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Rubella

Commonly called German measles, rubella is an acute, mildly contagious viral disease that produces a distinctive 3-day rash and lymphadenopathy. It occurs most often among children ages 5 to 9, adolescents, and young adults.

Worldwide in distribution, rubella flourishes during the spring (particularly in big cities), and epidemics occur sporadically. This disease is self-limiting, and the prognosis is excellent.

Causes

The rubella virus is transmitted through contact with the blood, urine, stools, or nasopharyngeal secretions of infected persons and possibly by contact with contaminated articles of clothing. Transplacental transmission, especially in the first trimester of pregnancy, can cause serious birth defects.

Humans are the only known hosts for the rubella virus. The period of communicability lasts from about 10 days before until 5 days after the rash appears.

Signs and symptoms

In 25-50% of rubella cases the disease is usually so mild there may be few or no signs or symptoms. In typical cases the incubation period is between 12-23 days, most people show symptoms within 16-18 days after exposure. Common symptoms include:

• Slight fever, sore throat, runny nose and malaise (may occur prior to appearance of rash, more so in adults than in children).
• Rash begins on the face that spreads to the neck, trunk and extremities.
  • Appear as pink or light red spots about 2-3mm in size.
  • Lasts up to 5 days (average is 3 days).
  • May or may not be itchy.
  • As rash passes, affected skin may shed in flakes.
  • Usually not as widespread as in measles.
• Tender or swollen glands almost always accompany rubella, most commonly behind the ears and at the back of the neck.

Other symptoms include pain and swelling in joints (arthralgia and arthritis). This is more common is adults, particularly women and may persist longer than 2 weeks. In some cases arthritis may become chronic and persist for months or years.

Diagnosis

Treatment

Because the rubella rash is self-limiting and only mildly pruritic, it doesn't require topical or systemic medication. Treatment consists of aspirin for fever and joint pain. Bed rest isn't necessary, but the patient should be isolated until the rash disappears.

Immunization with live-virus vaccine RA27/3, the only rubella vaccine available in the United States, is necessary for prevention and appears to be more immunogenic than previous vaccines. The rubella vaccine should be given with measles and mumps vaccines at age 15 months to decrease the cost and the number of injections needed.

Home Treatment

Rubella is usually a mild illness, especially in children and typically requires little special care at home. Monitor your child's temperature, and call your child's doctor if the fever climbs too high.

To relieve minor discomfort, you can give your child acetaminophen or ibuprofen. Avoid giving aspirin to a child who has a viral illness because the use of aspirin in such cases has been associated with the development of Reye syndrome , which can lead to liver failure and death.

Prevention

Rubella is preventable with vaccination. Rubella virus vaccine is recommended for all children. It is routinely given between 12 and 15 months of age, but is sometimes given earlier during epidemics. A second vaccination (booster) is routinely given between the ages of 4 to 6. MMR immunization is a combination vaccine that protects against measles, mumps, and rubella.

Women of child-bearing age may be screened by rubella serology. If immunity is not present, immunization can be given if conception can be prevented for 28 days after the vaccination. Vaccination should not be given at any time during pregnancy or to a person with an immune system altered by cancer, corticosteroid therapy, or radiation treatment.

Although great care is taken not to give vaccine to an already pregnant woman, in the rare instances where that has occurred, no abnormalities have been detected in the infants.