About Rubella(German Measles)
Rubella (German measles) is an infection caused by the rubella virus. Although it most commonly occurs in young children, it can affect anyone. The illness is usually mild. However, rubella in a pregnant woman can cause serious damage to the unborn child. Immunisation with the measles, mumps and rubella vaccine (MMR vaccine) has made rubella uncommon in the UK.
Rubella is an infection caused by a virus. It is usually mild with fever and a rash. About half of the people who get rubella do not have symptoms. If you do get them, symptoms may include
- A rash that starts on the face and spreads to the body
- Mild fever
- Aching joints, especially in young women
- Swollen glands
- Rubella is most dangerous for a pregnant woman’s baby. It can cause miscarriage or birth defects.
Rubella spreads when an infected person coughs or sneezes. People without symptoms can still spread it. There is no treatment, but the measles-mumps-rubella (MMR) vaccine can prevent it.
Rubella is an acute, contagious viral infection. While rubella virus infection usually causes a mild fever and rash illness in children and adults, infection during pregnancy, especially during the first trimester, can result in miscarriage, fetal death, stillbirth, or infants with congenital malformations, known as congenital rubella syndrome (CRS).
The rubella virus is transmitted by airborne droplets when infected people sneeze or a cough. Humans are the only known host.
Rubella spreads when someone who is infected coughs or sneezes tiny germ-filled droplets into the air and onto surfaces. People who catch the virus are contagious for up to a week before and a week after the rash appears. Some people don’t know they’re infected because they don’t have symptoms, but they can still pass the virus on to others.
Rubella is usually mild in children. Sometimes it doesn’t cause any symptoms.
A pink or red-spotted rash is often the first sign of infection. It starts on the face and then spreads down to the rest of the body. The rash lasts about 3 days. This is why rubella is sometimes called the “3-day measles.”
- Along with the rash, you or your child might have:
- A mild fever – from 99 F to 100 F
- Swollen and pink-colored eyes (conjunctivitis)
- Swollen glands behind the ears and on the neck
- Stuffy, runny nose
- Sore joints (more common in young women)
In children, the disease is usually mild, with symptoms including a rash, low fever (<39°C), nausea and mild conjunctivitis. The rash, which occurs in 50–80% of cases, usually starts on the face and neck before progressing down the body and lasts 1–3 days. Swollen lymph glands behind the ears and in the neck are the most characteristic clinical feature. Infected adults, more commonly women, may develop arthritis and painful joints that usually last from 3–10 days.
Once a person is infected, the virus spreads throughout the body in about 5-7 days. Symptoms usually appear 2 to 3 weeks after exposure. The most infectious period is usually 1–5 days after the appearance of the rash.
When a woman is infected with the rubella virus early in pregnancy, she has a 90% chance of passing the virus on to her fetus. This can cause miscarriage, stillbirth or severe birth defects known as CRS. Infants with CRS may excrete the virus for a year or more.
Children with CRS can suffer hearing impairments, eye and heart defects and other lifelong disabilities, including autism, diabetes mellitus, and thyroid dysfunction – many of which require costly therapy, surgeries, and other expensive care.
The highest risk of CRS is in countries where women of childbearing age do not have immunity to the disease (either through vaccination or from having had rubella). Before the introduction of the vaccine, up to 4 babies in every 1000 live births were born with CRS.
The rubella vaccine is a live attenuated strain, and a single dose gives more than 95% long-lasting immunity, which is similar to that induced by natural infection.
Rubella vaccines are available either in a monovalent formulation (vaccine directed at only one pathogen) or more commonly in combinations with other vaccines such as with vaccines against measles (MR), measles and mumps (MMR), or measles, mumps and varicella (MMRV).
Adverse reactions following vaccination are generally mild. They may include pain and redness at the injection site, low-grade fever, rash and muscle aches. 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.
Rubella (German measles) is infectious. That means you catch it from another person who has the rubella virus. Rubella is passed on by direct contact and by coughing and sneezing the virus into the air. It takes 2-3 weeks to develop symptoms after being infected. You are infectious from one week before symptoms begin until four days after the rash appears. Therefore, affected children should stay away from school and not mix with others for four days after the rash starts. Infected adults should stay away from work for four days to try to reduce the chance of spreading the infection.
Rubella in pregnancy:
If you are pregnant and have rubella (German measles) in the first few months of pregnancy, there is a high chance that the rubella virus will cause severe damage to your developing baby. The virus affects the developing organs and the baby may be born with a serious disability – the congenital rubella syndrome.
Complications of congenital rubella syndrome (rubella birth defects) include cataracts, deafness, and heart, lung, and brain abnormalities.
Having rubella infection in the first three months of pregnancy also increases your risk of having a miscarriage:
- If you are pregnant and come into contact with someone with rubella you should check your rubella status. Your midwife or doctor will normally have a record of this if you do not know. (A blood test is routinely taken early in pregnancy. This checks to see if you are immune and have antibodies in your blood against rubella.) Most women are immune due to previous immunization and will not develop rubella. No further action is needed if you are known to be immune. You do not need a rubella booster.
- If you are not immune and come into contact with someone with rubella then blood tests may be advised. These can tell if you are developing rubella before symptoms begin. Further action depends on the results of these tests.
- See a doctor if you are pregnant and develop an illness that you think may be rubella. Rubella is uncommon now due to immunisation. Other viruses can cause rashes similar to rubella. Most viruses do not harm the unborn child. Blood tests can confirm or rule out rubella if it is suspected.
In the unlikely case that you are confirmed to have rubella, you will be referred to a doctor who specializes in pregnancy and childbirth (an obstetrician). The obstetrician will discuss with you the possibility of your baby having congenital rubella syndrome. The risk is greater if you are less than 20 weeks pregnant. If you are more than 20 weeks pregnant, then the risk of your unborn baby developing congenital rubella syndrome is very small. No treatment can prevent the development of congenital rubella syndrome.
No medications can shorten the rubella infection, and symptoms are usually mild enough that no treatment is necessary.
- Bed rest and acetaminophen may help relieve any symptoms.
- If a woman contracts the virus during pregnancy, hyperimmune globulin may be prescribed to help fight off the virus and reduce the chance of congenital rubella syndrome.
- A person with a rubella infection should avoid coming into contact with anyone who may be pregnant and anyone who has a weakened immune system until 1 week after the rash appears.
- If a child has rubella, their school should be informed.
There is no treatment that will kill rubella (German measles) virus. Most people with rubella are not very ill, do not need any treatment and soon make a full recovery. The immune system makes antibodies during the infection. These clear the virus and then provide lifelong immunity. It is therefore very rare to have more than one bout of rubella.
- Paracetamol will ease a high temperature (fever) or aches and pains. Ibuprofen is an alternative.
- You should give children lots to drink if they have a fever.
- See a doctor if any worrying or unusual symptoms develop.
What is the difference between German measles and measles?
German measles (rubella) is caused by a different virus to the virus which causes measles, so they are completely different conditions. They do have some similar symptoms, such as a rash, temperature, and cold-like features. Both are now uncommon in the UK as the combined vaccine, measles, mumps and rubella (MMR) vaccine, protects against both.
If you catch measles in pregnancy, it may cause some problems but these are different problems to those caused by German measles. Measles in pregnancy may make you more likely to have a miscarriage or early (premature) delivery, whereas German measles cause your baby to have birth defects.
Rubella is sometimes known as “three-day measles,” as symptoms can be similar, but the symptoms of rubella are milder than those of measles.
- Measles causes a bright red rash and spots may appear inside the mouth, but a rubella rash is pink and mild.
- Coughing and sneezing can spread both viruses.
- The incubation period for measles is 1 to 2 weeks, but for rubella, it can take 2 to 3 weeks.
- Rubella is less contagious than measles.
- Symptoms will appear in around 90 percent of people exposed to measles, but only 25 to 50 percent of those infected with rubella will be symptomatic.
- Measles can lead to fatal complications, but rubella is normally only serious if contracted during pregnancy.
- With measles, there may be a fever of over 40 degrees Celsius (C) or 104 degrees Fahrenheit (F). With rubella, any fever will usually be below 38.3 degrees C, or 100.94 degrees F.
- Infection with both viruses can be prevented with the measles mumps and rubella (MMR) vaccination.
- Rubella spreads between people through coughs and sneezes.
- The virus replicates in the lymph nodes and the nasopharynx, the tube connecting the nasal cavity and the soft palate.
- Between 5 and 7 days after infection, the virus spreads throughout the body in the blood.
- A person who has rubella is contagious for a week before the rash appears and a week after.
- If a woman is pregnant and she may have come into contact with rubella, she should see a doctor at once.
- It is best to call the doctor’s office first, as they may wish to schedule an appointment at a time when there is the least chance of passing the virus on.
- If there are no symptoms, diagnosis is made by testing a saliva or blood sample. If IgM antibodies are present, this may indicate 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 the virus and has never been immunized.
- The only way to prevent the contraction of rubella is through vaccination.
- The MMR vaccine protects against rubella.
- The MMR vaccine protects against rubella.
- Taken with the measles and mumps vaccination, the rubella vaccine prevents transmission.
- The vaccine comes in the form of a live attenuated or weakened, virus. It is delivered at 12 to 15 months of age with a second dose at 4 to 6 years.
- Any adult who has not yet had the measle, mumps, and rubella (MMR) vaccine should receive it.
- Only the following adults do not need the MMR vaccine:
- anyone with blood tests showing they are immune to measles, mumps, and rubella
- those born before 1957
- 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 is not at high risk of measles or mumps exposure
- pregnant women or those thinking of getting pregnant in the next 4 weeks
- people with severely compromised immune systems
- Anyone who is sick should wait until they recover before having the vaccination.
- Side effects of the vaccine are minimal.
- Around 15 percent of people will have a mild fever around 7 to 12 days after the injection, and 5 percent will develop a minor rash.
- Teenage or adult women may experience joint aches. Fewer than 1 in 1,000,000 have a severe reaction.
- There is no link between the MMR vaccination and autism. The dangers of not being vaccinated are higher than the danger posed by any adverse effects.