Dermatologic Manifestations of Rubella

Updated: Oct 13, 2015
  • 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. Thus, it is important to ensure that a high percentage of the population remains vaccinated so as to maintain the herd immunity.

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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