rubella

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Rubella

 

Definition

Rubella is a highly contagious viral disease, spread through contact with discharges from the nose and throat of an infected person. 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. These complications include severe birth defects or death of the fetus.

Description

Rubella is also called German measles or 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 20 years 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.
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 12-23 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. This is why vaccination is so effective in reducing the number of rubella cases.
Women of childbearing age who do not have immunity against rubella should be the most 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.

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 some-times 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 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 20th week, 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 isolating the virus with a blood test or in a laboratory culture.
A blood test is done to check for rubella antibodies. 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

There is no drug treatment for rubella. Bed rest, fluids, and acetaminophen 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.

Alternative treatment

Rather than vaccinating a healthy child against rubella, many 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.

Prognosis

Complications from rubella infection are rare in children, pregnant women past the 20th week of pregnancy, and other adults. For women in the first trimester of pregnancy, there is a high likelihood of the child being born with one or more birth defect. Unborn children exposed to rubella early in pregnancy are also more likely to be miscarried, stillborn, or have a low birthweight. Although the symptoms of rubella pass quickly for the mother, the consequences to the unborn child can last a lifetime.

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.
Pregnant women should not be vaccinated, and 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 breastfeeding. People whose immune systems are compromised, either by the use of drugs such as steroids or by disease, should discuss possible complications with their doctor before being vaccinated.

Resources

Organizations

March of Dimes Birth Defects Foundation. 1275 Mamaroneck Ave., White Plains, NY 10605. (914) 428-7100. resourcecenter@modimes.org. http://www.modimes.org.
National Organization for Rare Disorders. P.O. Box 8923, New Fairfield, CT 06812-8923. (800) 999-6673. http://www.rarediseases.org.

Key terms

Incubation period — The time it takes for a person to become sick after being exposed to a disease.
Trimester — The first third or 13 weeks of pregnancy.

rubella

 [roo-bel´ah]
a mild systemic disease caused by a virus and characterized by a fever and a transient rash. It is not as contagious as chickenpox or measles, but there are frequent epidemics among schoolchildren, usually during the spring and early summer. The virus is spread by direct contact and by droplet infection. Rubella begins with a slight cold, fever, and sore throat. The lymph nodes behind the ears and at the back of the neck may swell, causing soreness or pain when the head is moved. The rash appears first on the face and scalp, and spreads to the body and arms the same day; it is similar to the rash of measles, although the spots usually do not run together. It fades after 2 or 3 days, although in a few cases the disease may last as long as a week. Called also German measles and three-day measles

If a pregnant woman contracts rubella, especially during the first trimester, the virus can damage the developing offspring. The location and extent of the resulting congenital anomaly are determined in large part by the developmental stage of the embryo at the time of the attack. Congenital heart defects, cataracts, mental retardation, and deafness are some of the more common defects resulting from maternal rubella.
Treatment and Prevention. Except for complications that may result if the disease is contracted during pregnancy, other complications are rare. No special treatment, medicine, or diet is necessary unless the patient has a high fever. One attack usually gives lifetime immunity to the disease, although a second attack does occasionally occur. The Centers for Disease Control and Prevention recommends two doses of rubella vaccine for all children, given as combination measles-mumps-rubella vaccine, with doses at least four weeks apart. The first dose should be given when the child is 12 months old. Vaccine is also recommended for susceptible nonpregnant adolescents and adults who do not have rubella immunity.
Congenital rubella syndrome is marked by a triad that includes microcephaly, microphthalmia, and congenital heart disease. From Damjanov, 2000.
congenital rubella syndrome (rubella syndrome) transplacental infection of the fetus with rubella usually in the first trimester of pregnancy, as a consequence of maternal infection (which may or may not be clinically apparent), resulting in various developmental abnormalities in the newborn infant. They include cardiac and ocular lesions, deafness, microcephaly, mental retardation, and generalized growth retardation, which may be associated with acute self-limited conditions such as thrombocytopenic purpura, anemia, hepatitis, encephalitis, and radiolucencies of long bones. Infected infants may shed the virus to all contacts for extended periods of time.

ru·bel·la

(rū-bel'ă), Do not confuse this word with rubeola.
An acute but mild exanthematous disease caused by rubella virus (Rubivirus family Togaviridae), with enlargement of lymph nodes, but usually with little fever or constitutional reaction; a high incidence of birth defects in children results from maternal infection during the first trimester of fetal life (congenital rubella syndrome).
[L. rubellus, fem. -a, reddish, dim. of ruber, red]

rubella

/ru·bel·la/ (roo-bel´ah) German measles: a mild viral infection marked by a pink macular rash, fever, and lymph node enlargement most often affecting children and nonimmune young adults; transplacental infection of the fetus in the first trimester may produce death of the conceptus or severe developmental anomalies. See also congenital rubella syndrome, under syndrome.

rubella

(ro͞o-bĕl′ə)
n.
A mild contagious eruptive disease caused by a virus and capable of producing congenital defects in infants born to mothers infected during the first three months of pregnancy. Also called German measles.

rubella

[ro̅o̅bel′ə]
Etymology: L, rubellus, somewhat red
a contagious viral disease characterized by fever, symptoms of a mild upper respiratory tract infection, lymph node enlargement, arthralgia, and a diffuse fine red maculopapular rash. Rubella virus is a togavirus belonging to genus Rubivirus. It is most closely related to group A arboviruses. It is an undeveloped RNA virus that does not cross-react with other togaviruses. The virus is spread by droplet infection, and the incubation time is from 12 to 23 days. Also called German measles, 3-day measles. Compare measles, scarlet fever.
observations The symptoms usually last only 2 or 3 days except for arthralgia, which may persist longer or recur. One attack confers lifelong immunity. If a woman acquires rubella in the first trimester of pregnancy, fetal anomalies may result, including heart defects, cataracts, deafness, and mental retardation. An infant exposed to the virus in utero at any time during gestation may shed the virus for up to 30 months after birth. Complications of postnatal rubella are rare. Complications due to rubella infection occur more frequently in adults and include conjunctivitis, testalgia, orchitis, arthralgia or arthritis, encephalitis, and hemorrhagic manifestations.
interventions The illness itself is mild and needs no special treatment. Live attenuated rubella vaccine is advised for all children to reduce chances of an epidemic and thus to protect pregnant women. The vaccine is not given to women already pregnant, and it is recommended that pregnancy be avoided for 3 months after the administration of rubella vaccine. Spread of the virus from a recently vaccinated individual rarely occurs. Immune serum globulin containing rubella antibodies may help prevent fetal infection in exposed susceptible pregnant women, but ordinary gamma globulin will not protect the fetus.
enlarge picture
Rubella

rubella

German measles, Röteln, three-day measles, third disease Infectious disease An acute, benign, but potentially teratogenic viral infection, most commonly affecting children Clinical, acquired Most common in children age 5-15; after a 2-3 wk incubation, an evanescent–3-5 day maculopapular rash begins on the face, neck and spreads caudally, accompanied by mild fever, malaise, sore throat, cervical lymphadenopathy and palatal enanthema–rose spots coalescing into a reddish blush in the fauces and an evanescent, rapidly extending maculopapular rash with innumerable, variably-sized lesions resolving by day 3 Management If mother is pregnant while acutely infected, abortion is advised, given frequency of congenital rubella syndrome. See Congenital rubella syndrome, Expanded rubella syndrome, TORCH. Cf Rubeola.

ru·bel·la

(rū-bel'ă)
An acute exanthematous disease caused by a rubella virus (Rubivirus), with enlargement of lymph nodes, but usually with little fever or constitutional reaction; a high incidence of birth defects in children results from maternal infection during the first several months of fetal life (congenital rubella syndrome).
Synonym(s): epidemic roseola, German measles, third disease.
[L. rubellus, fem. -a, reddish, dim. of ruber, red]

rubella

A common infectious disease caused by a respiratory virus. Rubella has an incubation period of up to 3 weeks, during which the virus spreads to lymph nodes, especially those in the back of the neck. The illness is mild and often consists of no more than a slight fever, swollen nodes and a scattered rash of slightly raised red patches. Rubella is notorious for its effects on the fetus, especially during the early months of pregnancy, when it can cause congenital heart disease and other physical malformations, CATARACT, deafness and mental retardation. An attack confers life-long immunity but all seronegative young girls and women should be vaccinated unless already pregnant and should be protected from pregnancy for 3 months after vaccination. Also known as German measles.

rubella

see GERMAN MEASLES.

rubella (rōō·beˑ·l),

n highly contagious viral disease that presents symptoms such as mild upper respiratory tract symptoms, fever, arthralgia, enlarged lymph nodes, and a fine red rash. Can cause deafness in children if it occurs in early gestation. Also called
German measles or
three-day measles.
Enlarge picture
Rubella.

ru·bel·la

(rū-bel'ă)
An acute but mild exanthematous disease caused by rubella virus, with enlargement of lymph nodes, but usually with little fever or constitutional reaction.
Synonym(s): German measles.
[L. rubellus, fem. -a, reddish, dim. of ruber, red]

rubella (roobel´ə),

n (German measles, 3-day measles), a highly contagious viral disease spread mainly by direct contact that has an incubation period of about 18 days. Manifestations include pharyngitis, regional lymphadenopathy, mild constitutional symptoms, and a maculopapular rash that becomes scarlatiniform. Oral lesions are red macules. When it occurs in pregnant women, it may cause congenital rubella syndrome with serious malformations of the developing fetus. Children infected with rubella before birth (a condition known as
congenital rubella) are at risk for the following: growth retardation; malformations of the heart, eyes, or brain; deafness; and liver, spleen, and bone marrow problems.

rubella

Patient discussion about rubella

Q. How expensive is a rubella test? I was told that in order to get a marriage license in Indiana, that my fiancee has to get tested for rubella. I was wondering how to go about doing that and how much a typical test costs. Thank you.

A. the average cost is 21$, and i'm not so sure it's in the way Terrany suggested...if i'm not mistaken, it's an antibody test to see if she is vaccinated or not. and that is a simple blood test:
http://www.labtestsonline.org/understanding/analytes/rubella/test.html

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