Rubella: Symptoms, Causes, Risk Factors, Complications, Diagnosis, Treatment, Prevention

Rubella, also called German measles or three day measles, is a contagious viral infection that causes a red rash on the body.

Updated: June 16, 2022

Rubella, also called German measles or three day measles, is a contagious viral infection that causes a red rash on the body. Usually people with rubella will have a fever and swollen lymph nodes. The infection is contagious and can spread from person to person through contact with droplets from an sneeze or cough of an infected person. This means that you can get German measles if you touch your mouth, nose, or eyes after touching something that has droplets from an infected person on it. You may also get German measles by sharing food or drinks with someone who is infected.
Although rubella share some characteristics, including the red rash with measles, it is not the same as measles. Rubella is caused by a different virus than measles, and is neither as infectious nor usually as severe as measles.
It is typically a mild infection that goes away within one week, even without treatment. However, it can be a serious condition in pregnant women, as it may cause congenital rubella syndrome in the fetus which can have a long term impact on the fetus. Congenital rubella syndrome can disrupt the development of the baby and cause serious birth defects, such as heart abnormalities, deafness, and brain damage. Therefore it is important to get treatment right away if you are pregnant and suspect you have German measles. The measles-mumps-rubella (MMR) vaccine is usually given to children twice before the age of 5 to prevent rubella.

Symptoms of Rubella:

The symptoms of rubella are so mild that they are difficult to notice. Symptoms normally appear with in 14 to 21 days after infection.The rash often starts on the face and moves to the trunk and limbs. They often last about three to seven days. After 3 to 5 days, it fades and disappears. It can be itchy.
Other symptoms include:

  • a stuffy or runny nose
  • headache
  • a mild fever
  • red, inflamed eyes
  • nerve inflammation
  • swollen and tender lymph nodes
  • aching joints or muscle pain

Though infection can happen at any age, Rubella rarely affects young infants or people over 40 years. A person who is infected with rubella at an older age will normally have more severe symptoms.
Rubella can lead to ear infections and brain swelling in rare case. If you notice prolonged headache, earache or stiff neck during or after a rubella infection, you seek immediate medical attention.

Causes of Rubella:

Rubella is caused by a virus that is passed from person to person. It can spread when an infected person coughs or sneezes, or it can spread by direct contact with the respiratory secretions, such as mucus of an infected person. It can also be transmitted from pregnant women to their fetus via the bloodstream. The virus replicates in the lymph nodes and the nasopharynx, the tube connecting the nasal cavity and the soft palate.
People who have rubella are most contagious from the week before the rash appears until about 2 weeks after the rash goes away. They can spread the virus before they even know that they have it.

Risk Factors of Rubella:

Most people who live in countries that do not offer routine immunization against rubella are at higher risk. The rubella vaccine is usually given to children as two shot. The first one when they are between 12 and 15 months old, and the second one when they are between ages 4 and 6. Infants and young toddlers who have not yet received all vaccines have a greater risk of getting rubella.
Many women who become pregnant are given a blood test to confirm immunity to rubella to avoid complications during pregnancy. As vaccines can typically provide lifelong immunity to the rubella virus, contact your doctor immediately if you have never received the vaccine and think you might have been exposed to rubella.

Complications of Rubella:

Rubella is a mild infection and once you have had the disease, you are usually permanently immune. Some women with rubella experience arthritis in the fingers, wrists and knees, which generally lasts for about one month. Rubella can cause an ear infection or inflammation of the brain in rare cases.
Congenital rubella syndrome is the most common complications of affected fetus. if you are pregnant when you contract rubella, the consequences for your unborn child may be severe, and can also be fatal in some cases.The rubella virus can pass through the placenta and move through the fetal circulation. It can destroy cells or prevent them from dividing causing congenital rubella syndrome.This can lead to miscarriage or stillbirth, or it can cause severe damage to the developing fetus, especially eye problems, hearing problems, and heart damage. Often, more than one defect can arise, with deafness being the most common.
These effects on the infant can include:

  • hearing impairment or loss
  • anemia
  • hepatitis
  • cataracts
  • congenital heart disease, especially pulmonary artery stenosis and patent ductus arteriosus
  • developmental delay
  • damage to the retina, known as retinopathy
  • an unusually small head, lower jaw, or eyes
  • liver, spleen or bone marrow issues, which sometimes disappear shortly after birth
  • low birth weight

Other conditions such as autism, achizophrenia, learning difficulties and type 1 diabetes may appear as the child develops.
Infants born to mothers who had rubella during the first 12 weeks of pregnancy develop congenital rubella syndrome. However, problems are rare if rubella is contracted after the first 20 weeks of pregnancy. Therefore, women who are planning to get pregnant should have tested their immunity to rubella before becoming pregnant. If a vaccine is needed, it is important to get it at least 28 days before trying to conceive.

Diagnosis of Rubella:

Since rubella appears similar to other viruses that cause rashes, virus culture or a blood test can be done to confirm the disease.This can detect the presence of different types of rubella antibodies in your blood. These antibodies indicate whether you have had a recent or past infection or a rubella vaccine.
The presence of IgM antibodies 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.

Treatment of Rubella:

Symptoms of rubella are often so mild that does not require any treatment. It goes off by own within few days. However, isolation from others is recommended, especially pregnant women and anyone who has a weakened immune system during the infectious period, that could be until one week after the rash appears. Bed rest and acetaminophen may help relieve any symptoms.
If you contract rubella while you are pregnant, and wish to continue your pregnancy, you may be given antibodies called hyperimmune globulin that can fight off the infection. This can reduce your symptoms, but does not eliminate the possibility of your baby developing congenital rubella syndrome. Discuss the risks to your baby with your doctor before taking any decision. Infants who are born with congenital rubella will require early treatment from a team of specialists.

Prevention of Rubella:

Vaccination is a safe and effective way to prevent rubella for most people. The rubella vaccine is typically combined with vaccines for the measles and mumps as well as varicella, the virus that causes chicken pox. The vaccine comes in the form of a live attenuated, or weakened, virus.
These vaccines are usually given to children who are between 12 and 15 months old. A booster shot will be needed again when children are between ages 4 and 6. Since the vaccines contain small doses of the virus, mild fevers and rashes may occur. It is important to have your immunity tested if you are not sure about the vaccination in past, especially if you:

  • are a woman of childbearing age and aren't pregnant
  • attend an educational facility
  • work in a medical facility or school
  • plan to travel to a country that doesn't offer immunization against rubella
  • If you have cancer, a blood disorder or another disease, or you take medication that affects your immune system, inform your doctor before getting an MMR vaccine.

Anyone who has not yet had the measles, mumps, and rubella (MMR) vaccine should receive it.
However, adults do not need the MMR vaccine in the following cases:

  • 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
  • people with severely compromised immune systems
  • pregnant women or those thinking of getting pregnant in the next 4 weeks
  • Anyone who is sick should wait until they recover before having the vaccination.

Side effects of the vaccine:

Most people does not experience any side effects from the vaccine. However, people may develop a fever between 7 and 12 days after the vaccination. There is a possibility of mild rash also. These side effects are minimal. Some teens and adult women experience temporary joint pain or stiffness after receiving the vaccine. A serious allergic reaction is very rare.
As autism is often identified in toddlers between the ages of 18 and 30 months, which is exactly the same time children are given their first MMR vaccine, it is considered as a risk factor for developing autism.
The risk of not being vaccinated are higher than the risk of any adverse effects.

Rubella Versus measles:

Rubella is sometimes known as three day measles or German 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.
  • 90 percent of people exposed to measles will develop symptoms, 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 104 degrees Fahrenheit where as with rubella, any fever will be mild and usually be below 100.94 degrees F.

Infection with both viruses can be prevented with the measles mumps and rubella (MMR) vaccination.

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