Rubella In Question Form

Link to CXR Fundamentals Series on EM:RAP

We explore Rubella (German measles or three-day measles), a disease that remains clinically relevant despite being considered nearly eradicated in the US due to vaccination.

• Congenital rubella syndrome can cause severe complications including cataracts, cardiac abnormalities, growth restriction, and hearing loss
• Rubella typically presents with cephalocaudal rash, low-grade fever, and arthralgia 
• The disease is less severe than measles but still concerning for pregnant women
• Written documentation of at least one MMR dose is sufficient evidence of immunity
• PCR testing provides the most accurate diagnosis during acute infection
• Isolation period is seven days after rash onset to prevent transmission
• Rubella has a long 17-day incubation period with contagiousness spanning 7 days before and after rash
• Droplet precautions are appropriate for hospitalized patients
• Management of exposed pregnant women involves isolation and post-delivery vaccination
• Global vaccination coverage varies significantly, with lower rates in low-income regions

The full Invictus program is coming soon with continuous updates, comprehensive videos, MCQs, and resources to support physicians throughout their careers.

Transcript

Intro and MRAP Updates

Speaker 1 0:03

Hey party people , mel Herbert here for your free Invictus podcast . Before we get started , let's talk about a couple of things . On MRAP , we have released the Radiology Fundamentals series . You should go and watch that if you're an MRAP subscriber , and if you're not an MRAP subscriber , well , you should be . This is an amazing series done by Chris Riley . We shot it in the studio . It's super high quality . It will get you up to speed about how to read an x-ray , whether it's super high quality . It will get you up to speed about how to read an x-ray , whether you're a newbie or whether you have been doing this for quite a while . It is really exceptionally done . It is by far the best radiological series for um test x-ray reading that I've ever seen . And this is just the first of the beginning of a number of series that we're going to have coming out on trauma , on pediatric trauma , on slit lamps , on opmology and a whole bunch of stuff shot at the highest level for your dining goodness .

Speaker 1 0:49

What else do I have to tell you about ? Oh , asep . If you go on ASEP this year , after the keynote I will be with Joe Sex and Noah Wiley of the Pit and we're going to do a conversation about the Pit and how it's made realistic , and Noah Wiley's going to be there and it's going to be a lot of fun . So hopefully we'll see you at ACIP . Acip is early this year . It is in Salt Lake City and it's in early September . I've never been to Salt Lake City , so I'm excited to go and check out the tar . That is you . Now let us get actually . The other thing is , I should tell you , is it on the YouTube channel ? I think I'm going to post a thing I did about IVIG . I'm fascinated by IVIG its indications how it works , when it works , when we should be thinking about it . So that'll be on the YouTube .

Rubella Overview

Speaker 1 1:30

But now let's get into this episode and I want to talk about Rubella . So let's do it as a series of 10 questions and I think by the end of it we'll have a pretty good idea about Rubella . I should say this oh , I forgot to say this when I did my in-service exam back in the day , I got a pretty good score , and then , when I certified , I got a pretty good score . And then , when I recertified , I got a pretty good score . And then , when I recertified it , I got a passing grade . Thank you , and I think part of that is because I'm old and demented . But also in the last recertification there was a ton of pediatrics and I'd stopped seeing a lot of pediatric patients a few years before , and there was a lot on rashes , pediatric rashes and viral syndromes , and I frankly just forget that stuff if I don't go over it constantly . So this is one of those syndromes which we should talk about . There'll probably be a few questions on the exam and let's do it .

Speaker 1 2:24

So what is the most common manifestation of congenital rubella syndrome ? I know we're going to talk about rubella and all these questions are going to be on rubella , but this is just a way of learning about rubella rather than just reading it . So rubella back in the day was a terrible disease , mostly because of infections that occurred during pregnancy ,

Congenital Rubella Syndrome

Speaker 1 2:43

and the rubella syndrome was associated with a significant amount of maternal death , with cataract issues , with encephalitis , with a whole bunch of bad things which would happen to fetuses , and so that's why , in order to get a marriage certificate , you had to have evidence that you had been vaccinated against rubella or had already had an infection . So it's a big deal for that reason In and of itself , if you're a little kid or an adult with rubella not that big a deal . Some people call this the three-day measles syndrome . So it's like measles but a lot less severe , except if you're pregnant . It's also called German measles .

Speaker 1 3:20

So what is the most common manifestation of congenital rubella syndrome ? A hearing loss , b cardiac abnormalities , c cataracts or D growth retardation . Which one do you think it is ? The answer is cataracts . You don't really need to know this for the exam , but that congenital syndrome which is associated with cardiac abnormalities , growth restriction , death , cataracts all of these bad things , cataracts is the most common one . Now . Death cataracts all of these bad things . Cataracts is the most common one .

Speaker 1 3:46

Now here's question . Two Six-year-old , unvaccinated child presents with a cephalocordial rash , starts in the head , goes down Low-grade fever , arthralgia After returning from Afghanistan . What is the most likely diagnosis ? Measles , rubella , scallop

Symptoms and Diagnosis

Speaker 1 4:00

fever , contact dermatitis Well , it could be measles or it could be rubella . But up fever contact dermatitis Well , it could be measles or it could be rubella . But since we're doing rubella , this is rubella . How do you tell the difference between rubella and measles ? Mostly because the rubella syndrome is a lot less severe . Remember that we talked about measles . When you've got measles , you are miserable , you don't usually get as sick and it doesn't last as long when you have rubella .

Speaker 1 4:22

Question three which of the following is considered evidence of rubella immunity ? A history of rubella symptoms without laboratory confirmation . B born after 1965 with no vaccination records . C written documentation with at least one dose of MMR or . D negative IgM serology . And the answer here is written documentation about at least one MMR vaccine . So even if you just have had one of the two doses , you're considered to have significant immunity . Now the other things may include things like you've got laboratory evidence of immunity with an IgG . You have born prior to 1957 , because then everybody had it . A history of symptoms without confirmation being born after 1965 or a negative IgM serology do not meet the criteria for whether you have prior immunity . If you want to know , you can do the IgG test to see if you've had it in the past or if you've had vaccinated and you forgot about it .

Speaker 1 5:21

Question four what is the recommendation isolation period for a patient with confirmed rubella after the onset of rash ? Is it three days ? Is it seven days ? Is it 14 days ? Is it seven days ? Is it 14 days ? Is it 23 days ? The correct answer is seven days . So you tend to be infectious for about seven days after it becomes obvious that you've got the disease . So you want to hide that person away for about seven days from

Pregnancy Concerns and Management

Speaker 1 5:44

the pregnant people , all right , or other unvaccinated persons , as it were .

Speaker 1 5:50

Which diagnostic test is likely the most accurate for confirming acute rubella syndrome ? So I've got this person , they've got the rash , they're heading down . What test could I do ? Could I do IgG serology B ? Could I do a PCR of nasal throat or urine samples ? Could I do an IgM or could I do a CBC ? And the answer is PCR . So if you're acutely sick and you want to know , there is a PCR and that is probably the best test during an acute sickness to make the diagnosis .

Speaker 1 6:20

Here's question six A pregnant woman is exposed to a confirmed case of rubella . What is the most appropriate management ? A administer MMR vaccine . B isolate her from pregnant stuff and vaccinate after delivery . C administer immune therapy . D no action . And the answer is isolate her from pregnant stuff and vaccinate after delivery . Now I actually don't know about immunoglobulin therapy for rubella , but now I do because I looked it up . So there is a Cochrane collaboration review that says that there is post-exposure passive immunization for preventing rubella and rubella syndrome that is available . So in that rare , rare circumstance where that comes up , this would be another option . The issue here is that rubella in the US was considered like a dead disease gone . Nobody has it , thank you very much . So this just doesn't come up that much , but maybe we'll see a return . But it turns out from the Copicurin collaboration they say that this passive hyperimmune globulin should help . The key thing with this one is isolation . Don't infect any more people . And then you vaccinate after delivery , usually 28 days after delivery .

Speaker 1 7:31

Question seven which of the following complications of rubella is most likely to require airway management or ventral tree support ? Florombo-cytopenic purpura that certainly occurs with rubella rarely , but you don't need to tube those people . Hepatic dysfunction absolutely concur with rubella syndrome , but you don't usually have to tube those people . Encephalitis absolutely occurs with rubella syndrome , but

Rubella Testing and Prevention

Speaker 1 7:55

you don't usually have to tube those people . Encephalitis absolutely occurs with rubella syndrome Rarely , but does occur Obviously you might want to tube that person . And then D arthralgia . So the answer is encephalitis , but they get arthralgia as well . Okay , let's do .

Speaker 1 8:03

Question eight what is the incubation period for rubella ? Is it seven days , 12 days , 17 days or 23 days ? Well , it's actually quite a long incubation period and it is about 17 days , and you're contagious for about 7 days before incubation and seven days after the rash . Let me say that again . So it's got a long incubation period , but you are contagious approximately seven days before the rash and seven days after the rash . So we already talked about that seven-day thing after the rash .

Speaker 1 8:34

Question nine which region has the lowest rubella vaccination coverage according to the 2020 surveillance reports ? The Africa region , the Southeast Asia region , the Western Pacific region or low-income countries ? And again , this is not something you really need to know , but it's you know . It's low-income countries because they have less vaccination and that doesn't really matter where you are . Vaccine's good it turns out . Last question A patient with suspected rubella is admitted to the hospital .

Speaker 1 9:00

Which precautions should be utilized ? Contact precautions , droplet precautions , airborne precautions or standard precautions be utilized Contact precautions , droplet precautions , airborne precautions or standard precautions ? And the answer is this is a droplet spread thing , so put on some masks on to everybody . It's not that infectious compared to measles , so

Invictus Program Updates

Speaker 1 9:17

droplet infections is considered sufficient and obviously keep your pregnant or potentially pregnant docs and nurses away from this patient if you can , if they're unvaccinated , okay . So that was a little bit about rubella done in a different way , done as mostly just you know questions .

Speaker 1 9:35

What's happening with the full invictus ? We are recording a lot of videos , we are editing a lot of videos , we are making a lot of mcqs , we are building a website . It's all happening as fast as we can . Great faculty . This is really going to be pretty cool , and the coolest thing is that we're going to continuously update it . We're going to continuously be involved with you . Emergency medicine is terrifying . You have to know so much and you have to know it for the rest of your career . And this little thing that we're creating it's going to help you pass your test , but I also think it's going to help you with your practice of ER and urgent care and all the things that you might be doing with your life . So , herbert , out for now . More soon , bye-bye .