Rubella

PPT

1. RUBELLA Presented by Dr. Daulal Chouhan 2 nd yr resident PSM Dept. Dr. SNMC, Jodhpur

2. RUBELLA (German Measles) Acute infectious, viral disease of older children and young adults, characterized by mild prodromal symptoms, typical rash and painful cervical lymphadenopathy

3. History In 1938 , the etiology was established by Hiro and Tasaka In 1941 Normal Gregg, reported the terotogenic property of virus In 1962 , the virus was isolated In 1966 , the virus was attenuated In 1967 , live attenuated vaccine was prepared

4. Problem Statement World wide in distribution Sporadically, often in epidemics, once in 6-8 years in a cyclic trend Common in children ages 5-10 years old Infection during pregnancy causes Congenital Rubella Syndrome WHO estimates that 100,000 cases of CRS occur in developing countries

5. Conti.. The 2008 estimates suggest that the highest CRS burden is in South East Asia (approximately 48%), India being a major contributor, and Africa (approximately 38%) Developing country have incidence rates of 0.6-4.1 per 1000 live births In 2012 and 2013 (till 31 st May) India reported 28 and 48 rubella outbreaks. Ministry of Health estimates that around 30,ooo abnormal children are being born annually because of rubella

6. Epidemiological Determinants Agent Factors Agent - Rubella virus, RNA virus (Toga virus family) - One antigenic type - Rapidly inactivated by chemical agents, low Ph , and UV light Reservoir –> Humans only, No known carrier state Source of Infection –> Majority subclinical cases, minor clinical cases Infective material –> Respiratory and throat secretions Period of communicability –> 1 week before and 1 week after the appearance of the rash

7. Host Factors Age –> 3-10 yrs ( developing countries) 15 yrs ( developed countries) - Both sexes are susceptible to infection Immunity – Life long after first attack - Maternal immunity up to 6 months of age Environmental Factors - Occurs in seasonal pattern, during winter and spring season Transmission - Droplet infection, droplet nuclei, vertical transmission, portal of entry : respiratory Incubation Period - 2 to 3 weeks ( average 18 days)

8. Clinical Features Post natal rubella occurs in neonates and childhood 50-65% asymptomatic Prodermal phase (mild) :- Coryza , sore throat, low grade fever and dry cough lasting for a day or two Lymphadenopathy :- Post auricular and posterior cervical lymph nodes enlarge slightly one week before the appearance of rash and persist for about 10-15 days after the disappearance of rashes - Not tender among children but tender among adults

9. Conti.. Exanthematous stage :- - Fine maculopapular rash - Minute, discrete and pinkish - Starts on face within 24 hours of the onset of the prodermal symptoms, spreads to trunk on 2 nd day and extremities on 3 rd day - Clears more rapidly, disappears in 3 days - So it is also called as 3-day measles - Rash absent (25% cases) in subclinical cases Conjunctivitis may occur

10. <- Newborn with postnatal rubella Post auricular lymph -> node enlargement <- Rubella infection in pregnancy

11. Complication Arthritis and arthralgia common among women Thrombocytopenic purpura Encephalitis is very rare Common dreadful complication is congenital malformations of the fetus in a pregnant mother

12. Diagnosis Virus isolation from throat swab Serological confirmation can be done by hemagglutination inhibition test Sensitive serological tests are ELISA and RIA

13. Congenital Rubella Syndrome Infants born with a number of defects due to intrauterine infection with rubella virus Congenital rubella is a chronic infection while acquired rubella is an acute infection First trimester of pregnancy is most disastrous time for the fetus , because it is in the stage organogenesis Foetal death and spontaneous abortion

14. The risk and severity of abnormalities varies with the time of infection in pregnancy Stage of gestation Risk of abnormalities in the infant (% of cases) First trimester 85 Second trimester 16 After 20 weeks Birth defects are uncommon

15. Conti.. Congenital malformations - Triad of Deafness, Cardiac (PDA) and Cataract Other defects - Glaucoma, retinopathy, micocephalus , cerebral palsy, IUGR, LBW, hepato-splenomegaly , mental and motor retardation

16. Prevention and Control Control Mild self limited illness Isolation of case in good ventilation room No specific treatment or Antiviral treatment is indicated Encourage the patient to rest Increase fluid intake Provide health teaching about rubella (cause, immunization)

17. Prevention Active Immunization Monovalent Rubella vaccine Wistar RA 27/3 strain, propagated on human diploid cell Live attenuated vaccine Freeze dried vaccine, supplied along with diluent sterile distilled water Dose :- 0.5 ml , SC in upper arm Storage temperature :- 2-8° C Preferred age for immunization is 15-18 months, single dose Efficacy rate is 95% Immunity lasts for at least 15 years, probably lifelong

18. Conti.. Pregnancy is an absolute contraindication Recipients of vaccine should be advised not to become pregnant in 3 months after getting vaccine Combined vaccine:- MR, MMR

19. Vaccination strategy for Rubella First protect women in 15-39 year age Second interrupt transmission by vaccinating children aged 1-14 years Third, all children at age 1 year

20. MMR Vaccine Live attenuated strains of :- - Edmonston -Zagreb Measles virus - L-Zagreb Mumps virus - Wistar RA 27/3 Rubella virus The reconstituted vaccine contains, in single dose of 0.5 ml not less than - 1000 TCID50 of Measles virus - 5000 TCID50 of Mumps virus - 1000 TCID50 of Rubella virus

21. Conti.. Dose – 0.5 ml, SC in upper arm Schedule – Two doses , 1 st at the age of 12-15 months and 2 nd at school entry (4-6 years) Freeze dried vaccine, supplied along with diluent sterile distilled water Reconstituted vaccine -> Destroyed by light, heat labile, susceptible to contamination (No preservative ) -> Protected from light, kept at 2-8°C and use within 4 hrs of reconstitution

22. MMR Adverse Reaction Fever Rash Joint symptoms Thrombocytopenia Parotiditis Deafness Encephlapathy

23. Contraindications and Precautions Sever allergic reaction to prior dose or vaccine component Pregnancy Immunosuppression Sever acute illness Recent blood product

24. Passive Immunization Using Human normal immunoglobulin Given to those who are at risk, such as young close contacts and infected pregnant mothers, preferably within 2-3 days of exposure It prevents or modifies the course of illness Dose -> 20 ml IM Therapeutic abortion is better way of prevention of congenital rubella

25. Global Measles and Rubella Strategic Plan 2012-2020 In 2012 the M&R Initiative launched a new Global Measles and Rubella Strategic Plan which covers the period 2012-20 Vision -> Achieve and maintain a world without measles, rubella and CRS

26. Goals By end 2015 Reduce global measles mortality by at least 95% compared with 2000 estimates Achieve regional measles and rubella/CRS elimination goals By end 2020 Achieve measles and rubella elimination in at least 5 WHO regions

27. The strategy focuses on the implementation of 5 core components :- Achieve and maintain high vaccination coverage with 2 doses of measles and rubella containing vaccines Monitor the disease using effective surveillance and evaluate programmatic efforts to ensure progress and the positive impact of vaccination activities

28. Conti.. Develop and maintain outbreak preparedness, rapid response to outbreaks and the effective treatment of cases Communicate and engage to build public confidence and demand for immunization Perform the research and development needed to support cost-effective action and improve vaccination and diagnostic tools

29. Measles-Rubella vaccination campaign 7 Feb. 2017 - India has launched one of the world’s largest vaccination campaigns against measles and rubella The campaign to vaccinate more than 410 million children aged 9 months to 15 years over the next 2 years is a big step towards improving child survival and preventing birth defects

30. Thank You Polio is gone Measles and Rubella is Next..