Dermatologic Manifestations of Rubella 

  • Author: Peter C Lombardo, MD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Jan 18, 2011
 

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

United States

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 is now unvaccinated adults.[2] Of increasing concern is 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 are just starting, are often susceptible to rubella. In one study, 44% of congenital rubella syndrome cases were in Hispanic infants.[4] This is a public health concern. In a recent outbreak in New York State, the infections spread from the Hispanic community, along train and work lines, to involve 14 towns and 95 individuals.

Mortality/Morbidity

Rubella is usually mild. Rarely, encephalitis, thrombocytopenia, or neuritis may occur. Such manifestations are usually self-limited.

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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Contributor Information and Disclosures
Author

Peter C Lombardo, MD  Clinical Associate Professor, Department of Dermatology, Columbia University College of Physicians and Surgeons; Private Practice, Sutton Place Dermatology, PC

Peter C Lombardo, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, New York Academy of Medicine, New York Dermatological Society, and New York State Society of Dermatology and Dermatologic Surgery (NYSSDDS)

Disclosure: Nothing to disclose.

Specialty Editor Board

Gregory J Raugi, MD, PhD  Professor, Department of Internal Medicine, Division of Dermatology, University of Washington at Seattle; Chief, Dermatology Section, Primary and Specialty Care Service, Veterans Administration Medical Center of Seattle

Gregory J Raugi, MD, PhD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Richard P Vinson, MD  Assistant Clinical Professor, Department of Dermatology, Texas Tech University School of Medicine; Consulting Staff, Mountain View Dermatology, PA

Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Association of Military Dermatologists, Texas Dermatological Society, and Texas Medical Association

Disclosure: Nothing to disclose.

Van Perry, MD  Assistant Professor, Department of Medicine, Division of Dermatology, University of Texas Health Science Center

Van Perry, MD is a member of the following medical societies: American Academy of Dermatology and American Society for Laser Medicine and Surgery

Disclosure: Nothing to disclose.

Catherine M Quirk, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania

Catherine M Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD  Director, Department of Dermatology, Geisinger Medical Center

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

References

  1. [Guideline] Centers for Disease Control and Prevention. Recommendations from an Ad Hoc Meeting of the WHO Measles and Rubella Laboratory Network (LabNet) on Use of Alternative Diagnostic Samples for Measles and Rubella Surveillance. MMWR Morb Mort Wkly Rpt. Jun 2008;57(24):657-660. [Full Text].

  2. Danovaro-Holliday MC, LeBaron CW, Allensworth C, et al. A large rubella outbreak with spread from the workplace to the community. JAMA. Dec 6 2000;284(21):2733-9. [Medline].

  3. Centers for Disease Control and Prevention. Rubella Outbreak-Westchester County, New York 1997-1998. MMWR Morb Mort Wkly Rpt. Jul 1999;48(26):560-563. [Full Text].

  4. Schluter WW, Reef SE, Redd SC, Dykewicz CA. Changing epidemiology of congenital rubella syndrome in the United States. J Infect Dis. Sep 1998;178(3):636-41. [Medline].

  5. Giles JP, Balsamo MR, Green RH, et al. Rubella: Studies on the Natural History and Prevention of the Disease. J Pediatr. 1963;63:816-7.

  6. American Association for Clinical Chemistry. Rubella. Lab Tests Online. Available at http://www.labtestsonline.org/. Accessed April 8, 2009.

  7. Jensen V. Measles on the rise as vaccinations fall, study reports. Royal Holloway, University of London. August 8, 2003;What's New.

  8. Omer SB, Salmon DA, Orenstein WA, deHart MP, Halsey N. Vaccine refusal, mandatory immunization, and the risks of vaccine-preventable diseases. N Engl J Med. May 7 2009;360(19):1981-8. [Medline].

  9. Madsen KM, Hviid A, Vestergaard M, et al. A population-based study of measles, mumps, and rubella vaccination and autism. N Engl J Med. Nov 7 2002;347(19):1477-82. [Medline].

  10. DeStefano F, Bhasin TK, Thompson WW, Yeargin-Allsopp M, Boyle C. Age at first measles-mumps-rubella vaccination in children with autism and school-matched control subjects: a population-based study in metropolitan atlanta. Pediatrics. Feb 2004;113(2):259-66. [Medline].

  11. Hitti M. Vaccine Court Rejects Autism Claims. WebMD Health News [serial online]. February 1, 2009;Available at http://www.medscape.com/viewarticle/588202.

  12. Shinefield H, Black S, Digilio L, et al. Evaluation of a quadrivalent measles, mumps, rubella and varicella vaccine in healthy children. Pediatr Infect Dis J. Aug 2005;24(8):665-9. [Medline].

  13. [Guideline] Centers for Disease Control and Prevention. Recommended adult immunization schedule---United States, 2009. MMWR Morb Mortal Wkly Rep. 2008;57(53):[Full Text].

  14. [Best Evidence] Klein NP, Fireman B, Yih WK, Lewis E, Kulldorff M, Ray P, et al. Measles-mumps-rubella-varicella combination vaccine and the risk of febrile seizures. Pediatrics. Jul 2010;126(1):e1-8. [Medline].

  15. [Best Evidence] Hviid A. Measles-mumps-rubella-varicella combination vaccine increases risk of febrile seizure. J Pediatr. Jan 2011;158(1):170. [Medline]. [Full Text].

  16. [Guideline] Marin M, Broder KR, Temte JL, Snider DE, Seward JF. Use of combination measles, mumps, rubella, and varicella vaccine: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. May 7 2010;59:1-12. [Medline]. [Full Text].

  17. Gellis SE. Rubella (German measles). In: Fitzpatrick's Dermatology in General Medicine. Vol 2. New York, NY: McGraw-Hill; 1999:2395-8.

  18. Georges P, ed. Rubella. In: 1997 Redbook: Report of the Committee on Infectious Diseases. Elk Grove Village, Ill: American Academy of Pediatrics; 1997:456-62.

  19. Lennette EH, Schmidt NJ. Diagnostic Procedures for Viral and Rickettsial Infections. 7th ed. Washington, DC: American Public Health Association; 1979:725-66.

  20. Mandell GL, Bennett JE, Dolan R, eds. Principles and Practice of Infectious Diseases. 5th ed. Philadelphia, Pa: WB Saunders; 2000:1708-14.

  21. Weedon D, Strutton G. Skin Pathology. Edinburgh, Scotland: Churchill Livingston; 1997:597.

 
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