Unfortunately, there's no specific antiviral treatment for Rubella
and remember, antibiotics are not effective because this is a viral illness.
Your patient can take acetaminophen to lower their fever as needed
and children older than 6 months can also take ibuprofen.
Remember, don't give any aspirin to anyone under 18
because this can cause Reye syndrome which is a rare but serious condition
that causes swelling in the liver and brain.
Treatment of a newborn baby is focused on managing their complications
including congenital heart defects and cataracts.
They babies may need surgery and the management of ocular congenital rubella syndrome
involves monitoring and glasses if required,
and these patients should see an ophthalmologist.
The prognosis. In children and adults, rubella is usually mild and self-limiting.
However, in babies born with congenital rubella syndrome, the prognosis is poor.
So how do we prevent the spread of rubella? This is through isolation.
You're contagious from one week before to one week after the rash starts
so patients need to stay on strict isolation.
You want to keep unvaccinated patients away from infected people.
Vaccination. Pregnant women are tested for their rubella antibodies
and if not immune, they're gonna receive their MMR vaccine after they have their baby.
You cannot administer an MMR vaccine during pregnancy because it is a live, viral vaccine.
Children will be vaccinated at 12 months and then again around kindergarten.
You can also prevent the spread passively and this is a short-term protection.
This is when mothers who are immune pass these protective antibodies onto their children in utero
and those antibodies protect the newborns and the infants with some immunity
but the protection's gonna fade over time, usually over 6 months.
Once the maternal antibodies have disappeared, the infant is susceptible to rubella infection.
Now, this shows you the different amounts of cases of rubella through the years
and you see it used to be quite high. The dotted line is cases of rubella
and the solid line is cases of congenital rubella syndrome.
You see they sort of mirror each other.
When there's a rise in cases of rubella, women may get pregnant,
and then have children with this congenital rubella syndrome.
There's a definite downward trend and that is due to our immunizations.
Herd immunity. This is where we promote and preserve widespread immunity.
Since the introduction of the rubella vaccine, rubella has virtually been eliminated in the United States
even though not everyone has been vaccinated and this effect is called herd immunity.
But herd immunity is weakening a bit likely due to the drop in vaccination rates.
Here we see on the left, if no one is immunized and infectious disease
including rubella is gonna spread throughout the population.
In the middle, we see if some people are immunized and some are not,
this contagious disease is still gonna spread through the population.
Now, this is our goal. This is herd immunity.
This is where most people are immunized and this can stop the spread of a contagious disease.
There are complications associated with rubella
including brain inflammation which is encephalitis.
Your patient can get a low platelet count or thrombocytopenia, ear infections, and pneumonia.
So this is the biggest problem, is when a woman is pregnant and she gets rubella.
The rubella infection can result in spontaneous abortions which are miscarriages, stillbirths,
congenital rubella syndrome, and the risk is highest with first-trimester exposures to rubella.
Another complication involves the heart and this is a PDA or patent ductus arteriosus
and this is a condition where the blood vessel called the ductus arteriosus
which connects the two major arteries, the aorta and the pulmonary artery,
does not close as expected after a baby is born.
You can also develop cerebral defects, ophthalmic defects
including cataracts, auditory defects causing hearing loss and deafness, prematurity,
and the risk for major defects is highest with infection.
Remember, in the first trimester.
Congenital rubella syndrome is the main reason for the development of the rubella vaccine.