Rubella

Definition
Rubella is a mild viral infection. The condition can cause serious complications for a developing fetus, however. Also known as German measles or three-day measles, rubella is typically so mild that little treatment is necessary. The number of cases has dropped significantly in the United States since the rubella vaccine was introduced in 1969. Before the vaccine was available, most children developed rubella. In the past few years, however, less than 200 cases of rubella have been reported in the United States each year.

Causes/associated factors
Rubella is caused by a virus. It occurs most often in late winter and spring. Once the virus lodges within the upper respiratory tract, it reproduces and spreads to the lymph nodes (small, round structures located throughout the body that help protect the body from invasion by bacteria or other organisms) and bloodstream. The virus may eventually affect the skin, central nervous system and, for pregnant women, the developing fetus. Once you contract rubella, you're not likely to get it again.
Before the rubella vaccine was available, preschool and elementary school children were at greatest risk for rubella. Today, it's most prevalent in adults who were never properly immunized. Children born to women who are immune to rubella are usually protected by their mother's antibodies for the first six to nine months of life.


Transmission
The rubella virus is spread by inhaling or having direct contact with infected respiratory droplets. The average incubation period (time from exposure to appearance of symptoms) ranges from 12 to 23 days. You're contagious for about a week before and after the rash appears. You're considered contagious during the same time frame even if you have mild symptoms or none at all.

Signs/symptoms
Twenty to 50 percent of people who contract rubella have no symptoms. For others, the symptoms may be so mild they're overlooked. If symptoms do appear, the most prominent are extremely enlarged lymph nodes around the ears and back of the neck, which develop up to a week before a rash breaks out. The lymph nodes may remain swollen for several weeks. This red and sometimes itchy rash has raised pinpoints. It often starts on the face and spreads from head to foot, lasting three to four days. Remember, not everyone with rubella will develop a rash.
Other symptoms may include:

fever below 101°F
fatigue
runny nose
inflammation of the lining of the eyes
headache
joint pain or swelling, especially in adults

Diagnosis
Diagnosis is based on symptoms. Blood tests may be done to test for rubella antibodies (compounds that help neutralize or destroy foreign substances in the blood). The rubella virus can be identified through tissue or fluid samples taken from the nose, throat, blood, urine or spinal fluid. This test is not standard practice because it takes a while to complete and isn't available in many labs, but it's especially useful if congenital rubella syndrome is suspected.

Treatment
Treatment is based on your symptoms. In general, get plenty of rest and closely monitor your symptoms. Your doctor may recommend a pain reliever such as acetaminophen for fever and pain. Because rubella is caused by a virus, an antibiotic won't be effective.

Complications
Complications of rubella may include:
arthritis (inflammation of a joint) that may last up to a month, especially in women (In fact, this is so common that some consider it a normal part of the infection rather than a complication.)
low platelet count that may lead to excessive bleeding for one in 5,000 cases, especially children (Platelets are substances in the blood cells that help blood clot.)
encephalitis (inflammation of the brain) for one in 5,000 cases, especially adults

Pregnancy-specific information
If you contract rubella during the first 20 weeks of pregnancy, there is a serious risk that your baby may develop congenital rubella syndrome. This condition can result in miscarriage, stillbirth or birth defects. If you're exposed to rubella while you're pregnant, it's important to seek medical advice right away. You may be given an injection of immune globulin, which helps your body fight the infection. It's not guaranteed to prevent the infection or congenital rubella syndrome, however.

Senior-specific information
Older adults who contract rubella face the same symptoms and complications as younger adults.

Prevention
If you have rubella, do everything possible to stay away from others who may not be immune to the rubella virus (especially pregnant women) until youh for seven days.
Immunization is essential to prevent rubella and its complications. The rubella vaccine is a live vaccine made of the weakened rubella virus. Children routinely receive the rubella vaccine in combination with the measles and mumps vaccines (known as MMR for measles, mumps and rubella). The first dose is given between ages 12 and 15 months, and a booster shot is given between ages 4 and 6. Children who have not been immunized according to this schedule can begin or complete the series any time. The second dose should be given at least four weeks after the first.

For adults, rubella immunization is recommended if you were born in 1957 or later and haven't had rubella or were never vaccinated. This is especially important for international travelers and students. The rubella vaccine may also be recommended for health care workers of any age who haven't been vaccinated or had a positive test for rubella immunity.

Women who may become pregnant and have not been vaccinated should be tested for immunity to rubella, even if born before 1957. If immunity cannot be confirmed, vaccination is recommended. Pregnancy should be avoided for at least one month after the vaccination.

The rubella vaccine should not be given if you are pregnant, could become pregnant within four weeks, or have had a severe allergic reaction to gelatin, neomycin or a prior dose of the vaccine. Your doctor may also not recommended if your immune system is not functioning properly (due to cancer, severe HIV infection or long-term treatment with steroid medication, for example).

Immunization may be delayed if:

you've received a blood product containing an antibody (such as platelets, a blood transfusion or an immune globulin) within the last three to 11 months (depending on the product) or will receive such a product in the next two weeks
you've had thrombocytopenia (a decrease in the number of platelets, substances that help blood clot)
you're currently ill