Paeds · infectious-diseases
Measles, rubella and congenital rubella
Also known as Measles (rubeola) · Rubella (German measles) · Congenital rubella syndrome · Koplik-spot illness · CRS triad (deafness, cataracts, cardiac)
Fellowship topic on measles, rubella and congenital rubella syndrome: the morbillivirus and rubivirus organisms and their lymphotropic and teratogenic mechanisms; the classic measles prodrome-rash course with Koplik spots and the immune-amnesia aftermath; the mild postnatal rubella illness versus the devastating first-trimester congenital rubella syndrome (deafness, cataracts, cardiac and neurodevelopmental deficit); the differential of febrile-rash illness in a child; IgM/PCR diagnosis timed to the illness; stepwise management of the measles case from vitamin A and supportive care through notification and isolation; prevention through the two-dose MMR schedule, antenatal rubella screening and the herd-immunity threshold above 95 per cent; the special populations (infants, pregnant non-immune women, immunocompromised and under-vaccinated communities); and ANZ/UK/US/Canada guidance.
On this page
Study tools
Your progress
Saved on this device.
Practise this topic
Target exams
Red flags
- A febrile, coughing child with coryza and conjunctivitis who develops a cephalocaudal rash — suspect measles and isolate immediately; this is highly contagious
- Measles complicated by pneumonia, croup with stridor, dehydration, neurological change or corneal ulceration — the leading causes of measles death; admit and treat
- A pregnant woman with a rubella-like rash or contact in the first trimester — confirm serology urgently; up to 90 per cent of first-trimester infections cause congenital rubella syndrome
- An infant with purpura, cataracts, PDA or sensorineural deafness and a maternal rubella exposure in pregnancy — congenital rubella syndrome until proven otherwise
- A subacutely deteriorating, previously measles-infected child with myoclonus and cognitive decline — consider subacute sclerosing panencephalitis
Life stages
Care settings
Clinical exam formats
Board mappings
- General Paediatrics and Infectious Diseases: measles, rubella and congenital rubella — clinical recognition, complications and management
- Immunisation: the two-dose MMR schedule and antenatal rubella screening
- Renewed curriculum — Infectious diseases: measles outbreak response, notification, isolation and contact prophylaxis
- Community and population child health: herd immunity, vaccine coverage and CRS prevention
- General Paediatrics: the febrile child with a cephalocaudal rash — diagnosis and management of measles
- Public health: notification, isolation, exclusion and post-exposure prophylaxis
- Long Case / Structured discussion: congenital rubella syndrome — diagnosis, multidisciplinary management and prevention
- Communication station: explaining measles, rubella, MMR vaccination and the pregnant contact to a family
- Level 2 / 3 — Infection: measles and rubella as vaccine-preventable diseases; diagnosis, complications and public-health responsibilities
- Public health and immunisation: the MMR schedule, herd immunity and elimination goals
- Foundation of Practice (FOP): measles prodrome and rash, Koplik spots, CRS triad and complications
- Applied Knowledge in Practice (AKP): diagnosis, vitamin A treatment, isolation, immunisation and CRS prevention
- History-taking and management: the child with measles or a febrile rash illness
- Communication: explaining measles isolation, MMR and a rubella exposure in pregnancy
- General Pediatrics Content Outline — measles, rubella and CRS: diagnosis, complications, vitamin A and prevention
- Infectious Diseases: morbillivirus and rubivirus, IgM/PCR, immune amnesia and CRS
- Bright Futures / immunisation: the two-dose MMR schedule
- Patient Care: diagnosis and stepwise management of measles, rubella and suspected CRS across age groups
- Systems-Based Practice and Population Health: notification, isolation, post-exposure prophylaxis and herd immunity
- Medical Knowledge: pathophysiology of measles immune amnesia and rubella teratogenicity
- Medical Expert: measles, rubella and CRS diagnosis, complications and management
- Health Advocate and Collaborator: MMR programme, antenatal screening, notification and elimination
- Communicator: explaining measles isolation and rubella-in-pregnancy risk to families
Same rash illness, two completely different stakes
Measles (in the child)
Rubella (in the unborn child)
A febrile, miserable child with Cough, Coryza and Conjunctivitis, plus the pathognomonic Koplik spots on the buccal mucosa, is measles until proven otherwise — and the rash follows, spreading head-to-toe. The rule the examiner rewards: the child is most infectious in the prodrome, before the rash appears — so the contagious window is the one where the diagnosis is hardest. [5] [1]
Overview & Definition
Picture a five-year-old brought to the emergency department with four days of fever, a streaming nose, a hacking cough and red, watery eyes, who this morning developed a blotchy red rash behind the ears that is now spreading down the body. The child has never been vaccinated. This is textbook measles, and the decision you make in the next five minutes — isolate, confirm, treat, notify — protects both the child and everyone who shared the waiting room. Recognising it early is what turns a preventable death into a survivable illness. [5] [1]
Measles, or rubeola, is an acute, highly contagious viral infection caused by the measles morbillivirus, a paramyxovirus spread largely by the airborne route. It is one of the most transmissible human pathogens known: a single case in a susceptible population can infect twelve to eighteen others, and the virus lingers in the air of a room for up to two hours after an infectious person has left it. Rubella, or German measles, is caused by the rubella rubivirus and is a far milder illness in children — but its teratogenic effect on the first-trimester fetus makes it one of the most consequential infections in pregnancy. Congenital rubella syndrome (CRS) is the constellation of permanent defects that follows maternal rubella in early pregnancy. [6] [1]
The clinician's work has three faces. The acute face is to recognise the child with measles, support them through the illness, give vitamin A, and prevent spread through isolation and notification. The obstetric face is to confirm or exclude rubella in early pregnancy and counsel honestly about CRS risk. And the population face is to run the immunisation programme — two MMR doses, antenatal screening, postpartum catch-up — because the child who never catches measles and the fetus who never meets rubella are children programme has protected. [8] [2]
References12ShowHide
- [1]WHO Measles vaccines: WHO position paper. Wkly Epidemiol Rec, 2009.PMID 19714924
- [2]WHO Rubella vaccines: WHO position paper. Wkly Epidemiol Rec, 2011.PMID 21766537
- [3]Mina MJ; Metcalf CJE; de Swart RL; Osterhaus ADME; Grenfell BT Long-term measles-induced immunodulation increases overall childhood infectious disease mortality. Science, 2015.PMID 25954009
- [4]Hussey GD; Klein M A randomized, controlled trial of vitamin A in children with severe measles. N Engl J Med, 1990.PMID 2194128
- [5]Perry RT; Halsey NA The clinical significance of measles: a review. J Infect Dis, 2004.PMID 15106083
- [6]Banatvala JE; Brown DWG Rubella. Lancet, 2004.PMID 15064032
- [7]Best JM Rubella. Semin Fetal Neonatal Med, 2007.PMID 17337363
- [8]McLean HQ; Fiebelkorn AP; Tempte JL; Wallace GS Prevention of measles, rubella, congenital rubella syndrome, and mumps, 2013: summary recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep, 2013.PMID 23760231
- [9]Huiming Y; Chaomin W; Mei M Vitamin A for treating measles in children. Cochrane Database Syst Rev, 2005.PMID 16235283
- [10]Zimmerman LA; Stanley CP; Goswami ND; Reef SE Progress Toward Rubella and Congenital Rubella Syndrome Control and Elimination — Worldwide, 2012-2020. MMWR Morb Mortal Wkly Rep, 2022.PMID 35143468
- [11]Toizumi M; Motomura H; Dinh Sy T; Takahashi K; et al Clinical manifestations of congenital rubella syndrome: A review of our experience in Vietnam. Vaccine, 2019.PMID 30503658
- [12]Lam T; Lillie J; Orr D; Stodden R; et al A recent surge of fulminant and early onset subacute sclerosing panencephalitis (SSPE) in the United Kingdom: An emergence in a time of measles re-emergence. Eur J Paediatr Neurol, 2021.PMID 34388650