Rubella

Rubella

📌 Definition

Rubella is an acute viral infectious disease, usually mild, caused by the Rubivirus, part of the Togaviridae family. It is characterized by moderate fever, a maculopapular rash, and lymphadenopathy. However, it is highly dangerous during pregnancy due to the risk of congenital rubella syndrome.

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📊 Epidemiology

• Transmitted via airborne droplets (droplet transmission) or transplacentally.

• More common among children and young adults.

• Incidence has drastically decreased in countries with high vaccination coverage.

• Incubation period: 14–21 days (average: 18 days).

• Contagious period: from 7 days before to 7 days after the onset of the rash.

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🧬 Pathogenesis

1. The virus enters through the respiratory tract and replicates in regional lymph nodes.

2. It spreads through the blood (viremia), reaching various tissues, including the placenta.

3. During pregnancy, it can cross the placental barrier and infect the fetus → congenital rubella.

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⚠️ Causes and Risk Factors

Cause:

• Infection with the rubella virus (Rubivirus).

Risk Factors:

• Lack of vaccination

• Close contact with infected individuals

• Pregnancy without prior immunization

• Travel to areas with low vaccination coverage

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🩺 Diagnosis

Clinical Presentation:

• Moderate fever

• Maculopapular rash, starting on the face and quickly spreading to the trunk and limbs

• Postauricular, cervical, and occipital lymphadenopathy (typical sign)

• General malaise, arthralgia (especially in women)

• Mild conjunctivitis, sore throat

Laboratory Diagnosis:

• Serology: Rubella-specific IgM (recent infection)

• IgG: Past immunity or post-vaccination response

• PCR testing on blood or secretions

• During pregnancy: amniotic fluid testing + ultrasound to assess fetal damage

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💊 Medical Treatment

• No specific antiviral treatment available

• Symptomatic management:

• Paracetamol or ibuprofen for fever and pain

• Rest and hydration

• During pregnancy, if infection is confirmed: consult infectious disease and obstetric specialists to assess fetal risk

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🩺 Nursing Care

• Monitor symptoms (fever, rash, pain)

• Educate the patient about the benign course and infectious nature

• Isolate the patient for at least 7 days after rash onset

• In pregnancy: provide emotional support, ultrasound monitoring, and coordinate care with OB-GYN and infectious disease specialists

• Skin care: soft clothing, avoid scratching

• Encourage good hydration

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🛡️ Prevention and Recommendations

• MMR vaccination (Measles, Mumps, Rubella):

• 1st dose at 12–15 months

• 2nd dose at 5–6 years

• Serological screening for women of childbearing age → vaccinate before pregnancy if not immune

• Avoid contact with infected individuals if pregnant and not immunized

• Education and awareness campaigns on vaccination

• Report suspected cases to health authorities

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⚠️ Complications

• Congenital rubella syndrome (if infection occurs during pregnancy, especially in the 1st trimester):

• Congenital deafness

• Heart defects (e.g., patent ductus arteriosus)

• Cataracts, microphthalmia

• Intellectual disability

• Post-rubella arthritis (mostly in adult women)

• Thrombocytopenia

• Encephalitis (rare)