Rubella

Rubella

Definition

Rubella is a highly contagious viral disease, spread through contact with discharges from the nose and 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 spread the disease for about four days after the appearance of symptoms. Rubella has an incubation period of 12–23 days.

Description

Rubella is also called German measles or the three-day measles. This disease was once a common childhood illness, but its occurrence has been drastically reduced since vaccine against rubella became available in 1969. In the three decades following the introduction of the vaccine, reported rubella cases dropped 99.6%. Only 229 cases of rubella were reported in the United States in 1996. A recent study indicates, however, that the age group pattern of rubella is shifting. As of 2002, the number of cases reported in people aged 15 years or younger is dropping, while the number of cases in people between 25 and 45 is rising.

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. This is why vaccination is so effective in reducing the number of rubella cases. The United States had a public health goal of eliminating all rubella within its borders by the year 2000; however, this goal was not attained because of new strains of the rubella virus entering the country from the Caribbean and Central America. The availability of molecular typing indicates that three separate strains of the virus caused localized outbreaks that were quickly contained. As of 2002, cases of rubella in the United States are more common among Hispanics than among Caucasians, Native Americans, or African Americans.

Women of childbearing age who do not have immunity against rubella should be the most concerned about infection. Rubella infection during the first three months of pregnancy can cause a woman to miscarry or cause the baby to be born with severe birth defects, including mental retardation and sensory impairments. In addition, recent studies indicate that infants exposed to rubella in utero (in the womb) are at increased risk of developing schizophrenia as adults.

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. As a result, outbreaks among foreign-born males have occurred on cruise ships and at summer camps in the United States. The United Kingdom is considering targeting immigrants of either sex from underdeveloped countries for rubella immunization following several cases of babies born with congenital rubella syndrome.

Causes & 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. Although rubella causes only mild symptoms of low fever, swollen glands, joint pain, and a fine red rash in most children and adults, it can have severe complications for women in their first trimester of pregnancy. Babies may be miscarried or stillborn and a high percentage are born with birth defects. Birth defects are reported to occur in 50% of women who contract the disease during the first month of pregnancy, 20% of those who contract it in the second month, and 10% 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 fifth month, there are rarely any complications.

Diagnosis

The rash caused by the rubella virus and the accompanying symptoms are so similar to other viral infections that it is impossible for a physician to make a confirmed diagnosis on visual examination alone. The only sure way to confirm a case of rubella is by checking for antibodies with a blood test or in a laboratory culture.

When the body is infected with the rubella virus, it produces both immunoglobulin G (IgG) and immunoglobulin

M (IgM) antibodies to fight the infection. Once IgG exists, it persists for a lifetime, but the special IgM antibody usually wanes over six months. A blood test can be used either to confirm a recent infection (IgG and IgM) or determine whether a person has immunity to rubella (IgG only). The lack of antibodies indicates that a person is susceptible to rubella.

All pregnant women should be tested for rubella early in pregnancy, whether or not they have a history of vaccination. If the woman lacks immunity, she is counseled to avoid anyone with the disease and to be vaccinated after giving birth.

Treatment

Rather than vaccinating a healthy child against rubella, some alternative practitioners recommend allowing the child to contract the disease naturally at the age of five or six years, since the immunity conferred by contracting the disease naturally lasts a lifetime. It is, however, difficult for a child to contract rubella naturally when everyone around him or her has been vaccinated.

Ayurvedic practitioners recommend making the patient comfortable and giving the patient ginger or clove tea to hasten the progress of the disease. Traditional Chinese medicine uses a similar approach. Believing that inducing the skin rash associated with rubella hastens the progress of the disease, traditional Chinese practitioners prescribe herbs such as peppermint (Mentha piperita ) and chai hu (Bupleurum chinense ). Cicada is often prescribed as well. Western herbal remedies may be used to alleviate rubella symptoms. Distilled witch hazel (Hamamelis virginiana ) helps calm the itching associated with the skin rash and an eyewash made from a filtered diffusion of eyebright (Euphrasia officinalis ) can relieve eye discomfort. Antiviral western herbal or Chinese remedies can be used to assist the immune system in establishing equilibrium during the healing process. Depending on the patient's symptoms, among the remedies a homeopath may prescribe are Belladonna, Pulsatilla, or Phytolacca. These can be used with or with out bilberry .

Allopathic treatment

There is no drug treatment for rubella. Bed rest, fluids, and acetaminophen or Motrin for pain and temperatures over 102°F (38.9°C) are usually all that is necessary.

Babies born with suspected CRS are isolated and cared for only by people who are sure they are immune to rubella. Congenital heart defects are treated with surgery.

Expected results

Complications from rubella infection are rare in children, pregnant women past the fifth month of pregnancy, and other adults.

Prevention

Vaccination is the best way to prevent rubella and is normally required by law for children entering school. Rubella vaccine is usually given in conjunction with measles and mumps vaccines in a shot referred to as MMR (mumps, measles, and rubella). Children receive one dose of MMR vaccine at 12–15 months and another dose at four to six years. The MMR vaccine has aroused some controversy since early 2000 because of media reports that it increases the risk of wheezing and lower respiratory tract disorders in young children. A recent study of vaccine safety has concluded, however, that there is no connection between the MMR vaccine and a reported rise in the incidence of wheezing in children.

Pregnant women should not be vaccinated; women who are not pregnant should avoid conceiving for at least three months following vaccination. To date, however, accidental rubella vaccinations during pregnancy have not clearly been associated with the same risk as the natural infection itself. Women may be vaccinated while they are breast-feeding. People whose immune systems are compromised, either by the use of such drugs as steroids or by disease, should discuss possible complications with their doctor before being vaccinated.

Resources

BOOKS

Cooper, Louis Z. "Rubella." In Rudolph's Pediatrics, 21st ed., edited by M. M. Rudolph, J. I. E. Hoffman, and C. D. Rudolph. Stamford, CT: McGraw-Hill, 2002.

Gershon, Anne. "Rubella (German Measles)." In Harrison's Principles of Internal Medicine, 15th ed., edited by Anthony S. Fauci. New York: McGraw-Hill, 2001.

PERIODICALS

Brown, A. S., and E. S. Susser. "In Utero Infection and Adult Schizophrenia." Mental Retardation and Developmental Disabilities Research and Review 8 (January 2002): 51–7.

Carvill, S., and G. Marston. "People with Intellectual Disability, Sensory Impairments and Behaviour Disorder: A Case Series." Journal of Intellectual Disability Research 46 (March 2002): 264–72.

Case Definitions for Infectious Conditions under Public Health Surveillance. Morbidity and Mortality Weekly Report 46 (1997): 30.

Dixon, B. "Triple Vaccine Fears Mask Media Efforts at Balance." Current Biology 12 (March 5, 2002): R151-R152.

Mullooly, J. P., J. Pearson, L. Drew, et al. "Wheezing Lower Respiratory Disease and Vaccination of Full-Term Infants." Pharmacoepidemiology and Drug Safety 11 (January-February 2002): 21–30.

Reef, S. E., T. K. Frey, K. Theall, et al. "The Changing Epidemiology of Rubella in the 1990s: On the Verge of Elimination and New Challenges for Control and Prevention." Journal of the American Medical Association 287 (January 23, 2002): 464–72.

Sheridan E., C. Aitken, D. Jeffries, et al. "Congenital Rubella Syndrome: A Risk in Immigrant Populations." Lancet 359 (February 23, 2002): 674–675.

ORGANIZATIONS

March of Dimes Resource Center. 1275 Mamaroneck Avenue, White Plains, NY 10605. (888) 663-4637. <http://www.modimes.org>.

National Organization of Rare Disorders. 55 Kenosia Avenue PO Box 1968 Danbury, CT 06813-1968. (800) 999-6673. orphan@rarediseases.org. <http://www.rarediseases.org>.

Kathleen Wright

Rebecca J. Frey, PhD