Snapshot A mother brings her 14-month-old daughter to the pediatrician for the evaluation of a rash. The mother describes the rash as beginning on the face, and subsequently spreading to the rest her body over 1 day. She also reports that her daughter has a mild fever, and redness in her eyes. She has not been vaccinated per parents' preferences. Temperature is 100°F (37.8°C). There is mild bilateral nonexudative conjunctivitis, postauricular lymphadenopathy, and petechiae on the soft palate and uvula. Pink maculopapules are found in the face, neck, trunk, and extremities. Introduction Vaccine preventable viral exanthem caused by the rubella virus from the Togaviridae family Acquired via inhalation of aerosols replicates within nasopharyngeal cells and regional lymphnodes initially → viremia Congenital rubella syndrome hematogenous spread of the virus from the mother to the fetus highest infection rate in the first trimester maternal immunity is protective birth defects: sensorineural deafness ocular cataracts pigmentary retinopathy cardiac defects includes patent ductus arteriosus, branch pulmonary artery stenosis "blueberry muffin lesions" petechiae and purpura Presentation Clinical manifestations acute development of a maculopapular rash beginning on the face and spreading caudally the rash becomes generalized in about 24 hours lasts ~ 3 days there may be minimal systemic symptoms low grade fever rubella often presents with a low-grade fever (usually < 101°F [38°C]) fever from measles can be ~104°F (40°C) lymphadenopathy usually post auricular, posterior cervical, suboccipital Forchheimer spots soft palate exanthem (can also appear on the uvula) small red macules or petechiae non-specific arthralgias/arthritis Evaluation Antibody testing rubella-specific IgM antibody via enzyme immunoassay (most commonly used) or > 4-fold rise in rubella-specific IgG antibody in acute and convalescent samples Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) Viral isolation great for surveillance and viral strain identification Differential Measles Parvovirus B19 infection Treatment Medical management mainly supportive treatment there is no specific therapy to target this virus Preventive measures immunization with measles mumps and rubella (MMR) vaccine recommended at 12-to-15 months old, and 4-to-6 years old contraindications (remember, this is a live attenuated virus vaccine): severe allergic reaction pregnancy or having plans to become pregnant counsel patient to not become pregnant for at least 28 days after being administered the MMR vaccine there is a theoretical risk of the fetus acquiring congenital rubella syndrome immunodeficiency (e.g., primary, HIV [CD4+ < 200/microL])