Rubella; German measles
Rubella is a contagious viral infection with mild symptoms associated with a rash.
Causes, incidence, and risk factors
The disease is caused by a virus that is spread through the air or by close contact. It can also be transmitted to a fetus by a mother with an active infection, causing severe disease in the fetus. In children and adults, rubella is usually mild and may even go unnoticed.
Children generally have few symptoms, but adults may experience fever, headache, malaise, and a runny nose before the rash appears. A person can transmit the disease from 1 week before the onset of the rash, until 1-2 weeks after the rash disappears. The disease is less contagious than rubeola (measles). Lifelong immunity to the disease follows infection, and there is a safe and effective vaccine to prevent rubella.
Rubella is most serious because of its ability to produce defects in a developing fetus if the mother is infected during early pregnancy. Congenital rubella syndrome occurs in 25% or more of infants born to women who acquired rubella during the first trimester of pregnancy.
Defects are rare if the infection occurs after the 20th week of pregnancy. One or more defects may occur in an infected fetus and include deafness, cataracts, microcephaly, mental retardation, congenital heart defects, and other problems. A miscarriage or stillbirth may occur.
Risk factors include lack of immunization and exposure to an active case of rubella.
- Low-grade fever (102 F or lower)
- General discomfort or uneasiness (malaise)
- Runny nose
- Inflammation of the eyes (bloodshot eyes)
- Rash with skin redness or inflammation
- Muscle or joint pain
- Encephalitis (rare)
- Bruising (from low platelet count, rare)
Signs and tests
- A rubella serology
- A nasal or throat swab for viral culture
There is no treatment for this disease. Acetaminophen can be given to reduce fever. The treatment of congenital rubella syndrome is for the defects that may be present.
Rubella is usually a mild, self-limited infection.
About 25% or more infants born to mothers infected with rubella during early pregnancy will develop congenital rubella syndrome associated with a poor outcome.
- Congenital rubella syndrome
- Encephalitis (rare)
- Otitis media (rare)
- Transient arthritis (common in adolescent children with rubella)
Calling your health care provider
Call for an appointment with your doctor if:
- You are a woman of childbearing age and are unsure of your immunity to rubella
- Severe headache, stiff neck, earache, or visual disturbances develop during or after a case of rubella
- You or your child need to receive MMR immunization (vaccine)
Rubella is preventable with vaccination. Rubella virus vaccine is recommended for all children. It is routinely given between 12 and 15 months of age, but is sometimes given earlier during epidemics. A second vaccination (booster) is routinely given between the ages of 4 to 6. MMR immunization (vaccine) is a combination vaccine that protects against measles, mumps, and rubella.
Women of child-bearing age may be screened by rubella serology. If immunity is not present, immunization can be given if conception can be prevented for 28 days after the vaccination. Vaccination should not be given at any time during pregnancy or to a person with an immune system altered by cancer, corticosteroid therapy, or radiation treatment.
Although great care is taken not to give vaccine to an already pregnant woman, in the rare instances where that has occurred, no abnormalities have been detected in the infants.
by Gevorg A. Poghosian, Ph.D.