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Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Rubella


Text Only Home | Graphic-Rich Site | Overview | Risk and Causation | Diagnosis | Treatment | Prognosis | Differential Diagnosis | Specialists | Comorbid Conditions | Complications | Factors Influencing Duration | Length of Disability | Ability to Work | Maximum Medical Improvement | Failure to Recover | Medical Codes | References

Medical Codes

ICD-9-CM:
056.00 - Rubella with Unspecified Neurological Complication
056.01 - Encephalomyelitis Due to Rubella; Encephalitis Due to Rubella; Meningoencephalitis Due to Rubella
056.09 - Rubella with Neurological Complications, Other
056.71 - Arthritis Due to Rubella
056.79 - Rubella with Other Specified Complications, Other
056.8 - Rubella with Unspecified Complications
056.9 - Rubella without Mention of Complication
647.50 - Infectious and Parasitic Conditions in the Mother Classifiable Elsewhere, but Complicating Pregnancy, Rubella, Unspecified as to Episode of Care or Not Applicable
647.51 - Infectious and Parasitic Conditions in the Mother Classifiable Elsewhere, but Complicating Pregnancy, Rubella, Delivered, with or without Mention of Antepartum Condition
647.52 - Infectious and Parasitic Conditions in the Mother Classifiable Elsewhere, but Complicating Pregnancy, Rubella, Delivered, with Mention of Postpartum Condition
647.53 - Infectious and Parasitic Conditions in the Mother Classifiable Elsewhere, but Complicating Pregnancy, Rubella, Antepartum Condition or Complication
647.54 - Infectious and Parasitic Conditions in the Mother Classifiable Elsewhere, but Complicating Pregnancy, Rubella, Postpartum Condition or Complication

Related Terms

  • German Measles
  • Three-day Measles

Overview

Image Description:
Rubella - A child's head, face and chest are seen covered with an evenly distributed rash on the face and neck and a scattered rash shown on the upper body.
Click to see Image

Rubella, or German measles, is a mild viral disease caused by the rubella virus (member of the Togaviridae family, genus Rubivirus). It is moderately contagious and is spread by respiratory droplets during coughing, sneezing, and talking. Once infected, the individual has lifelong immunity to the disease. The most important aspect of rubella is the high incidence of congenital rubella syndrome (CRS) (see Complications) in the newborn if a non-immune mother (either not vaccinated or who has not had rubella) is infected during the first or second trimester of her pregnancy. Individuals with immune system impairment (those with AIDS, autoimmune diseases, or on chemotherapy) are also at greater risk for acquiring rubella.

Incidence and Prevalence: Due to effective immunization programs, rubella is seen infrequently; in 2004, the Centers for Disease Control and Prevention (CDC) reported that, since 2001, less than 25 cases have occurred yearly in the US (Dyne). When infrequent small outbreaks of rubella do occur in the US, most cases are in individuals who are natives of countries where vaccination is not routine. From 2000–2005 no rubella outbreaks were reported (Ezike). Worldwide, the number of reported cases is high in countries where routine immunization is lacking or has been introduced only recently (Ezike); however, the worldwide incidence of rubella is decreasing as more countries make immunizations available as a standard part of childhood preventative medicine. In areas without immunization, rubella epidemics occur every 4 to 7 years.

Source: Medical Disability Advisor



Causation and Known Risk Factors

Most children receive routine vaccination against rubella in the US. In many states this vaccination is required for school attendance. However, it is estimated that 10% to 20% of women of childbearing age still have not been vaccinated. People most at risk are immigrants who come from countries where vaccination is not standard and those native-born citizens who refuse immunization for religious or philosophical reasons.

Source: Medical Disability Advisor



Diagnosis

History: The incubation period is usually 12 to 23 days. History often includes contact with another individual ill with rubella. The disease is usually mild and may even go unnoticed. Children can have few symptoms, but adults may experience warning symptoms (prodrome symptoms) that include a rash with skin redness or inflammation, low-grade fever, joint aches (arthralgias), headache, loss of appetite (anorexia), general discomfort (malaise), a runny nose, and loss of interest in personal care. The rash usually begins on the face, neck, and torso and progresses down the body to the arms and legs, lasting 3 to 5 days. Minor joint and muscle aches (myalgias) may last from 1 to 14 days.

Physical exam: The exam may reveal a faint rash, low-grade fever, and enlarged and tender lymph nodes (lymphadenopathy) behind the ears and at the back and sides of the neck. Redness of the eyes (conjunctivitis) is usually present. Sometimes, purple spots (petechiae) called "Forchheimer spots" may be seen on the soft palate.

Tests: Normally rubella is diagnosed on the basis of signs and symptoms rather than from test results. However, blood tests (serology) may confirm early rubella infections in pregnant women. As the immune system mounts a response to the virus, virus-specific antibodies appear. A nasal or throat swab may be taken for a viral culture.

Source: Medical Disability Advisor



Treatment

There is no treatment for rubella that will change the progression of the infection. Symptoms can be treated with over-the-counter medications to relieve the fever, headache, or muscle and joint aches. Individuals are contagious and should be quarantined for about a week after symptoms appear, especially if they work with at-risk individuals (those with altered immunity or non-immune women of childbearing age).

The most effective way to reduce the spread of rubella infections is through vaccination, particularly among children. Healthy young adults can also be vaccinated effectively. Because of the high risk of serious complications from congenital infection of the fetus, women who anticipate bearing children should be tested for their susceptibility to rubella infection. If they show susceptibility, women should be vaccinated at least 3 months before they anticipate becoming pregnant (if already pregnant, vaccination must not be done). If a woman is infected with rubella during the first or second trimester of pregnancy, she should seek immediate medical attention to monitor the developmental progress of the fetus.

Source: Medical Disability Advisor



Prognosis

The prognosis for rubella is generally excellent. In otherwise healthy individuals, rubella infections clear within 2 to 3 weeks, resulting in lifelong immunity against the virus. Treatment of symptoms such as headache and arthralgias with analgesic medications helps the individual become more comfortable during the self-limiting course of the disease; the individual then recovers completely. Rubella infection or inadvertent vaccination of pregnant mothers is generally not an immediate risk to the mother, but can lead to fetal death or CRS.

Source: Medical Disability Advisor



Differential Diagnosis

  • Allergic drug reaction
  • Erythema infectiosum (fifth disease)
  • Roseola
  • Rubeola (measles)
  • Scarlet fever

Source: Medical Disability Advisor



Specialists

  • Infectious Disease Internist
  • Internal Medicine Physician
  • Obstetrician/Gynecologist

Source: Medical Disability Advisor



Comorbid Conditions

  • Compromised immune system

Source: Medical Disability Advisor



Complications

The most serious complication of rubella infection occurs if a non-immune woman is infected during the first or second trimester of pregnancy. If this happens, her baby can be born with CRS (up to 65% of infants); this syndrome of serious birth defects may result in an abnormally small head (microcephaly), mental retardation, congenital heart defects, cataracts, blindness, and hearing impairment. If infection occurs in the first 2 months of pregnancy, the risk of this syndrome or of spontaneous abortion (miscarriage) is 20% to 50%. There is a small risk of the syndrome if the woman receives the vaccine too close to becoming pregnant.

Very rarely, rubella causes ear infection (otitis media), inflammation of the brain (encephalitis), or results in blood clotting abnormalities. Individuals with deficient immunity (e.g., leukemia, lymphoma, generalized cancer, AIDS) or who are undergoing steroid treatment or chemotherapy may experience more serious disease if infected with rubella. These individuals should not receive the rubella vaccine. The rubella vaccination itself can cause a transient viral infection in the blood (viremia). Up to 40% of women over age 25 may develop this.

Source: Medical Disability Advisor



Factors Influencing Duration

After the quarantine period, up to a week of disability may be required. The length of extended disability for complications of rubella infection will depend upon the nature and severity of the symptoms. The immune status of the person at the time of rubella infection will affect the development of complications and alter the length of disability. Diabetic individuals and those with compromised immune systems (e.g., undergoing chemotherapy or with AIDS) may have more severe infections and require longer disability. Pregnant women who become infected may need a longer period of disability, particularly if they experience difficulties with their pregnancy or if their child is born with CRS.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Extended restrictions or accommodations will not be required after the overt symptoms of infection disappear.

Risk: Because it is often difficult to determine who is at risk for the disease, people with rubella should be isolated from other individuals for at least 1 week after the initial symptoms appear. In an immunocompromised individual, working with heavy public contact, with indigent or incarcerated populations, or in health care settings may place the individual at increased risk of further or recurrent infection. An individual with symptom onset within the last 24 to 48 hours may be at a more infectious state and should avoid working in settings with immunocompromised individuals. Some risk can be mitigated by frequent hand washing, gloves, or masks.

Capacity: Upon return to work after the isolation period, capacity may be mildly reduced for a short period of time (1 to 2 weeks) by malaise, headaches, or muscle and joint pains. Once the infection has resolved, capacity will be unaffected.

Tolerance: Tolerance is dependent on whether the individual experiences residual symptoms associated with the infection upon return to work; however, tolerance is typically not an issue.

Source: Medical Disability Advisor



Maximum Medical Improvement

60 days.

Source: Medical Disability Advisor



Failure to Recover

If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case.

Regarding diagnosis:

  • Has individual had contact with someone with rubella?
  • Has individual traveled recently to countries where rubella is prevalent?
  • Does individual have a rash?
  • Did the rash start on the face, neck, and torso, and then spread to the rest of the body?
  • Does individual have a low-grade fever, arthralgias, or headache?
  • Does individual have loss of appetite, malaise, runny nose, and loss of interest in personal care?
  • On exam, was lymphadenopathy present?
  • Does individual have conjunctivitis?
  • Was petechia present on the soft palate?
  • Was rubella serology done? Antibody testing?
  • Have conditions with similar symptoms been ruled out?

Regarding treatment:

  • Did individual respond to conservative treatment?

Regarding prognosis:

  • Was individual isolated from other individuals who may be at risk?
  • Does the individual have any conditions that may affect ability to recover?
  • Is individual in the first or second trimester of pregnancy?

Source: Medical Disability Advisor



References

Cited

Dyne, Pamela L. "Pediatric Rubella." eMedicine. Ed. Richard G. Bachur. 16 Apr. 2012. Medscape. 4 Nov. 2014 <http://emedicine.medscape.com/article/802617-overview#showall>.

Ezike, Elias. "Pediatric Rubella." eMedicine. Ed. Russell W. Steele. 13 May. 2013. Medscape. 4 Nov. 2014 <http://emedicine.medscape.com/article/968523-overview#showall>.

Source: Medical Disability Advisor