of low vision devices, if required.<ref name="pmid12365660">{{cite journal
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| |author=Weisinger HS, Pesudovs K
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| |title=Optical complications in congenital rubella syndrome
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| |journal=Optometry
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| |volume=73
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| |issue=7
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| |pages=418–24
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| |year=2002
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| |pmid=12365660
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| |doi=
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| }}</ref>
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| ==Prognosis==
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| Rubella infection of children and adults is usually mild, self-limiting and often asymptomatic. The prognosis in children born with CRS is poor.<ref name="pmid3288422">{{cite journal | |
| |author=Freij BJ, South MA, Sever JL
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| |title=Maternal rubella and the congenital rubella syndrome
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| |journal=Clin Perinatol
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| |volume=15
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| |issue=2
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| |pages=247–57
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| |year=1988
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| |pmid=3288422
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| |doi=
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| }}</ref>
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| ==Epidemiology==
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| Rubella is a disease that occurs worldwide. The virus tends to peak during the spring in countries with temperate climates. Before the vaccine to rubella was introduced in 1969, widespread outbreaks usually occurred every 6-9 years in the United States and 3-5 years in Europe, mostly affecting children in the 5-9 year old age group.<ref name="pmid11798368">{{cite journal
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| |author=Reef SE, Frey TK, Theall K, ''et al''
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| |title=The changing epidemiology of rubella in the 1990s: on the verge of elimination and new challenges for control and prevention
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| |journal=JAMA | |
| |volume=287
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| |issue=4
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| |pages=464–72
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| |year=2002
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| |pmid=11798368
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| |doi=
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| |url=http://jama.ama-assn.org/cgi/pmidlookup?view=long&pmid=11798368
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| }}</ref> Since the introduction of vaccine, occurrences have become rare in those countries with high uptake rates. However, in the UK there remains a large population of men susceptible to rubella who have not been vaccinated. Outbreaks of rubella occurred amongst many young men in the UK in 1993 and in 1996 the infection was transmitted to pregnant women, many of whom were immigrants and were susceptible. Outbreaks still arise, usually in developing countries where the vaccine is not as accessible.<ref name="pmid16989272">{{cite journal
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| |author=Reef S | |
| |title=Rubella mass campaigns
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| |journal=Curr. Top. Microbiol. Immunol.
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| |volume=304
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| |issue= | |
| |pages=221–9
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| |year=2006
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| |pmid=16989272
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| |doi=
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| }}</ref>
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| During the epidemic in the US between 1962-1965, Rubella virus infections during pregnancy were estimated to have caused 30,000 still births and 20,000 children to be born impaired or disabled as a result of CRS.<ref name="pmid11348695">{{cite journal
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| |author=Plotkin SA
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| |title=Rubella eradication
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| |journal=[[Vaccine]]
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| |volume=19
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| |issue=25-26
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| |pages=3311–9 | |
| |year=2001
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| |pmid=11348695
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| |doi=
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| |url=http://linkinghub.elsevier.com/retrieve/pii/S0264410X01000731
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| }}</ref><ref>Cooper,L.Z. Congenital Rubella in the United States. 1975 In: Krugman,S Gershon,A (eds), Symposium on Infections Of the Fetus and Newborn Infant. New York, Alan R. Liss Inc.,p.1.</ref>
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| Universal immunisation producing a high level of [[herd immunity]] is important in the control of epidemics of rubella.<ref name="pmid11105178">{{cite journal
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| |author=Danovaro-Holliday MC, LeBaron CW, Allensworth C, ''et al'' | |
| |title=A large rubella outbreak with spread from the workplace to the community
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| |journal=JAMA
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| |volume=284
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| |issue=21
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| |pages=2733–9
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| |year=2000
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| |pmid=11105178
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| |doi=
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| |url=http://jama.ama-assn.org/cgi/pmidlookup?view=long&pmid=11105178
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| }}</ref>
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| ==History==
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| Rubella was first described in the mid-eighteenth century. [[Friedrich Hoffmann]] made the first clinical description of rubella in 1740,<ref name=Ackerknecht1982>{{cite book |author=Ackerknecht, Erwin Heinz |title=A short history of medicine |publisher=Johns Hopkins University Press |location=Baltimore |year=1982 |pages=129 |isbn=0-8018-2726-4}}</ref> which was confirmed by de Bergen in 1752 and Orlow in 1758.<ref name="pmid18109609">{{cite journal
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| |author=Wesselhoeft C
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| |title=Rubella and congenital deformities
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| |journal=N. Engl. J. Med.
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| |volume=240
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| |issue=7
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| |pages=258–61
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| |year=1949
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| |pmid=18109609
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| |doi=
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| }}</ref>
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| In 1814, George de Maton first suggested that it be considered a disease distinct from both measles and scarlet fever. All these physicians were German, and the disease was known as Rötheln (from the German name ''Röteln''), hence the common name of "German measles". <ref>Best, J.M., Cooray, S., Banatvala J.E. '''Rubella''' in ''Topley and Wilson's Microbiology and Microbial Infections'', Vol. 2, Virology, Chapter 45, p.960-92, ISBN 0 340 88562 9, 2005 </ref> Henry Veale, an English Royal Artillery surgeon, described an outbreak in India. He coined the name "rubella" (from the Latin, meaning "little red") in 1866.<ref name=Ackerknecht1982/><ref name=Lee2000>{{cite journal |author=Lee JY, Bowden DS |title=Rubella virus replication and links to teratogenicity |journal=Clin. Microbiol. Rev. |volume=13 |issue=4 |pages=571-87 |year=2000 |pmid=11023958 |url=http://cmr.asm.org/cgi/content/full/13/4/571}}</ref><ref name=cdc>{{cite book
| | ==Cases Studies== |
| | author = Atkinson W, Hamborsky J, McIntyre L, Wolfe S, eds.
| | [[Rubella case study one|Case #1]] |
| | year = 2007
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| | url = http://www.cdc.gov/vaccines/pubs/pinkbook/pink-chapters.htm
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| | title = Epidemiology and Prevention of Vaccine-Preventable Diseases. 10th ed.
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| | chapter = Chapter 12. Rubella
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| | chapterURL = http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/rubella.pdf
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| | publisher = Centers for Disease Control and Prevention
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| | accessdate = 2007-07-03
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| }}</ref><ref name=MoHNZ>{{cite book
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| | year = 2006
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| | month = April
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| | title = Immunisation Handbook 2006
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| | publisher = Ministry of Health, Wellington, NZ.
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| | url = http://www.moh.govt.nz/moh.nsf/indexmh/immunisation-handbook-2006
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| | chapter = Chapter 11 - Rubella
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| | chapterURL = http://www.moh.govt.nz/moh.nsf/pagesmh/4617/$File/2006-11rubella.pdf
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| | isbn=0-478-29926-5
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| | accessdate = 2007-07-03
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| }}</ref>
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| It was formally recognised as an individual entity in 1881, at the International Congress of Medicine in London.<ref>Smith, J. L. Contributions to the study of Rötheln. Trans. Int. Med. Congr. Phil. '''4''',14. 1881</ref> In 1914, Alfred Fabian Hess theorised that rubella was caused by a virus, based on work with monkeys.<ref name=whonamedit>{{cite journal
| | ==External Links== |
| | first = Alfred Fabian
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| | last = Hess
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| | year = 1914
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| | title = German measles (rubella): an experimental study
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| | journal = The Archives of Internal Medicine
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| | location = Chicago
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| | volume = 13
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| | pages = 913-916
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| }} as cited by {{cite web
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| | first = Ole Daniel
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| | last = Enersen
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| | url = http://www.whonamedit.com/doctor.cfm/2283.html
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| | title = Alfred Fabian Hess
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| | publisher = WhoNamedIt
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| | accessdate = 2007-07-03
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| }}</ref> In 1938, Hiro and Tosaka confirmed this by passing the disease to children using filtered nasal washings from acute cases.<ref name=cdc/>
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| In 1940, there was a widespread epidemic of rubella in Australia. Subsequently, ophthalmologist Norman McAllister Gregg found 78 cases of congenital cataracts in infants and 68 of them were born to mothers who had caught rubella in early pregnancy.<ref name=Lee2000/><ref name=cdc/> Gregg published an account, ''Congenital Cataract Following German Measles in the Mother'', in 1941. He described a variety of problems now know as [[congenital rubella syndrome]] (CRS) and noticed that the earlier the mother was infected, the worse the damage was. The virus was isolated in tissue culture in 1962 by two separate groups led by physicians Parkman and Weller.<ref name=MoHNZ/><ref name=Lee2000/>
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| There was a pandemic of rubella between 1962 and 1965, starting in Europe and spreading to the United States.<ref name=MoHNZ/> In the years 1964-65, the United States had an estimated 12.5 million rubella cases. This led to 11,000 miscarriages or therapeutic abortions and 20,000 cases of congenital rubella syndrome. Of these, 2,100 died as neonates, 12,000 were deaf, 3,580 were blind and 1,800 were mentally retarded. In New York alone, CRS affected 1% of all births <ref> J.B. Hanshaw, J.A. Dudgeon, and W.C. Marshall. Viral diseases of the fetus and newborn. W.B. Saunders Co., Philadelphia, 1985 </ref>
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| In 1969 a live attenuated virus vaccine was licensed.<ref name=cdc/> In the early 1970s, a triple vaccine containing attenuated measles, mumps and rubella (MMR) viruses was introduced.<ref name=MoHNZ/>
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| ==See also==
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| * [[Eradication of infectious diseases]]
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| == References ==
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| <!--<nowiki>
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| {{Reflist|2}}
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| ==External links== | |
| * [http://www.virology-online.com/viruses/Rubella.htm Rubella] at Wong's Virology.
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| * [http://www.immunize.org/rubella/index.htm Immunization Action Coalition: Rubella]
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| * {{DermNet|viral/rubella}} | | * {{DermNet|viral/rubella}} |
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| [[Category:Pediatrics]] | | [[Category:Pediatrics]] |
| [[Category:Togaviruses]] | | [[Category:Togaviruses]] |
| [[Category:Infectious disease]]
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| [[bg:Рубеола]] | | [[Category:Dermatology]] |
| [[cs:Zarděnky]] | | [[Category:Emergency mdicine]] |
| [[de:Röteln]] | | [[Category:Disease]] |
| [[eo:Rubeolo]]
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| [[es:Rubéola]]
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| [[fa:سرخجه]]
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| [[he:אדמת]]
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| [[id:Rubela]]
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| [[ja:風疹]]
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| [[la:Rubella]]
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| [[ms:Penyakit Rubela]]
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| [[no:Røde hunder]]
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| [[pl:Różyczka]]
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| [[pt:Rubéola]]
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| [[ro:Rubeolă]]
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| [[simple:Rubella]]
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| [[sv:Röda hund]]
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