Rubella Health Article

Definition

Rubella, also called German measles or three-day measles, is a highly contagious viral disease that in most children and adults causes mild symptoms of low fever, swollen glands, joint pain, and a fine red rash. Although rubella causes only mild symptoms in child and adult sufferers, the infection can have severe complications for the fetus of a woman who becomes infected with the virus during the first trimester of pregnancy. These complications include severe birth defects or death of the fetus.

Description

Rubella is spread through contact with fluid droplets expelled from the nose or throat of an infected person. A person infected with the rubella virus is contagious for about seven days before any symptoms appear and continues to be able to spread the disease for about four days after the appearance of symptoms. Rubella has an incubation period of 12 to 23 days.

Although rubella is generally considered a childhood illness, people of any age who have not been vaccinated or previously caught the disease can become infected. Having rubella once or being immunized against rubella normally gives lifetime immunity. For this reason vaccination is highly effective in reducing the number of rubella cases.

Women of childbearing age who do not have immunity against rubella should be particularly concerned about getting the disease. Rubella infection during the first three months of pregnancy can cause a woman to miscarry or cause her baby to be born with birth defects. Although it has been practically eradicated in the United States, rubella is still common in less developed countries because of poor immunization penetration, creating a risk to susceptible travelers. Some countries have chosen to target rubella vaccination to females only and outbreaks in foreign-born males have occurred on cruise ships and at U.S. summer camps.

Demographics

Although rubella was once a common childhood illness, its occurrence has been drastically reduced since vaccine against it became available in 1969. According to statistics for 1964–1965, prior to routine rubella immunization in the United States, there were 2,100 newborn deaths and 11,250 miscarriages attributed to rubella infection of pregnant women. In addition, about 20,000 infants were born with birth defects attributable to rubella infection in utero. Of these babies, 11,600 were born deaf; 3,580 were born blind; and 1,800 suffered severe developmental delay. In the 20 years following the introduction of the vaccine, reported rubella cases dropped 99.6 percent. In 2000, there were only 152 reported cases of rubella infection and seven reported cases of congenital rubella.

Causes and symptoms

Rubella is caused by the rubella virus (Rubivirus). Symptoms are generally mild, and complications are rare in anyone who is not pregnant.

The first visible sign of rubella is a fine red rash that begins on the face and rapidly moves downward to cover the whole body within 24 hours. The rash lasts about three days, which is why rubella is sometimes called the three-day measles. A low fever and swollen glands, especially in the head (around the ears) and neck, often accompany the rash. Joint pain and sometimes joint swelling can occur, more often in women. It is quite common to get rubella and not show any symptoms (subclinical infection).

Symptoms disappear within three to four days, except for joint pain, which may linger for a week or two. Most people recover fully with no complications. However, severe complications may arise in the unborn children of women who get rubella during the first three months of their pregnancy. These babies may be miscarried or stillborn. A high percentage is born with birth defects. Birth defects are reported to occur in 50 percent of women who contract the disease during the first month of pregnancy, 20 percent of those who contract it in the second month, and 10 percent of those who contract it in the third month.

The most common birth defects resulting from congenital rubella infection are eye defects such as cataracts, glaucoma, and blindness; deafness; congenital heart defects; and mental retardation. Taken together, these conditions are called congenital rubella syndrome (CRS). The risk of birth defects drops after the first trimester, and by the twentieth week, there are rarely any complications.