UNITV RUBELLA GERMAN MEASLES Presented by Mrs Juliet

UNIT-V RUBELLA (GERMAN MEASLES) Presented by : Mrs. Juliet D’Souza Department : Community health nursing

LEARNING OBJECTIVES � At the end of the class the students are able to § Define rubella. § Discuss the epidemiological determinants of rubella. § Mention the clinical features of rubella. § List out the diagnostic evaluation of rubella. § Explain the management of rubella § Enumerate the prevention of rubella.

INTRODUCTION � Rubella was discovered in 18 th century. � The name rubella originated from a Latin word meaning little red. � It is a mild viral infection that occurs most frequently in children and young adults. � Rubella infection in pregnancy may lead to fetal death or congenital rubella syndrome.

Introduction � Global statistics reveal that an estimated 110000 babies are found to be born with CRS every year. � The name 3 -day measles is used because of the typical course of rubella exanthema that begins initially on the face and neck and spreads centrifugally to the trunk and extremities within 24 hours.

Definition �Rubella, also called German measles or three- day measles, caused by rubivirus. �The signs of the disease are: swelling of lymph nodes in the neck and a skin rash which first appears on the face and then rapidly spreads to other parts of the body.

Epidemiological determinants � Agent factors: § RNA virus of the toga virus family causes rubella. § The virus is found in the nasopharynx, throat, blood, CSF and urine of an infected person. § Person is infectious from a week before the appearance of symptoms to about a week after the appearance of the rashes. § Infants born with congenital rubella may shed the virus for many months.

Host factors � Humans are the only known host. � Rubella affects mainly the children in the age group of 3 -10 years. � Persons older than 15 years now account for over 70% of the cases in developed countries. � One attack results in life long immunity , second attacks are rare.

Environmental factor �This disease shows seasonal pattern of occurrence. �It occurs in temprate zones during the later winter and spring with the epidemics of every 4 -9 years

Mode of transmission � The virus is transmitted directly from person to person by droplet nuclei from nose and throat. � The portal entry is via the respiratory route. � The virus can cross the placental barrier and infect the fetus.

Incubation period �Usually 2 -3 weeks with an average of 18 days.

Symptoms � Children manifest the symptoms of rash , low fever, sore throat, cough , nausea and mild conjunctivitis. � Rash starts on the face and neck before progressing down the body and lasts 1 -3 days � Lymph glands behind the ears and in the neck are swollen. � Infected adults more commonly women , may tend to develop arthritis and painful joints that normally lasts from 3 -10 days.

Complications � Arthritis in the finger, wrists and knees � Otitis media � Encephalitis. � Miscarriage � Still birth � Severe birth defects � Arthralgia � Thrombocytopenic purpura � Encephalitis

Main Clinical Events During Pregnancy �The clinical events occurring in the neonatal age is more important and divided into two major groups �Congenital Rubella �Post Natal Rubella

Congenital rubella syndrome �Occurs during the first trimester of pregnancy. � Affects the development of the fetus. �May lead to several birth defects. � Infection may affect all organs. �May lead to fetal death or premature delivery. �Severity of damage to fetus depends gestational age.

Postnatal rubella � Occurs in Neonates and Childhood � Viremia (presence of virus in the blood) develops after 7 – 9 day � Lasts for 13 – 15 days � The appearance of suggestive immunologic basis for the rash � In 20 – 50 % cases of primary infections are subclinical.

Management �Rubella is a mild self limited illness. �No specific treatment or Antiviral treatment is indicated. �Isolation and quarantine �Increase fluid intake �Encourage the patient to rest

Treatment �Good ventilation �Encourage the patient to drink juices. �Provide health teaching about Rubella (cause, immunizations)

Prevention � Rubella can be prevented by immunization. � The vaccine is given at the same time as the measles and mumps vaccine. � If pregnant or planning to get pregnant, get blood tests to check for rubella protection. � Avoid close contact with anyone who has rubella infection. � Anyone with rubella should stay home until non infectious.

MMR Vaccine �The MMR vaccine is a mixture of three live attenuated viruses, administered via injection for immunization against measles, mumps and rubella virus. �It is generally administered to children around the age of one year, with a second dose before starting school( 0. 5 ml) subcutaneously.

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