www.elitecme.com | 2019 | INFECTIOUS DISEASE, DISASTER PLANNING & WOUND CARE 29 child-bearing potential must ensure that they are aware of the need to be properly vacci- nated, prior to becoming pregnant. SELF-ASSESSMENT QUESTION Answers are listed on the last page of the course. 8. The most common manifestation of con- genital rubella syndrome (CRS) is: a) Deafness. b) Blindness. c) Seizures. d) Heart defects. RUBELLA AND BREASTFEEDING There is no data to necessitate the prevention of mothers breastfeeding their infants if they are suffering from a rubella infection, or if they have received a vaccination for rubella (Lamounier, et al. 2004). DIAGNOSIS AND LABORATORY TESTING FOR RUBELLA Because the rash caused by a rubella infec- tion can appear similar to many other ill- nesses and because nearly half of all infected patients can present with no rash (or any other symptoms), laboratory evidence is necessary to verify a rubella infection. The only adequate proof of infection includes: a positive viral culture for rubella, a detection of virus by polymerase chain reaction, or the presence of a rubella-specific IgM antibody. The rubella virus can be found in blood, nasal secretions, throat swabs, urine, and cere- brospinal fluid specimens. Blood (serology) testing for immune system indicators is the most common method of confirming rubella. A significant increase in rubella antibodies, or rubella IgM, can confirm acute rubella cases. Blood should be collected as early as possible after the onset of symptoms (within seven to 10 days) and again in two to three weeks (CDC, 2016-2). The virus can be isolated from throat cul- tures if the cultures are taken from one week before, through two weeks after the onset of rash. Furthermore, cultures should be col- lected from any suspected case of rubella or CRS. Due to the labor intensity of generat- ing viral cultures, their usage is limited and not typically conducted for routine diagnosis. Even so, the isolation of rubella virus is a crit- ical tool to characterize the epidemiology of infection and should be conducted in all cases of rubella or CRS when possible. False-positive test results can occur in patients affected by other viral infections such as parovirus, mono- nucleosis, or in the presence of a positive rheu- matoid factor (CDC, 2016-2). TREATMENT OF RUBELLA Acquired rubella There is no approved treatment that will shorten the course of a rubella infection. In most cases, the symptoms experienced by rubella patients are mild and do not require an intervention. However, since rubella is somewhat contagious, isolation of other peo- ple— especially pregnant women—during the infectious period is warranted. In cases of pregnant women afflicted with rubella who choose to continue their preg- nancy, clinicians may prescribe hyperimmune globulin in an attempt to counter the infection. While this may reduce maternal symptoms, it does not eliminate the risk of CRS (Mayo Clinic). A variety of simple self-care measures are required in cases of rubella infection: • Rest, as appropriate; • Over-the-counter acetaminophen for aches and fever; • Isolation from people that may be immunocompromised; • Alerting people who may have been exposed (Mayo Clinic). Congenital rubella syndrome (CRS) There are no specific antiviral agents that are effective against rubella. As a result, sup- portive treatment should be provided to all patients who are suspected to have CRS. Infants with CRS should be isolated; contact precautions should be followed since viral shedding is common in infants affected with CRS for up to 12 months after birth, unless viral cultures have been obtained demonstrat- ing negative results (Ezike, 2017-1). Asymptomatic infants born to mothers with a known rubella infection should have their vision and hearing screened for abnormalities. The treatment of symptomatic infants includes: • A complete and comprehensive eye evalua- tion. Some patients may need to be referred to an ophthalmologist to treat corneal clouding (corneal clouding can be indicative of infantile glaucoma), cataracts, or retinal disease. Severe cases may need to be corrected with surgical interventions; • Babies suffering from respiratory dis- tress may require supportive intensive care treatment; • Infants with an enlarged spleen should be monitored for adverse effects, but no treat- ment is advised. • Cases of hyperbilirubinemia may require phototherapy or exchange transfusions; • If severe thrombocytopenia develops, cor- ticosteroids should not be used; rather, intra- venous treatment with immunoglobulin may be considered; • Heart abnormalities should be evaluated through echocardiography and referred to cardiology to treat or prevent congestive heart failure. Surgical treatment may be necessary to correct heart anomalies; Neurologic evaluations may be necessary in symptomatic infants to assess for potential abnormalities related to the central nervous system (Ezike, 2017-1). POST-EXPOSURE PROPHYLAXIS Rubella vaccine and Ig are not effective for post-exposure prophylaxis against rubella. Administering a rubella vaccination after exposure is not harmful when administered appropriately and may protect the patient against future exposures. Contraindications and precautions to live attenuated vaccine use should still be followed in the event of exposure to rubella (HSE, 2012). VACCINATION AGAINST RUBELLA Three vaccinations against rubella that were derived from various animal sources were licensed in 1969. These vaccinations were eventually replaced by a human strain that minimized adverse reactions in 1979. The currently available rubella vaccine is a live attenuated virus, first isolated in 1965 from a fetus that was infected with rubella. In the U.S., a rubella vaccine is available only in combination with measles and mumps in the MMR vaccine, or in combination with measles, mumps, and varicella in the MMRV vaccine. The ACIP recommends that MMR vaccine be used if any of its components are indicated (CDC, 2016-2). Even though the rubella virus can be found in nasal secretions of vaccine recipients, the |  CONTINUING EDUCATION