MULTAN   -   Rubella is an acute mild exanthematous (skin eruption or rash occurring as a symptom in a disease such as measles) infection of children and adults resembling mild measles but with the potential to cause fetal infection and birth defect.

Nishtar Medical University (NMU) Senior Medical Officer, Dr  Imran Rafiq, told  APP that unlike measles, rubella is only moderately contagious and prior to vaccination (MMR) incidence was the highest in the spring among children aged 5 to 9 years.

Once termed third disease, measles and scarlet fever being the first and second exanthematous infections in childhood, he said adding that after infection, through Measles-Mumps-Rubella (MMR) vaccination, most people develop life long protection against this disease.

Reinfection occurs (majority asymptomatic) as demonstrated by rise in antibody titre in previously vaccinated people, the SMO informed.  

There have been rare cases of congenital rubella acquired through the reinfection of a vaccinated mother. This disease spreads by droplets. Patients are at their most contagious when the rash is erupting and virus may shed from 10th day before to two weeks after its appearance, Dr Imran explained.

Rash may be immune mediated; it appears as immunity develops and viral titre falls. Infants with congenital  rubella shed large qualities of the virus for many months. About the clinical features he maintained that the incubation period of this disease is 12 to 23 days while postnatal rubella is a mild infection.

Adults may experience malaise, fever, anorexia, (loss of appetite) whereas the main symptoms are palpable and enlarged cervical and posterior auricular  and cervical lymph nodes and a maculopapular rash starting on the face and moving down which may be accompanied by coryza and conjunctivitis which last for 3 to 5 days, senior medic noted.Complications are uncommon and Arthritis may occur affecting the wrist fingers and knee joint and dissolving over a month may be seen as a rash appears (women more than men).

Hemorrhagic manifestation occurs in  three thousand (children more than adults) and may be due to low platelet count as well as vascular damage.

He said that Congenital rubella can be catastrophic in early pregnancy leading to fetal death, premature delivery, and many conjunctile defects.

The younger the fetus when infected the more severe the illness is, he said and added that in the first two months of gestation, there is an up to 85 pc chances of being affected by either multiple defects or spontaneous abortion.

In the third month  of gestation, there are around 30 pc chances of developing a single defect ( deafness)   dropping to 10 per cent  in the 4 month and nil after 20 week of gestation.

Replying to a question  Dr Imran said that temporary defects included: low birth weight, (LBW), low platelet count, enlarged liver and spleen, Hepatitis, meningitis and jaundice. While permanent defects include hearing loss, cardiac abnormalities, small size head, inguinal hernia, cataract and glaucoma.

Developmental  defects may become apparent as the Infant grows, for example myopia. mental retardation diabetes, behaviour and language disorders. Positive IgM rubella or four field rise in IgG is diagnostic. All women of child bearing age  should be vaccinated before pregnancy. Women should not become pregnant in the three months following vaccination, he recommended.