Rubella is an infection caused by the rubella virus; it can cause severe harm to the unborn child. The number of rubella cases has fallen dramatically, thanks to vaccination programs, but the battle against this infection is not yet won.
The symptoms of rubella (also known as German measles) are often so mild that more than half of people with the infection do not even notice that they have contracted it.1
However, rubella contracted during early pregnancy can cause substantial negative outcomes for the unborn child. This is known as congenital rubella syndrome.
Rubella is a preventable disease; the vaccine is often given in conjunction with measles and mumps (MMR vaccine). Before the vaccine was widely available, the US would see widespread outbreaks every 6-9 years. In Europe, outbreaks would occur every 3-5 years.
Although the World Health Organization (WHO) declared the Americas officially free of rubella transmission on 29 April 2015, the current rate of vaccination is only around 80%. Because the disease can arrive with overseas travelers, it is essential to maintain a high rate of immunization.
In this article, we will discuss the symptoms, diagnosis and treatment of rubella.
Contents of this article:
Here are some key points about rubella. More detail and supporting information is in the main article.
- "Rubella" is Latin for "little red"
- Rubella is viral and predominantly transmitted by coughs
- The rubella virus can pass across the placenta and affect the fetus
- Roughly half of rubella cases present very few symptoms
- The predominant symptom of rubella is a rash, but other symptoms include a runny nose, headache and fever
- Rubella in pregnant women can cause congenital rubella syndrome in the unborn child
- Congenital rubella syndrome is the leading cause of congenital deafness
- Diagnosis can be made by testing blood or saliva samples
- There are no medications that shorten the rubella infection
- The rubella vaccination is the only way to prevent the disease.
What is rubella?
Rubella's rash is less bright than measles but itchier.
Image credit: CDC
Characterized by a red rash, "rubella" is Latin for "little red." The rash from which it gets its name is generally less bright than measles but can be itchy.
Rubella was first described as a separate disease from measles by scientists in Germany, hence its alternative name - German measles.
The virus replicates in the lymph nodes and the nasopharynx (the tube connecting the nasal cavity and the soft palate) and is transmitted via coughs. An individual with rubella is contagious for 1 week before the rash arrives and for 1 week after.
Between 5 and 7 days after infection, the virus can be found in the blood as it spreads throughout the body. The rubella virus is capable of passing through the placenta and has teratogenic (mutation-causing) properties. The virus can destroy cells, or prevent them from dividing - this causes congenital rubella syndrome.
Rubella rarely strikes in young infants or people over 40. In general, the older the individual, the worse the symptoms of rubella will be.
Symptoms of rubella
Around half of rubella cases pass unnoticed. For infections that are serious enough to take hold, the major symptom is a pinkish-red rash that appears 2-3 weeks after exposure to the virus.2
The rash often starts on the face and moves to the trunk and limbs. After 3 days of the rash, it fades and disappears, hence one of its alternative names - 3-day measles.
Other symptoms of rubella include:
- Stuffy or runny nose
- Mild fever (102 °F or lower)
- Inflamed, red eyes
- Testicular swelling
- Inflammation of nerves
- Lymph nodes enlarged and tender
- Joint aches.
Congenital rubella syndrome
Congenital rubella syndrome occurs when a pregnant woman contracts the rubella virus and it passes through the placenta to the unborn child. The infection can trigger miscarriage or stillbirth, or cause severe damage to the developing fetus. Congenital rubella syndrome is the leading cause of congenital deafness.
If infected during the first trimester, there is a 51% chance that the fetus will be affected. This likelihood drops to 23% if infected 13-26 weeks after conception. Worldwide, there are an estimated 100,000 cases of congenital rubella syndrome every year.3
Often, more than one defect can arise, with deafness being the most common. These effects on the infant can include:4
Cataracts due to congenital rubella syndrome.
Image credit: CDC
- Deafness or hearing impairment
- Congenital heart disease (especially pulmonary artery stenosis and patent ductus arteriosus)
- Developmental delay
- Retinopathy (acute damage to the retina)
- Microphthalmia (abnormally small, deformed eyes)
- Liver, spleen or bone marrow issues (sometimes disappearing shortly after birth)
- Small head
- Low birth weight
- Micrognathism (small lower jaw).
As the child develops, there might be conditions that appear as they age. These might include autism,5schizophrenia,6 learning disabilities and diabetes.7 However, if rubella is contracted after the 20th week of pregnancy, problems in the newborn are rare.
Although currently under control in the US, rubella can mete out a deadly toll if an outbreak occurs. According to the Centers for Disease Control and Prevention (CDC):
"During the 1962-1965 global rubella pandemic, an estimated 12.5 million rubella cases occurred in the United States, resulting in 2,000 cases of encephalitis, 11,250 therapeutic or spontaneous abortions, 2,100 neonatal deaths, and 20,000 infants born with congenital rubella syndrome."
The precise mechanisms by which the rubella virus influences the fetus are unknown. Some research shows that it might involve apoptosis, otherwise known as programmed cell death.
Apoptosis is a normal physiological process that is triggered for a variety of reasons. For instance, the separation of a fetus' fingers and toes is reliant on the apoptosis of the cells between each digit.
It appears that under the influence of rubella, this mechanism becomes out of control. Some studies implicate a tumor-suppressor protein called p53. Research into the molecular actions involved is ongoing.
Diagnosis of rubella
If an individual believes they have rubella, it is important to call the doctor's office rather than visiting. It is vital to avoid interaction with pregnant women.8
Diagnosis is made by testing a saliva or blood sample. If IgM antibodies are present, they signify a new rubella infection. If IgG antibodies are present, they indicate that a rubella infection has either been present in the past or the individual has already been vaccinated.
If neither antibody is present, the individual does not carry a rubella infection and has never been immunized.
Treatment of rubella
There are no medications that shorten the rubella infection. Most often, the symptoms are mild enough that no treatment is necessary. Doctors recommend that someone with a rubella infection isolates themselves during the infectious period - 1 week before the rash appears (if the individual thinks they have been infected) and 1 week after the rash appears.
If pregnant, hyperimmune globulin may be prescribed to help fight off the virus and reduce the chance of congenital rubella syndrome.9
Prevention of rubella
Rubella is included in the MMR vaccination alongside measles and mumps.
The only effective way to prevent the contraction of rubella is through vaccination. Taken in conjunction with measles and mumps, the MMR vaccine prevents transmission and has been in use for 40 years.
The vaccine comes in the form of a live attenuated (weakened) virus and is delivered at 12-15 months with a second dose at 4-6 years old.
The following adults should get the MMR vaccine:
- Those working in health care
- Women of childbearing age
- International travelers.
The following adults do not need the MMR vaccine:
- Anyone with blood tests showing they are immune to measles, mumps and rubella
- People born before 1957 who are not planning on getting pregnant
- Anyone who has already had two doses of MMR or one dose of MMR plus a second dose of measles vaccine
- Anyone who has already had one dose of MMR and are not at high risk of measles or mumps exposure.
Pregnant women or people thinking of getting pregnant in the next 4 weeks should not get the shot. Also, anyone who is sick should wait until they are better before having the vaccination.
Side effects of the vaccine are minimal. Roughly 15% of people will have a mild fever around 7-12 days after the injection and 5% will develop a minor rash. Teenage or adult women may experience joint aches. Fewer than 1 in 1,000,000 have a severe reaction.
According to the WHO:
"Mass immunization campaigns in the Region of the Americas involving more than 250 million adolescents and adults did not identify any serious adverse reactions associated with the vaccine."
It is also worth noting that there is no evidence whatsoever of any link between the MMR vaccination and autism.10-14
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