RUBELLA

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ETIOLOGY
The name rubella is derived

from Latin, meaning little red.

It was not until 1814 that it was

first described as a separate disease in the German medical literature, hence the common name German measles.
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Hiro and Tosaka in 1938

confirmed the viral etiology by passing the disease to children using filtered nasal washings from persons with acute cases.
The first rubella vaccines were

licensed in 1969.

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RUBELLA VIRUS
Rubella virus is classified as a

togavirus, genus Rubivirus.

It is an enveloped RNA virus,

with a single antigenic type that does not cross-react with other members of the togavirus group.
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Rubella virus is

relatively unstable and is inactivated by lipid solvents, trypsin, formalin, ultraviolet light, low pH, heat, and
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EPIDEMIOLOGY
Rubella infections occurred

in epidemic proportion at 6to 9- intervals

1964- more than 20,000

cases of congenital rubella syndrome and an unknown number of stillbirths occurred in the United 3/19/12

In countries where

vaccination is uncommon, the incidence of rubella infection is high and epidemic are frequent
Individuals who have not

been vaccinated have a higher level of susceptibility 3/19/12

Individuals Requiring Rubella

Immune Status Determination

Preschool-age and school-age

children
All females at or just before

child bearing age

Woman about to be married Married women Pregnant women
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SIGNS and SYMPTOMS

Vary widely from person to

person and may not be recognized in some cases especially if the characteristic rash is light or absent, as may occur in substantial number of cases
Rubella infection also resemble

in other disorders such as 3/19/12

ACQUIRED INFECTION
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Incubation Period
Varies from 10-21 days, and

12 to 14 days is typical
Infected person usually

contagious for 12-15 days, beginning 5 to 7 days before the appearance of rash
Last from 3 to 5 days and

generally requires minimal

Permanent effects are
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CLINICAL PRESENTATION
Usually mild Begins with prodromal period of

catarrhal symptoms
Followed by involvement of

retroauricular, posterior cervical and postoccipital lymph nodes

Finally, emergence of

maculopapular rash on the face and then on the neck and trunk
Temperature less than 34.4 C is
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CONGENITAL INFECTION
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usually mild, self-limiting

disease with only rare complication in children and adults

in pregnant women especially

those infected in the first trimester have devastating effects on the fetus

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 in utero infection can result in fetal death

or manifest as rubella syndrome

Rubella Syndrome deafness cataracts heart defects microcephaly bone alterations liver and spleen damage

About 10 % to 20 % of infants infected in 3/19/12 utero fail to survive beyond 18 months

clinical evidence of congenital

rubella infection may not be recognized for months or even years after birth
Rubella immunity develops in

almost all children who had congenital rubella.

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IMMUNOLOGICAL MANIFESTATION
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ACQUIRED INFECTION
appearance of both

immunoglobulin G (IgG) and immunoglobulin M ( IgM) antibodies is associated with the appearance of clinical signs and symptoms

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IgM
IgM antibodies become detectable

a few days after the onset signs and symptoms and reach peak levels at 7 to 10 days
these antibodies persist but

rapidly diminish in concentration over the next 4 to 5 weeks until antibody is no longer clinically detectable 3/19/12

IgG
production of IgG also associated

with clinical signs and symtoms

antibody increase rapidly for the

next 7 to 21 days, then level of or even decrease in strength

detection of IgG antibody is a

useful indicator of rubella infection only when acute and convalescent blood are drawn 3/19/12 several weeks apart

PASSIVE LATEX AGGLUTINATION TEST

(The to edit Master subtitle style ClickRUBAscanCard Test )

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The RUBAscanCard Test is a

passive latex agglutination test for the qualitative detection of rubella IgG and IgM antibodies in human serum or as an aid in the determination of immune status.
The RUBAscanCard Test can

also be used to give semiquantitative results when serial dilutions of properly paired 3/19/12 specimens are tested to

PRINCIPLE
Latex is sensitized according to

a patented process using solubilized rubella virus antigens from disrupted virions.
This latex reagent, when mixed

with serum containing rubella antibodies on a card surface, will agglutinate forming visible clumps. 3/19/12

PRINCIPLE
In the absence of antibody, or if

the concentration is insufficient to react, the latex will remain smooth and evenly dispersed.
In a qualitative sense, the

presence of rubella antibodies is an indication of previous infection and presumptive of immunity. 3/19/12

PRINCIPLE
An interpretation of the test

results can be used to evaluate the immune status of the individual with regard to resistance or susceptibility to primary rubella infection.
The test is configured to give

qualitative results by testing specimens either undiluted or 3/19/12

SPECIMEN COLLECTION and PREPARATION

Single specimens are required

for qualitative antibody level determinations.

In suspected clinical infections

or exposure, two specimens for semi-quantitative testing should be obtained.

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The first should be collected

within three days of the onset of rash or at the time of exposure and tested upon arrival at the laboratory.
This specimen should then be

stored frozen until the second specimen is collected 7-21 days after the onset of rash or at least 30 days after exposure if no clinical symptoms occur.3/19/12 Both

Whole blood is collected and the

serum is separated. Specimens may be stored up to 48 hours at 2 - 8C. Specimens should be frozen if longer storage is required.
Do not heat inactivate serum.

Serum that displays excessive particulate matter, lipemia, or hemolysis could affect the test. patient is required prior to
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No special preparation of the

QUALITY CONTROL
Reagent B, RUBAscan Card Dilution

Buffer, Phosphate buffered saline solution, containing bovine serum albumin, with 0.02% sodium azide (preservative).

Control ++, RUBAscan High Reactive

Control (human serum), with 0.1% sodium azide (preservative). Control (human serum), with 0.1% sodium azide (preservative).3/19/12

Control +, RUBAscan Low Reactive

PROCEDURE
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UNDILUTED SPECIMENS
1.Mark the card to identify Control +, Control -, or all samples being tested. 2. With a micropipettor, place 25 L of Control +, Control -, or patient sample onto the appropriate circle. 3. Using a new plastic stirrer for 3/19/12 each circle, spread the serum to

4.

Gently invert the dispensing bottle several times to thoroughly mix Reagent A. 5. Before uncapping the bottle, gently tap base on counter top to assure no latex reagent remains in the tip. Dispense one freefalling drop of Reagent A (approx. 15L) onto each circle containing the serum. 6. Place the card on a rotator and
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ALTERNATE PROCEDURE
This procedure will approximate a 10 IU/mL sensitivity level. 1. Mark the card to identify Control +, Control -, or all samples being tested. 2. With a micropipettor, add 100 L of Reagent B to the appropriate squares for each control and sample being tested. 3. With a micropipettor, add 25 L of
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4.

Using the same micropipettor with a new tip, place 25 L of Control + directly into the buffer in the appropriate square and mix the serum and buffer by drawing up-and-down with the micropipettor 12 times. Avoid the formation of bubbles. The serum in this square is now a 1:5 dilution. 5. Using the same micropipettor 3/19/12

6.

Repeat the procedures in step 3 (with a new tip each time) for the Control - or for each patient sample being tested. 7. Using a new plastic stirrer for each circle, spread the serum to fill the entire circle. 8. Gently invert the dispensing bottle several times to thoroughly mix Reagent3/19/12 A.

9. Before uncapping the bottle, gently tap

base on counter top to assure no latex reagent remains in the tip. Dispense one free-falling drop of Reagent A (approx. 15L) onto each circle containing the serum.

10. Place the card on a rotator and rotate for 8 min under a moistened humidifying cover. 11. Immediately following mechanical rotation, read the card macroscopically in the wet state under a high intensity incandescent lamp. Gently tilt the card 3/19/12 (three or four back-and-forth motions) to

INTERPRETATION of RESULT
The Control + should show

agglutination, while the Control - should show no agglutination.

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