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The following text is from an archived Red Book® edition and may not reflect current recommendations or information. To view the current edition, click here.
Section 3. Summaries of Infectious Diseases
Rubella
Clinical Manifestations
Etiology
Epidemiology
Diagnostic Tests
Treatment
Isolation of the Hospitalized Patient
Control Measures
CLINICAL MANIFESTATIONS:
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Postnatal Rubella. Rubella usually is a mild disease characterized by a generalized erythematous maculopapular rash, generalized lymphadenopathy (commonly suboccipital, postauricular, and cervical), and slight fever. Transient polyarthralgia and polyarthritis rarely occur in children but are common in adolescents and adults, especially females. Encephalitis and thrombocytopenia are rare complications. Maternal rubella during pregnancy can result in miscarriage, fetal death, or a constellation of congenital anomalies (congenital rubella syndrome).
Congenital Rubella. The most commonly described anomalies associated with congenital rubella syndrome are ophthalmologic (cataracts, retinopathy, and congenital glaucoma), cardiac (patent ductus arteriosus, peripheral pulmonary artery stenosis), auditory (sensorineural hearing impairment), and neurologic (behavioral disorders, meningoencephalitis, and mental retardation). In addition, infants with congenital rubella syndrome often are growth retarded and may have radiolucent bone disease, hepatosplenomegaly, thrombocytopenia, and purpuric skin lesions (giving a "blueberry muffin" appearance). Mild forms of the disease can be associated with few or no obvious clinical manifestations at birth. The occurrence of congenital defects is as high as 85% if infection occurs during the first 4 weeks of gestation, 20% to 30% during the second month, and 5% during the third or fourth month.
ETIOLOGY: Rubella virus is an enveloped, positive-stranded RNA virus classified as a Rubivirus in the Togaviridae family.
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EPIDEMIOLOGY: Humans are the only source of infection. Postnatal rubella is transmitted primarily through direct or droplet contact from nasopharyngeal secretions. The peak incidence of infection is during late winter and early spring. Approximately 25% to 50% of infections are asymptomatic. Immunity from wild-type or vaccine virus usually is prolonged, but reinfection on rare occasions has been demonstrated and rarely has resulted in congenital rubella. The period
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