Rubella

Overview

Rubella is a contagious viral infection best known by its distinctive red rash. It's also called German measles or three-day measles. This infection may cause mild or no symptoms in most people. However, it can cause serious problems for unborn babies whose mothers become infected during pregnancy.

Rubella isn't the same as measles, but the two illnesses share some signs and symptoms, such as the red rash. Rubella is caused by a different virus than measles, and rubella isn't as infectious or as severe as measles.

The measles-mumps-rubella (MMR) vaccine is safe and highly effective in preventing rubella. The vaccine provides lifelong protection against rubella.

In many countries, rubella infection is rare or even nonexistent. However, because the vaccine isn't used everywhere, the virus still causes serious problems for babies whose mothers are infected during pregnancy.

Symptoms

The signs and symptoms of rubella are often difficult to notice, especially in children. Signs and symptoms generally appear between two and three weeks after exposure to the virus. They usually last about 1 to 5 days and may include:

• Mild fever of 102 F (38.9 C) or lower
• Headache
• Stuffy or runny nose
• Red, itchy eyes
• Enlarged, tender lymph nodes at the base of the skull, the back of the neck and behind the ears
• A fine, pink rash that begins on the face and quickly spreads to the trunk and then the arms and legs, before disappearing in the same order
• Aching joints, especially in young women

When to see a doctor

Contact your health care provider if you think you or your child may have been exposed to rubella or if you notice the signs or symptoms that may be rubella.

If you're considering getting pregnant, check your vaccination record to make sure you've received your MMR vaccine. If you're pregnant and you develop rubella, especially during the first trimester, the virus can cause death or serious birth defects in the developing fetus. Rubella during pregnancy is the most common cause of congenital deafness. It's best to be protected against rubella before pregnancy.

If you're pregnant, you'll likely undergo a routine screening for immunity to rubella. But if you've never received the vaccine and you think you might have been exposed to rubella, contact your health care provider immediately. A blood test might confirm that you're already immune.

Causes

Rubella is caused by a virus that's passed from person to person. It can spread when an infected person coughs or sneezes. It can also spread by direct contact with infected mucus from the nose and throat. It can also be passed on from pregnant women to their unborn children through the bloodstream.

A person who has been infected with the virus that causes rubella is contagious for about one week before the onset of the rash until about one week after the rash disappears. An infected person can spread the illness before the person realizes he or she has it.

Rubella is rare in many countries because most children are vaccinated against the infection at an early age. In some parts of the world, the virus is still active. This is something to consider before going abroad, especially if you're pregnant.

Once you've had the disease, you're usually permanently immune.

Complications

Rubella is a mild infection. Some women who have had rubella experience arthritis in the fingers, wrists and knees, which generally lasts for about one month. In rare cases, rubella can cause an ear infection or inflammation of the brain.

However, if you're pregnant when you get rubella, the effect on your unborn child may be severe, and in some cases, fatal. Up to 90% of infants born to mothers who had rubella during the first 12 weeks of pregnancy develop congenital rubella syndrome. This syndrome can cause one or more problems, including:

• Growth delays
• Cataracts
• Deafness
• Problems with the development of the heart (congenital heart defects)
• Problems with the development of other organs
• Problems with mental development and learning

The highest risk to the fetus is during the first trimester, but exposure later in pregnancy also is dangerous.

Prevention

The rubella vaccine is usually given as a combined measles-mumps-rubella (MMR) vaccine. This vaccine may also include the chickenpox (varicella) vaccine — MMRV vaccine. Health care providers recommend that children receive the MMR vaccine between 12 and 15 months of age, and again between 4 and 6 years of age — before entering school.

The MMR vaccine prevents rubella and protects against it for life. Getting the vaccine can prevent rubella during future pregnancies.

Babies born to women who have received the vaccine or who are already immune are usually protected from rubella for 6 to 8 months after birth. If a child requires protection from rubella before 12 months of age — for example, for certain foreign travel — the vaccine can be given as early as 6 months of age. But children who are vaccinated early still need to be vaccinated at the recommended ages later.

Providing the MMR vaccine as a combination of recommended vaccines can prevent delays in protection against measle, mumps and rubella — and with fewer shots. The combination vaccine is as safe and effective as the vaccines given separately.

No proven link between the MMR vaccine and autism

Widespread concerns have been raised about a possible link between the MMR vaccine and autism. However, extensive reports from the American Academy of Pediatrics, the National Academy of Medicine, and the Centers for Disease Control and Prevention conclude that there is no scientifically proven link between the MMR vaccine and autism.

These organizations note that autism is often identified in toddlers between the ages of 18 and 30 months, which is about the time children are given their first MMR vaccine. But this coincidence in timing shouldn't be mistaken for a cause-and-effect relationship.

Do you need the MMR vaccine?

You don't need a vaccine if you:

• Had two doses of the MMR vaccine after 12 months of age.
• Have blood tests that show you're immune to measles, mumps and rubella.
• Were born before 1957. People born before 1957 are likely to have had measles, mumps and rubella during childhood and are immune. However, without a blood test that shows immunity, the MMR vaccine is recommended.

Get a vaccine if you have not had two doses of the MMR vaccine after age 12 months or a blood test to show that you're immune to measles, mumps and rubella.

Ensuring immunity is especially important if you:

• Are a nonpregnant woman of childbearing age
• Attend college, trade school or postsecondary school
• Work in a hospital, medical facility, child-care center or school
• Plan to travel overseas or take a cruise

The vaccine is not recommended for:

• Pregnant women or women who plan to get pregnant within the next four weeks
• People who have had a life-threatening allergic reaction to gelatin, the antibiotic neomycin or a previous dose of MMR vaccine

If you have cancer, a blood disorder or another disease, or you take medication that affects your immune system, talk to your health care provider before getting an MMR vaccine.

Side effects of the vaccine

Most people experience no side effects from the vaccine.

For some people, minor side effects may appear about two weeks after vaccination, but usually occur less often after the second shot. These can include:

• Sore arm at the injection site
• Fever
• Mild rash or redness at the injection site

Very few people experience:

• Temporary joint pain or stiffness, especially in teens and adult women who weren't previously immune to rubella
• Swelling of the glands in the cheeks or neck
• Seizures that occur with a fever
• Low level of cells in the blood that help with clotting (platelets), which can cause unusual bleeding or bruising
• Rash all over the body
• Serious allergic reaction, very rarely

After a diagnosis

If you've been exposed to the virus and get rubella, you can help keep friends, family and co-workers safe by telling them about your diagnosis. If your child has rubella, let the school or child-care provider know.

Diagnosis

The rubella rash can look like many other viral rashes. So health care providers usually confirm rubella with the help of lab tests. You may have a virus culture or a blood test, which can detect the presence of different types of rubella antibodies in your blood. These antibodies show whether you've had a recent or past infection or a rubella vaccine.

Treatment

No treatment shortens the course of rubella infection, and symptoms don't usually need to be treated because they're often mild. However, health care providers usually recommend isolation from others — especially from pregnant women — during the infectious period. Isolate from others as soon as rubella is suspected and until at least seven days after the rash disappears.

Support of an infant born with congenital rubella syndrome varies depending on the extent of the infant's problems. Children who have multiple complications may require early treatment from a team of specialists.

Self care

Simple self-care measures are required when a child or adult is infected with the virus that causes rubella, such as:

• Bed rest
• Acetaminophen (Tylenol, others) for relief from fever and aches

Use caution when giving aspirin to children or teenagers. Though aspirin is approved for use in children older than age 3, children and teenagers recovering from chickenpox or flu-like symptoms should never take aspirin. This is because aspirin has been linked to Reye's syndrome, a rare but potentially life-threatening condition, in such children. For treatment of fever or pain, consider giving your child infants' or children's over-the-counter fever and pain medications such as acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin, others) as a safer alternative to aspirin.

Preparing for your appointment

As you prepare for your appointment, it's a good idea to write down any questions you have. Your health care provider is likely to ask you a number of questions as well. Being ready to answer them may reserve time to go over any points you want to spend more time on.

Your provider may ask:

• Have you been vaccinated for rubella?
• How long have you had signs or symptoms, such as a rash or aching joints?
• Have you been exposed to anyone with rubella?
• Have you traveled to other countries in recent weeks? Which countries?
• Does anything seem to improve your symptoms?
• Does anything seem to worsen your symptoms?

When you check in for the appointment, be sure to tell the check-in desk that you suspect an infectious disease. You and your child may be asked to wear a face mask or shown to an exam room immediately.