Dermatologic Manifestations of Rubella

Updated: Aug 10, 2017
  • Author: Peter C Lombardo, MD; Chief Editor: Dirk M Elston, MD  more...
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Overview

Background

Rubella is usually a mild viral illness involving the skin, the lymph nodes, and, less commonly, the joints. The most important complication of rubella is congenital rubella syndrome (CRS).

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Pathophysiology

Rubella is an RNA virus classified as a Rubivirus in the Togaviridae family.

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Epidemiology

Frequency

Before the live rubella vaccine, epidemics of the disease were seen in young children (most common), adolescents, and young adults every 5-9 years in winter and early spring. Since the rubella vaccine, the number of rubella cases has decreased significantly.

Because of the morbidity of measles and rubella, the World Health Organization (WHO) maintains a worldwide Measles and Rubella Laboratory Network (LabNet) to monitor the behavior of the viruses. [1] Because of the unreliability of clinical diagnosis, laboratory surveillance is important in setting rubella elimination goals. Serum-based diagnostics remain the criterion standard; however, programs are being developed using dried blood samples and oral fluid for confirmation of infection in those areas where patients might resist venipuncture or where transportation and refrigeration of blood samples is difficult.

One major focus of infection in the recent past was unvaccinated adults. [2] Of concern was the high incidence of rubella in unvaccinated Hispanic immigrants and congenital rubella syndrome in their offspring. [3] Individuals from Columbia, the Dominican Republic, and Central America, where vaccination programs were just starting, were often susceptible to rubella. In one study, 44% of congenital rubella syndrome cases were in Hispanic infants. [4] This was a public health concern. In an outbreak in 1997-98 in New York State, the infections spread from the Hispanic community, along train and work lines, to involve 14 towns and 95 individuals.

Now fortunately, the Pan American Health Organization of the WHO announced that the endemic transmission of rubella has ended in the Americas and that the Americas are free of endemic rubella. [5]  The last confirmed case was in Argentina in 2009. This end of endemic rubella was achieved by the high percentage of vaccination in the population. This does not mean that the threat of rubella is over, as the remainder of the world is not rubella–free, and, with the mobility of the world population, cases of rubella may still enter the United States.

The Centers for Disease Control and Prevention (CDC) [6] states that a nonimmune woman with a rubella infection in the first trimester stands a 90% chance of miscarriage, stillbirth, or transmittal of congenital rubella syndrome (CRS) to her baby. Five of 10 healthy babies do not receive the vaccine, even though it now costs about a dollar. The CDC maintains that 79 countries now are using the vaccine more, but the WHO [7] maintains that 45 member states have not yet introduced the vaccine and two regions (African and Eastern Mediterranean) have not yet set control targets. Therefore, it is possible for rubella to enter the United States, and so it is essential to maintain a high level of immunization in the population to ensure herd immunity. Constant vigilance remains crucial.

Race

Rubella has no racial predilection.

Sex

Both sexes are equally affected by rubella.

Age

Rubella primarily affects young children, but adolescents and young adults are also affected.

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Prognosis

The prognosis is usually excellent, with the exception of congenital rubella syndrome (CRS).

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Patient Education

Now that endemic rubella is eliminated in the Americas, the threat of rubella epidemics and subsequent congenital rubella syndrome would be from cases of rubella that enter the United States from other areas of the world and infect the unvaccinated clusters in this country. Therefore, the Measles and Rubella Initiative calls for monitoring the disease using effective surveillance, developing and maintaining outbreak preparedness, communicating and engaging to build public confidence and demand for immunization, and continuing research to improve cost-effective vaccinations and diagnostic tools. [8]

For patient education materials, see the articles Immunization Schedule, Adults and Immunization Schedule, Children.

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