Rubella

What is Rubella?

Rubella - commonly known as German measles or ‘3-day measles’- is an infection that mainly affects the skin and lymph nodes.

Rubella is generally a mild disease in children so the main medical danger of rubella is the infection of pregnant women as it can cause congenital rubella syndrome in developing babies. However, there are now far fewer cases of rubella and congenital rubella due to immunization.  Most rubella infections today appear in young, non-immunized adults rather than in children.

What causes Rubella?

Rubella is caused by the rubella virus (not the same virus that causes measles), which is usually transmitted by airborne droplets breathed out from an infected person. What are the signs and symptoms of rubella?

Rubella usually begins with 1-2 days of a mild fever and swollen, tender lymph nodes (glands found at different points in the body), usually in the back of the neck or behind the ears. A rash then begins on the face and spreads downward. As it spreads, it usually clears on the face – this rash is often the first sign of illness that a parent notices.  The rubella rash can look like many other viral rashes. It appears as either pink or light red spots, which may merge to form evenly coloured patches. The rash can itch and lasts up to 3 days but as it clears, the affected skin occasionally sheds in very fine flakes.

Other symptoms of rubella can include headache, loss of appetite, mild conjunctivitis (inflammation of the lining of the eyelids and eyeballs), a stuffy or runny nose, swollen lymph nodes in other parts of the body, and pain and swelling in the joints (especially in young women). However, many people with rubella have few or no symptoms.

People who have rubella are most contagious from 1 week before to 1 week after the rash appears. Someone who is infected but has no symptoms can still spread the virus.

The incubation period for rubella is 14-23 days, with an average incubation period of 16-18 days. This means that it can take 2-3 weeks for a child to get rubella after they are exposed to someone with the disease.

The rubella rash usually lasts 3 days. Lymph nodes may remain swollen for a week or more, and joint pain can last for more than 2 weeks. Children who have rubella usually recover within 1 week, but adults may take longer.

Rubella in pregnancy

Rubella in a pregnant woman can cause congenital rubella syndrome, with potentially devastating consequences for the developing baby. Children who are infected with rubella before birth are at risk of growth retardation; mental retardation; malformations of the heart and eyes; deafness; and liver, spleen, and bone marrow problems.

How is rubella prevented?

Rubella can be prevented by the rubella vaccine. Widespread immunization against rubella is critical to controlling the spread of the disease, thereby preventing birth defects caused by congenital rubella syndrome.

The rubella vaccine is usually given to children at 12-15 months of age as part of the scheduled measles-mumps-rubella (MMR) immunization. A second dose of MMR is generally given at 4-6 years of age. Talk to your child’s doctor to see when the vaccine is needed.

The rubella vaccine should not be given to pregnant women or to a woman who may become pregnant within 1 month of receiving the vaccine. If you are thinking about becoming pregnant, make sure that you're immune to rubella through a blood test or proof of immunization. If you're not immune, you should receive the vaccine at least 1 month before you become pregnant. Pregnant women who are not immune should avoid anyone who has the illness and should be vaccinated after delivery so that they will be immune during any future pregnancies.

What is the treatment of rubella?

Rubella cannot be treated with antibiotics because they do not work against viral infections but fortunately unless there are complications, rubella will normally get better on its own.

Rubella is typically mild in children, who often can be cared for at home. To relieve minor discomfort, you can give your child paracetamol or ibuprofen. Do not give aspirin to a child under the age of 16.

Call the doctor if your child develops a fever of 38.9°C or above (in a child younger than 6 months, call for a fever above 38°C), or if your child appears to be getting more unwell.

Any pregnant woman who has been exposed to rubella should contact her obstetrician (doctor that deals with birth and pregnancy) immediately.