Rubella

Rubella, also known as German measles or 3-day measles, is a viral infection caused by a virus in the Togaviridae family. The infection itself is actually pretty mild, in fact, it's estimated that 25% to 80% of infections don't cause any symptoms at all. However, if a pregnant woman contracts rubella, her baby may suffer severe birth, especially if she is infected during her first trimester. Fortunately, since a vaccine was developed in 1969, rubella infections have decreased dramatically around the world.

Rubella Transmission

Rubella only occurs in humans and it's seen most often in the late winter and spring. Rubella is transmitted in respiratory droplets and it takes close contact to cause an infection. You can come in contact with respiratory droplets if:

• You come in direct contact with saliva or mucus from an infected person, such as through kissing an infected person.
• Someone near you sneezes or coughs into the air and you breath in some of the droplets.
• Someone coughs or sneezes into his hand, immediately touches something, then you touch the same object and wipe your nose or your mouth.

Rubella Infection

If someone who hasn't been immunized against rubella comes in contact with the virus it sets off a chain of events:

1. The virus invades the mucous membranes of the nose and respiratory tract and spreads to the lymph nodes.
2. The virus enters the bloodstream and the person's immune system starts making antibodies to fight off the infection.
3. Because your immune system is busy fighting off the rubella virus, it's less effective at fighting off other viruses or bacteria.
4. Finally, in most cases, your immune system is able to kill off the the remaining virus and you recover from the infection.

Rubella Symptoms

Many rubella infections are asymptomatic, meaning you don't get any symptoms even though you have the infection. If you do get symptoms they usually start 14 to 21 days after the virus has invaded your body. Adolescents and adults might get prodromal symptoms for 1-5 days before the rash appears. These symptoms can include:

• Mild headache
• Swollen lymph nodes
• Fever
• Fatigue
• Eye pain
• Sore throat

The next symptom in adolescents and adults, and the first symptom in children is a rash. The rash starts on the forehead and spreads down the body, usually in 1 day. The rash consists of red spots that are discrete, might be slightly raised, and are itchy. On day 2 the rash starts to go away on the face, and by the end of day 3 the rash is usually gone.

The swollen lymph nodes usually last for 5 to 8 days and sometimes red spots can be seen on the soft palate and uvula, the piece of tissue that hangs down at the back of your mouth. Often adult women who develop rubella will have joint pain that lasts for weeks to months.

Congenital Rubella Syndrome (CRS)

If a pregnant woman who doesn't have immunity to rubella becomes infected with the virus, that infection is passed on to her baby and can cause birth defects. A pregnant woman might not have immunity to rubella either because she received the vaccination but didn't make enough antibodies or because she wasn't vaccinated. Examples of the more common birth defects a rubella infection may cause include:

• Cataracts or glaucoma
• Heart defects
• Hearing impairment
• Growth retardation
• Small head
• Mental retardation

To prevent CRS pregnant women should be tested for immunity to rubella at their first obstetrician visit. If a pregnant woman is not immune to rubella, the American College of Obstetricians and Gynecologists (ACOG) and the CDC recommend she be vaccinated with MMR vaccine after delivery.

Rubella Diagnosis

When rubella was more prevalent it could be difficult to diagnose because it might not cause many symptoms at all. Now, because rubella is an uncommon infection in developed countries, most doctors don't think of it as a possibility. To definitively diagnose rubella, a blood test may be done looking for antibodies to the rubella virus or changes in the number of antibodies over a 2-4 week period.

Rubella Treatment

The treatment of rubella is mainly supportive, treating the symptoms that are bothering the infected person the most. If a pregnant woman gets rubella there are no medications that have been shown to reduce her baby's chance of developing CRS.

Rubella Prevention

Rubella is best prevented with vaccination. The vaccine contains live attenuated virus which means the virus has been altered so it can't cause the disease. In 1971 the rubella vaccine was combined with vaccines against measles and mumps to give us the current MMR vaccine. MMR is given between 12-15 months of age and again between 4-6 years of age.

_Sources:

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_{De Santis, M et al. ìRubella infection in pregnancy.î Reproductive Toxicology. 21(2006): 390-8.}

_{Mancini AJ and A Shani-Adir. ìOther Viral Diseases.î Dermatology, 2nd Ed. Eds. Jean Bolognia, and et. al. Mosby, 2008. 1222-3.}

_{Vander Straten, MR, and SK Tyring. ìRubella.î Dermatologic Clinics. 20(2002): 225-31.}

_{Wolfrey JD, et al. "Pediatric Exanthems." Clinics in Family Practice. 5(2003): 568-573.}