NWT Clinical Practice Guidelines for Primary Community Care Nursing - Communicable Diseases

Rubella (German ) Definition • infectiosum (fifth disease) Viral exanthematous illness, often mild and • Mononucleosis subclinical. Rarely seen in an adequately immunized population. Complications In Fetus Cause Congenital syndrome may result in any of • Rubella the following fetal anomalies: • Deafness Transmission • Cataracts • Airborne spread of respiratory droplets • Microcephaly • Direct contact with nasopharyngeal secretions • Mental retardation • May also be passed through the placenta to the • Cardiac lesions fetus • Hepatosplenomegaly • Jaundice Incubation The risk is highest in the first trimester. • 14-23 days In Children Contagion • Thrombocytopenia • High In Adolescents Communicability • • 1 week before to 14 days after erupts • Encephalitis

History Diagnostic Tests • Mild illness None. • Up to 50% of cases are asymptomatic • Low-grade fever Management • Mild systemic signs (e.g. headache, malaise) Prevention of Congenital Rubella • Arthralgia (joint pain), more common in Syndrome in Fetus adolescents • All female adolescents and women of childbearing age should be given measles- Physical Findings mumps-rubella (MMR) vaccine unless they have • Low-grade fever documented proof of immunity • Conjunctivitis • Women immunized against rubella are advised • Macular rash, which starts on face and not to become pregnant for at least 1 month after progresses to trunk and then the extremities receiving the vaccine • Rash does not coalesce and lasts about 3 days • The vaccine-type virus can cross the placenta; • Lymphadenopathy (especially post-auricular, however, no case of congenital rubella has ever posterior cervical and suboccipital nodes) occurred in newborns of women who were • Arthritis (in adolescents) inadvertently immunized while pregnant • The fetal risk in women "accidentally" Differential Diagnosis immunized during is minimal and • Rubeola (measles) does not mandate automatic termination of the • Unspecified viral pregnancy • Adverse drug reaction •

September 2004 Rubella (German Measles) - Pediatrics 1 NWT Clinical Practice Guidelines for Primary Community Care Nursing - Communicable Diseases

• If a pregnant woman is exposed to rubella Goals of Treatment (native disease, not associated with vaccine), an • Treat the symptoms of the illness antibody titer should be obtained immediately; if • Prevent spread to others antibody is present, the woman is immune and not at risk Nonpharmacologic Interventions • If antibody is not detectable, a second titer • Rest should be obtained 3 weeks later; if antibody is • Fluids in adequate amounts to maintain present in the second specimen, infection has hydration occurred and the fetus is at risk for congenital • Parents or caregiver should be advised to limit rubella syndrome new visitors to the home, especially pregnant • If antibody is not detectable in the second women, for 14 days after appearance of rash specimen, a third titer should be obtained 3 • Report all cases to the public health department weeks later (i.e. 6 weeks after exposure); a negative result at this time means that infection Pharmacologic Interventions has not occurred, whereas a positive result Antipyretic and analgesic for fever and pain: means that infection has occurred, and the fetus acetaminophen (A class drug), 10-15 mg/kg q4h is at risk for congenital rubella syndrome prn • Consult a physician about use of immune globulin for prophylaxis during pregnancy, as it Antibiotics are to be used only if bacterial predictably and reliably prevents rubella and complications occur. congenital rubella syndrome Monitoring and Follow-Up For further information, see the Canadian • Advise parents or caregiver to bring the child Immunization Guide, 6th edition (Health Canada back to the clinic if there are signs of 2002). complications • Complete recovery usually occurs in 1-2 weeks Prevention and Control of Disease in Children Referral • Rubella vaccine (as measles-mumps-rubella This is usually a self-limiting illness, so referral is [MMR]) is given in two doses: first dose after usually not necessary. Be alert for complications child's first birthday, second dose at 18 months such as encephalitis, and refer as needed. of age

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