Pediatric Rubella Treatment & Management

  • Author: Elias Ezike, MD; Chief Editor: Russell W Steele, MD   more...
 
Updated: Oct 3, 2011
 

Medical Care

Postnatal rubella

Treatment is supportive. No specific antiviral agent for rubella is currently available.

Starch baths and antihistamines may be useful for adult patients with uncomplicated rubella and troublesome itching.

For complicated cases, treatment is as follows:

  • For severe arthritis affecting weight-bearing joints, encourage rest. Nonsteroidal anti-inflammatory drugs (NSAIDs) may be helpful, but corticosteroids are not indicated.
  • For patients with encephalitis, provide supportive care with adequate fluid and electrolyte maintenance.
  • Thrombocytopenia is usually self-limited but, if severe, consider intravenous immunoglobulin (IVIG). Corticosteroids have not demonstrated any specific benefit. Splenectomy is not indicated.

Congenital rubella syndrome

Treatment is supportive. Provide vision screening and hearing screening for asymptomatic newborns.

Treatment of symptomatic newborns is as follows:

  • Provide careful evaluation of the eyes and ophthalmology referral for babies with corneal clouding, cataract, and retinopathy. Corneal clouding may indicate infantile glaucoma.
  • Babies with congenital rubella syndrome who develop respiratory distress may require supportive treatment in the ICU.
  • Hepatosplenomegaly is monitored clinically. No intervention is required.
  • Patients with hyperbilirubinemia may require phototherapy or exchange transfusions if jaundice is severe to prevent kernicterus.
  • True hemorrhagic difficulties have not been a major problem; however, IVIG may be considered in infants who develop severe thrombocytopenia. Corticosteroids are not indicated.
  • Infants who have a rubella-related heart abnormality should be carefully observed for signs of congestive heart failure. Echocardiography may be essential for diagnosis of heart defects.

Contact isolation is required for patients with congenital rubella during hospitalizations because babies are infected at birth and are usually contagious until older than 1 year unless viral cultures have produced negative results.

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Surgical Care

Postnatal rubella

Surgical care is not indicated.

Congenital rubella syndrome

Surgical treatment may be required for congenital heart anomalies, including patent ductus arteriosus (PDA), coarctation of aorta, ventricular septal defect (VSD), atrial septal defect (ASD), and pulmonary artery stenosis.

Surgical treatment may be required for eye defects such as glaucoma, cataract, and retinal neovascularization.

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Consultations

Infectious disease specialist

Consult an infectious disease specialist for complicated postnatal rubella and congenital rubella syndrome.

Otolaryngologist

Audiometric testing and other hearing screening tests are necessary to promptly diagnose hearing loss in children who may benefit from proper educational programs.

Cardiologist and cardiothoracic surgeon

Children with congenital heart diseases require cardiology referral and echocardiography for adequate management. Lifesaving cardiac repair may be necessary.

Ophthalmologist

An ophthalmologic evaluation and follow-up care are necessary in children with ocular abnormalities. Glaucoma, cataract, and retinal neovascularization may require surgical intervention.

Neurologist

A neurologic evaluation and follow-up care are needed for children who have CNS anomalies, including motor weakness and delay, poor balance, mental retardation, behavioral abnormalities, and learning deficits.

Rehabilitation specialist

Adequate rehabilitation programs comprising physical and occupational therapy may be beneficial for patients with motor weakness and motor delay.

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Diet

Diet is as tolerated.

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Activity

Activity in rubella can be maintained as tolerated; however, rest is advised for patients who develop arthralgia or arthritis.

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Contributor Information and Disclosures
Author

Elias Ezike, MD  Consulting Staff, Beaumont Pediatric Center, PLLC

Elias Ezike, MD is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Coauthor(s)

Jocelyn Y Ang, MD  Assistant Professor, Department of Pediatrics, Division of Infectious Diseases, Children's Hospital of Michigan and Wayne State University

Jocelyn Y Ang, MD is a member of the following medical societies: American Academy of Pediatrics, Infectious Diseases Society of America, and Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Leonard R Krilov, MD  Chief of Pediatric Infectious Diseases and International Adoption, Vice Chair, Department of Pediatrics, Professor of Pediatrics, Winthrop University Hospital

Leonard R Krilov, MD is a member of the following medical societies: American Academy of Pediatrics, American Pediatric Society, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, and Society for Pediatric Research

Disclosure: Medimmune Grant/research funds Cliinical trials; Medimmune Honoraria Speaking and teaching; Medimmune Consulting fee Consulting

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Leslie L Barton, MD  Professor Emerita of Pediatrics, University of Arizona College of Medicine

Leslie L Barton, MD is a member of the following medical societies: American Academy of Pediatrics, Association of Pediatric Program Directors, Infectious Diseases Society of America, and Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Robert W Tolan Jr, MD  Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine

Robert W Tolan Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa, and Physicians for Social Responsibility

Disclosure: Novartis Honoraria Speaking and teaching

Chief Editor

Russell W Steele, MD  Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, and Southern Medical Association

Disclosure: Nothing to disclose.

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Number of rubella cases per year.
Number of congenital rubella syndrome cases per year.
Deaths from rubella per year.
Image in a 4-year-old girl with a 4-day history of low-grade fever, symptoms of an upper respiratory tract infection, and rash. Courtesy of Pamela L. Dyne, MD.
Table 1. Reported Cases of Rubella, Deaths From Rubella, and Number of Cases of Congenital Rubella Syndrome in the United States From 1969-2007[2, 3, 4, 5]
YearNumber of CasesNumber of DeathsCases of Congenital Rubella Syndrome
196957,6862931
197056,5523177
197145,0862068
197225,5071442
197327,8041635
197411,9171545
197516,6522130
197612,4911230
197720,3951723
197818,2691030
197911,795162
19803,904150
19812,077519
19822,32547
1983970322
198475215
198563010
198655115
198730605
198822516
198939643
19901,125811
19911,401147
1992160111
199319205
199422707
199512816
199623804
199718105
199836407
199926709
200017609
20012323
200218N/A1
20037N/A1
200410N/A0
200511N/A1
200611N/A1
200712N/A0
Table 2. Clinicopathologic Abnormalities in Congenital Rubella
Abnormality Common/UncommonEarly/DelayedComment
General
Intrauterine growth retardationCommonEarly...
PrematurityUncommonEarly...
StillbirthUncommonEarly...
AbortionUncommonEarly...
Cardiovascular system
Patent ductus arteriosusCommonEarlyMay occur with pulmonary artery stenosis
Pulmonary artery stenosisCommonEarlyCaused by intimal proliferation
Coarctation of the aortaUncommonEarly...
MyocarditisUncommonEarly...
Ventricular septal defectUncommonEarly...
Atrial septal defectUncommonEarly...
Eye
CataractCommonEarlyUnilateral or bilateral
RetinopathyCommonEarlySalt-and-pepper appearance; visual acuity unaffected; frequently unilateral
Cloudy corneaUncommonEarlySpontaneous resolution
GlaucomaUncommonEarly/DelayedMay be bilateral
MicrophthalmiaCommonEarlyCommon in patients with unilateral cataract
Subretinal neovascularizationUncommonDelayedRetinopathy with macular scarring and loss of vision
Ear
Hearing lossCommonEarly/DelayedUsually bilateral; mostly sensorineural; may be central in origin; rare when maternal rubella occurs >4 months' gestation; sometimes progressive
CNS
MeningoencephalitisUncommonEarlyTransient
MicrocephalyUncommonEarlyMay be associated with normal intelligence
Intracranial calcificationsUncommonEarly...
Encephalographic abnormalitiesCommonEarlyUsually disappear by age 1 y
Mental retardationCommonDelayed...
Behavioral disordersCommonDelayedFrequently related to deafness
AutismUncommonDelayed...
Chronic progressive panencephalitisUncommonDelayedManifest in second decade of life
HypotoniaUncommonEarlyTransitory defect
Speech defectsCommonDelayedUncommon in absence of hearing loss
Skin
Blueberry muffin spotsUncommonEarlyRepresents dermal erythropoiesis
Chronic rubelliform rashUncommonEarlyUsually generalized; lasts several weeks
Dermatoglyphic abnormalitiesCommonEarly...
Lungs
Interstitial pneumoniaUncommonDelayedGeneralized; probably immunologically mediated
Liver
HepatosplenomegalyCommonEarlyTransient
JaundiceUncommonEarlyUsually appears in the first day of life
HepatitisUncommonEarlyMay not be associated with jaundice
Blood
ThrombocytopeniaCommonEarlyTransient; no response to steroid therapy
AnemiaUncommonEarlyTransient
Hemolytic anemiaUncommonEarlyTransient
Altered blood group expressionUncommonEarly...
Immune system
HypogammaglobulinemiaUncommonDelayedTransient
LymphadenopathyUncommonEarlyTransient
Thymic hypoplasiaUncommonEarlyFatal
Bone
Radiographic lucenciesCommonEarlyTransient; most common in distal femur and proximal tibia
Large anterior fontanelUncommonEarly...
MicrognathiaUncommonEarly...
Endocrine glands
Diabetes mellitusCommonDelayedUsually becomes apparent in second or third decade of life
Thyroid diseaseUncommonDelayedHypothyroidism, hyperthyroidism, and thyroiditis
Growth hormone deficiencyUncommonDelayed...
Genitourinary system
CryptorchidismUncommonEarly...
Polycystic kidneyUncommonEarly...
Table 3. Age-Specific CD4+ T-lymphocyte Count and Percentage of Total Lymphocytes as a Criteria for Severe Immunosuppression in Persons with HIV
Age Range
< 12 mo1-5 y6-12 y≥13 y
Total CD4+ T-lymphocytes< 750/mcl< 500/mcl< 200/mcl< 200/mcl
CD4+ T-lymphocytes (as % of total lymphocytes)< 15%< 15%< 15%< 14%
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