Rubella Infection


Rubella is an acute febrile illness caused by Rubella virus, a single-stranded RNA virus of Togavirus family 

-It is commonly known as German measles or 3-day measles. 

-the virus enters the body through inhalation 

-it replicates in the upper respiratory tract and spreads in the bloodstream to other organs, skin and lymphoid tissues 

-the incubation period is 14 to 21 days 

-the virus has high infectivity but low virulence

Symptoms & Signs 

A.Infection in young children and adults: Fever, rash, malaise, arthralgia, lymphadenopathy, which is most prominent in the posterior cervical and postauricular areas.

Arthralgia: The most common complication of Rubella is arthralgia, and it occurs most frequently in women 

Rubella rash: A fine, pink maculopapular rash begins on the face and rapidly spreads to the trunk and extremities. It lasts for 3 days.  

B.Congenital Infection

-The greatest significance of rubella is not the acute illness but the risk of fetal damage in pregnant women. 

-the risk of fetal malformation is highest in the early stages of pregnancy 

-Intravenous immune globulin injected into the mother does not protect the fetus against rubella infection 

-The classic triad of congenital rubella consists of cataracts, cardiac abnormalities, and deafness. 

-The most common developmental manifestation of congenital rubella is mental retardation.

A.General: Failure to thrive, growth retardation, malabsorption  

B.Cerebral: Microcephaly, encephalitis

C.Ocular: Cataracts, glaucoma, microphthalmia, chorioretinitis 

D.Deafness: Sensorineural in most cases 

E.Cardiac: Pulmonary artery stenosis, pulmonary valvular stenosis,

patent ductus arteriosus, ventricular septal defect

F.Hematologic: Thrombocytopenia, lymphopenia, intravascular coagulation 

G.Skin: Blueberry muffin purpura on head, neck and trunk 


Confirmation of the diagnosis requires laboratory studies. 

A. Nucleic Acid Detection: Rubella virus nucleic acid is detected using RT-PCR 
B. Isolation and Identification of Virus: Rubella virus isolated from nasopharyngeal or throat swabs 
C. Serology: Rubella HI test 


Infection in young children and adults: Rubella is a mild, self-limited illness; no specific treatment is indicated; Patients should be isolated for 7 days after rash onset

Congenital infection: there is no specific treatment 


The primary purpose of rubella vaccination is to prevent congenital rubella infections. 

-Live attenuated rubella vaccine (MMR or MMRV) given in two doses, first dose at 12 to 15 months of age and the second dose at 4 to 6 years of age

-Pregnancy should be avoided for at least 28 days after vaccination.

-Pregnant women should not receive the vaccine, but should be screened for rubella IgG antibodies



-Mumps is a viral infection which primarily affects salivary glands. 

-Mumps virus is a single-stranded RNA virus and is a member of paramyxovirus family 

-The virus is transmitted by the respiratory route via droplets, saliva, and fomites.

-The highest incidence of infection is usually during the late winter and spring months, but it can occur during any season.

-It is observed to occur most frequently in the 5- to 15-year age group. 

The incubation period of mumps is ~19 days

-Viremia allows the virus to travel to all body organs, including salivary glands and central nervous system.

Symptoms & Signs 

The prodrome of mumps consists of low-grade fever, headache, anorexia malaise, and myalgia

-Hallmark of mumps: Unilateral or bilateral parotid swelling

-Other manifestations: Epididymo-orchitis, pancreatitis, acquired deafness, aseptic meningitis and encephalitis 

-Mumps during the first trimester of pregnancy increases the risk of miscarriage


-Diagnosis is made based on clinical findings or/and detection of viral RNA by reverse-transcriptase PCR (RT-PCR) or viral culture 


-Mumps is a self-limited, usually mild, disease. 

-Treatment is supportive and consists of antipyretics, fluids, and analgesics. 

-Stay home from school or work for 5 days after symptom onset.


-Usually Natural infection confers life-long protection

The MMR vaccine is given routinely subcutaneously to all healthy children at age 12–15 months with a second dose at age 4–6 years.

-Mumps vaccine contains live attenuated virus. It is not recommended for pregnant women



Measles is an acute, highly infectious disease characterized by fever, respiratory symptoms, Koplik spots and a maculopapular rash. 

-Measles virus is a highly contagious, spherical, single-stranded, enveloped RNA virus that is a member of the Paramyxoviridae family.

-The virus gains access to the human body via the respiratory tract and is transmitted primarily by respiratory droplets

-Measles is endemic throughout the world.

Symptoms & Signs 

Incubation period: The incubation period for measles is 10 days to fever onset and 14 days to rash onset. 

Prodromal Phase: Cough, Coryza, Conjunctivitis, high-grade fever. Coryza consists of nasal obstruction, sneezing, and sore throat resembling upper respiratory infections. 

Koplik spots

-Pathognomonic of measles

-typically occur 2 days before the rash and only last 12 to 72 hours. 

-they appear as small, irregular and red with whitish center on the palatal or buccal mucosa opposite the molars or on vaginal membranes – ‘grains of sand’ or ‘table salt crystals’ 

Rash: Maculopapular rash progressing in  “downward and outward” fashion; appears 3 – 4 days after onset of prodrome, begins on the face and behind the ears; then spreads to the trunk and extremities, including the palms and soles

-Patients are contagious during the prodromal phase (2–4 days) and the first 2–5 days of rash In the hospital setting, patients with measles should be placed under air-borne precautions.


-Diagnosis is made based on clinical features 

-Labs: Leukopenia, thrombocytopenia, proteinuria  

-A positive serum immunoglobulin (Ig) M antibody for measles confirms the diagnosis. Treatment 

-Antipyretics, fluid resuscitation 

-Vitamin A treatment to reduce morbidity and mortality 

-Limited use of antivirals like ribavirin 

-Serious complications include otitis media, encephalitis, pneumonia, and bleeding disorders. 

Infection confers lifelong immunity.



Two doses of vaccine are estimated to be 97% protective. 

Children: Measles, mumps, and rubella vaccinations should be given as MMR or MMRV at 12–15 months and again at 4–6 years of age. 

Adults: Adults born in 1957 or later should have at least one dose of MMR vaccine 

Contraindications: Vaccine contraindicated in pregnant women, women intending to become pregnant within the next 28 days, immunocompromised persons, and persons with an anaphylactic reaction to a prior dose or vaccine components like neomycin, gelatin, and in children receiving high-dose corticosteroid therapy