What is Rubella?
Rubella (German: Rüphelahls) is a viral disease caused by the human herpesvirus type 1 (HHV-1). HHV-1 causes the most common form of childhood cancer, called congenital rubella syndrome (CRS), which affects approximately one out of every 400 live births.
The word “rubella” is the Latin diminutive of “rubeola,” which is the word for “red” in Latin. The word “rubeola” comes from the Latin words rubeus meaning “red” and olere meaning “to be active.”
There are many forms of “red measles,” including African measles, Amurtican measles, and Alaskan measles. All of these forms are named for the striking red rash they cause.
The term “german measles” is misleading and should be abandoned.
What are the symptoms of rubella?
See Your doctor if you think you have rubella (german measles). The following list includes general information about the symptoms of rubella. Each child may experience symptoms differently. Symptoms can include:
rash that begins as small red spots that usually cover the face and spread to the trunk. The rash is generally not itchy.
swelling of lymph nodes in the back of the neck
acute arthritis (pain and swelling affecting multiple joints) in one or more joints, including the small joints of the hands and feet.
Congenital rubella syndrome (CRS) is caused by the mother acquiring rubella during the first 20 weeks of pregnancy. The risk period for mothers is between 10 and 26 days after exposure.
Congenital rubella syndrome is a collection of birth defects caused by congenital rubella that can affect many parts of the body. It is one of the most preventable causes of developmental disability.
The most common symptom of congenital rubella syndrome (CRS) is deafness.
How is rubella spread?
Rubella is spread by contact with respiratory secretions from an infected person. In addition to respiratory secretions, the virus can be present in blood and urine. It is not spread through saliva, or sneezing. The incubation period (the time between exposure to an organism and the start of symptoms) is generally 14 days (but can range from 12 to 28 days).
How do you treat rubella?
There is no specific treatment for rubella. Supportive care is given for issues such as ear pain or deafness caused by the infection. There is a vaccine that can help prevent infection.
How can you prevent rubella?
The most effective way to prevent rubella is to get the MMR vaccine. The first dose is given to infants between the age of 12 and 15 months, with a second dose before the child enters school (generally at age 4 to 6 years).
Usually, a person is protected from infection one week after getting the vaccine.
The vaccine is not 100 percent effective. It is possible to get rubella if you have been vaccinated against it. A person who has been vaccinated and still contracts the infection will usually have a less severe case.
If you haven’t been vaccinated, or if you don’t know if you have, see your doctor. It is important to get the vaccine before becoming pregnant. The vaccine is less effective if the woman is already pregnant.
If you are pregnant and have not been vaccinated against rubella, don’t go to areas where there is an outbreak of rubella while you are pregnant. If you are planning to travel to an area with an outbreak, or are in the first 12 weeks of your pregnancy, get the vaccine within three days of the exposure.
The vaccine is known to be safe in pregnancy. However, it is less effective in women who have already been exposed to the virus.
If you are not vaccinated by the time you are three months pregnant, you will need to be monitored for rubella. If you develop a rash, fever or joint pains within six days of a potential exposure then you will be tested to see if you have been infected. If you are infected, then the pregnancy may need to be investigated.
There is no treatment for a woman who becomes infected with rubella during pregnancy to prevent the baby developing congenital rubella syndrome. The most important thing is to ensure the baby does not catch the infection during pregnancy.
Travelling to an area where there is a rubella outbreak can be scary. Before you go, tell your doctor or midwife if you are going overseas so steps can be taken to monitor you for infection during your trip. It is also important that you are up to date with your vaccinations before you travel.
Once you return, make sure you do not have contact with pregnant women. If you do have contact, it is important to alert others that you may have been infected with rubella.
What are the risks if you are exposed to rubella?
If you get rubella while you are pregnant, the main risks to your baby are deafness, cataracts, heart problems, mental retardation and growth problems. You may also have a miscarriage or stillbirth. Rubella is very dangerous for a baby before it is born. If the baby is infected in the womb, it may be born too early.
Infection in the first 20 weeks of pregnancy leads to miscarriage in about 8 percent of cases. If the infection is in the first eight weeks, the risk of miscarriage is more than 50 percent. The earlier the infection, the greater the risk of birth defects.
If you are infected in the second 20 weeks of pregnancy, the risk of miscarriage is about 2 percent. If you are infected between weeks 19 and 36, the risk of miscarriage is about 15 percent. If you are infected after week 36, the risk of miscarriage is less than 1 percent.
If you become infected during pregnancy, you will need to see your doctor immediately. Your doctor will try to reduce the risk of your baby being born early or with congenital rubella syndrome.
If you have a rash, high temperature or joint pains within six days of a potential exposure to rubella you will need to see a doctor. If you are pregnant, the rash is sometimes called a “non-specific rash” and can be confused with other infections. Your doctor will take a blood test to see if you have rubella.
If you are found to have rubella within the first 12 weeks of your pregnancy, you may be given a free injection of the rubella vaccine. The vaccine will not harm your baby. The earlier you are vaccinated after exposure to rubella, the more effective it is.
Your doctor will want to see you again within three days of the vaccination. If your vaccine is successful, it will protect you from getting rubella and any associated complications. However, it will not protect your baby.
Your doctor may advise you to have an ultrasound scan to check on the health of your baby.
If you are found to have rubella after week 12 of your pregnancy, your doctor will try to reduce the risk of your baby being born early or with congenital rubella syndrome.
The most important thing to do is to try to stop you becoming ill. You will be isolated from other people and a private room may be provided for you. You may need to take several medicines.
Your doctor may give you immunoglobulin. This is a mixture of antibodies from donated blood. It should reduce your risk of developing rubella, but it will not protect your baby. Your doctor may also give you a free vaccine injection. The vaccine should protect you from developing rubella, but it will not protect your baby.
Your doctor may also prescribe you steroids. These should help your baby’s lungs develop more quickly if you are induced or have a caesarean section.
Is rubella still common?
In the United States, the MMR vaccine is often given after one year of age. In countries where the vaccination is given at a later age, it sometimes causes fewer symptoms than it does in the United States. As a result, some people in the United States mistakenly think they had measles rather than rubella.
The name of the virus has also changed recently from “German measles” to “infectious mononucleosis” and now it is called “mono”. Many people do not realise they have rubella. If you go to a doctor with a rash and high temperature, they do not always test for rubella.
About 85 percent of people in the United States are immune to rubella. The disease is now rare in the United States. About 11,000 people per year develop rubella, but most of these are imported cases (people who brought it from another country).
In 2011, there were 19 cases of congenital rubella syndrome reported in the United States. This is thought to be an underestimate of the true number. Between 2011 and 2014, there were 27 cases of confirmed congenital rubella syndrome in Australia.
How can you prevent getting or passing on rubella?
Rubella is contagious from one week before the rash appears to three weeks after. You can pass it on by breathing, talking or coughing. You can also pass it on by sharing food or drink. The best way to prevent the disease is to make sure you are immunised against it.
If you have rubella, you should stay away from pregnant woman because you can give them rubella and harm their baby. You should avoid crowded places, such as shopping centres and cinemas. If you develop a rash or fever, you should contact your doctor straight away.
Your doctor will probably want to give you a free vaccine injection as soon as they can. This will prevent you developing rubella.
In the United States, rubella is rare. About 85 percent of people are immune to the disease.
The vaccine is usually given as part of the MMR jab. You should have been given this vaccine if you are aged between 12 and 15. If you are studying medicine, biology or a similar subject, you should ask your teachers about having the vaccine again.
Rubella is uncommon in Australia. Between 2011 and 2014, there were 27 cases of congenital rubella syndrome reported in Australia. Most of these were in babies whose mothers had rubella for the first time.
Can rubella be treated?
There is no cure for rubella. Most people recover within one to two weeks. Some people, however, develop more serious complications, including arthritis and encephalitis. If you experience a headache, neck stiffness or a fever for more than 48 hours after the initial symptoms appear, you should seek medical advice.
Most pregnant women do not experience serious complications from rubella. However, in the United States, between 2001 and 2015, there were 883 reports of congenital rubella syndrome. This is when a woman contracts rubella while she is pregnant.
The virus passes through the placenta and causes birth defects in the foetus. These may include deafness, blindness, heart problems and stunted growth. Most foetuses do not survive, and if they do, they will have serious health problems.
Are there any treatments for babies with congenital rubella syndrome?
There is a vaccine which can help to protect babies from congenital rubella syndrome. It is given into the muscle in babies when they are between 15 and 20 weeks old. It is not always given as part of the routine vaccination schedule because many women become immune naturally during their childhood.
The vaccine protects 85 percent of babies from congenital rubella syndrome.
What are the complications of rubella?
Less than 1 percent of people with rubella develop a disease called acute encephalitis. This causes inflammation of the brain, and can lead to deafness, blindness or other complications.
The virus can also lead to problems with women’s pregnancies, leading to miscarriage, stillbirth or birth defects.
How can you prevent congenital rubella syndrome?
If a woman has rubella during her first pregnancy, there is a 13 percent chance of her baby having congenital rubella syndrome. If she has rubella during her second pregnancy, the risk is two percent. If she has rubella during a third or subsequent pregnancy, the risk of congenital rubella syndrome drops to less than one percent.
The vaccine can also help to prevent congenital rubella syndrome. If a woman has the vaccine during her first pregnancy, there is a 92 percent chance that her baby will not develop congenital rubella syndrome. If she has the vaccine during her second pregnancy, there is a 85 percent chance that her baby will not develop congenital rubella syndrome.
Should you have the vaccine?
The vaccine is most effective if you have it before you become pregnant for the first time. Girls and women in Australia are routinely given the vaccine in their teenage years, as part of the National Immunisation Program.
If you have had two or more doses of rubella vaccine in the past, you are considered immune and don’t need to be re-vaccinated. If you have been vaccinated but do not know if you had two doses, or if you have only had one dose in the past, talk to your doctor about whether you need the vaccine.
If you are not sure whether you or your child has already been vaccinated, check with your doctor. You may need to be re-vaccinated, especially if you are planning to become pregnant or have recently become pregnant.
Should your child be vaccinated?
In Australia, the vaccine is part of the National Immunisation Program and is routinely given to all children at 18 months and four years of age.
The National Immunisation Program Schedule advises when all children need to be vaccinated by their doctor.
If you are unsure whether your child has been vaccinated, check with their healthcare provider.
Should you or your child have the vaccine if you are pregnant?
If you find out that you are pregnant and have not had the vaccine, it is still safe to be vaccinated. The vaccine is not a live vaccine so it does not pose a risk of rubella to you or your unborn child.
If you are pregnant and considering having the vaccine, it is important that you tell your doctor or immunisation provider before they give you the vaccine. They will be able to tell you if you are eligible and if so, help you to work out the best time to have it and what other vaccines can be given at the same time.
Australian Government Department of Health: National Immunisation Program Schedule
Mothers to Be: Rubella (German measles)
Mothers to Be: Rubella vaccine in pregnancy
Mothers to Be: Rubella vaccination
Mothers to Be: Rubella – congenital rubella syndrome
Mothers to Be: Congenital rubella syndrome
CSL Limited: Rubella virus Factsheet
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