Infection: Rubella

Definition

Rubella is a mild viral illness characterized by a rash that in some ways resembles the reddish rash of measles. However, the two diseases should not be confused. Rubella is sometimes called German measles because it was first described by German doctors in the eighteenth century.

Description

Rubella is a contagious illness transmitted from person to person by droplets in the coughing or sneezing of an infected person. It is not as contagious as measles, however. The disease is mild and may sometimes not be noticed, particularly in children, who recover more quickly than adults. In most people, rubella runs its course in two to five days.

Rubella has a fairly long incubation period of two to three weeks. The most important complication of rubella is congenital rubella syndrome (CRS), a condition that can develop in some babies born to mothers who had rubella during the first three months of pregnancy. About 20 percent of these pregnancies end in miscarriage. Babies with CRS may be born with incurable birth defects such as blindness; mental retardation; abnormalities of the heart, eyes, or brain; low birth weight; and disorders of the liver or spleen. In later childhood, they are at increased risk of glaucoma, movement disorders, autoimmune disorders, and mental disorders such as schizophrenia.

Demographics

Rubella is much less common in the United States than it was before the development of the measles-mumps-rubella (MMR) vaccine in 1969. In 1963 and 1964, there was a rubella epidemic in the United States and twelve million people were infected with the disease, including thousands of pregnant women. According to the Centers for Disease Control and Prevention (CDC), 11,000 babies died before birth and another 20,000 were born with CRS. After the vaccine became available, the number of rubella cases dropped rapidly, to about 1,000 per year by the early 2000s. There are only about ten cases of CRS each year in the

United States at present, most of them involving Hispanic mothers who were not vaccinated.

Before 1969, rubella was most common among children between the ages of five and fourteen years. In recent years most people infected in the United States are older teenagers or young adults. Males and females are equally likely to get rubella.

Causes and Symptoms

The cause of rubella is a virus that typically enters the body through the throat or the nasal passages. People can also get the disease by touching a soiled tissue or handkerchief that was used by an infected person. The virus reproduces itself in the moist tissues that line the nose and throat. It then moves into the lymph nodes and from there into the central nervous system and the bloodstream, usually five to seven days after infection. In pregnant women, the virus can infect the baby through the mother's blood.

The first symptoms of rubella are a generally unwell feeling and loss of appetite. These are followed by a reddish or pinkish rash that begins on the face and spreads downward over the rest of the body; swollen glands in the neck and behind the ears; a low-grade fever of 101°F (38.3°C); joint pains; headache; a runny nose; and reddened eyes. The rash may itch but usually goes away in a few days without staining the skin like the characteristic rash of measles.

A person with rubella is contagious from one week before the onset of the rash until about a week after the rash disappears, but is highest just before and on the day that symptoms appear. Children rarely have any complications with rubella but older teenagers or adults may develop joint pains similar to those of arthritis. In most adults, these joint pains go away in several months to a year.

Diagnosis

In some cases rubella can be diagnosed by the doctor on the basis of the physical symptoms. Some doctors, however, will order a virus culture made from a throat swab or a blood test to confirm the diagnosis.

Treatment

Rubella is a mild disease that does not require special treatment in most cases. Patients can rest in bed and take acetaminophen or another non-aspirin pain reliever to bring down the fever. They should, however, stay away from other people and tell friends and family members (especially pregnant women) that they may have been exposed to rubella.

Prognosis

In a very few cases, people may develop an ear infection or encephalitis (viral infection of the brain) as complications of rubella, but these are very rare. Most people recover completely in a week without lasting effects.

The prognosis for children affected by congenital rubella syndrome is poor; many die at an early age from heart defects and other abnormalities. Those who survive childhood usually require specialized care for blindness, deafness, or mental retardation.

A Rubella Tragedy

Gene Tierney (1920–1991) was a glamorous actress who starred in a number of stage plays and films in the 1940s and 1950s. Married to a fashion designer named Oleg Cassini, Tierney became pregnant with her first child, a daughter, in early 1943. In June, Tierney caught German measles while making an appearance at a Hollywood club for people in the military. She later found out that she had been infected by a woman in the Marine Corps who knew she had rubella but snuck out of her barracks under quarantine to meet Tierney and ask for her autograph.

Tierney's daughter Daria was born prematurely in October 1943, weighing little more than three pounds. The little girl was also deaf, partially blind, and severely mentally retarded. She eventually required full-time institutional care. Tierney later wrote in her autobiography, “After that I didn't care whether ever again I was anyone's favorite actress.” In 1962, the famous detective writer Agatha Christie (1890– 1976) published a mystery titled The Mirror Crack'd from Side to Side. Its plot line was based on Tierney's tragedy. The major difference is that in Christie's story, the woman who infected the actress with rubella is poisoned in revenge.

Prevention

A person who has had rubella is protected for life against becoming infected with the disease again. For children who have not had the

disease, it can be easily prevented by two doses of the combined measles-mumps-rubella (MMR) vaccine, usually given between twelve and fifteen months of age for the first shot, and between four and six years of age (before school entry) for the second vaccination.

Women of childbearing age who are not sure whether they received the MMR vaccine as children or are otherwise immune to the virus can have a blood test to find out whether antibodies against the virus are present. If not, they can be immunized as long as they postpone getting pregnant for twenty-eight days after the vaccination. Women should not be vaccinated against rubella at any time during pregnancy, or if they have an immune system weakened by cancer chemotherapy, radiation treatment, or HIV infection. People who are moderately or severely ill with any disease or disorder should consult their doctor before being vaccinated.

The Future

Rubella is likely to become an increasingly uncommon disease in the United States. Nonetheless, children should continue to be immunized against it, as periodic outbreaks occur from time to time when Americans travel to countries where immunization against the disease is not routine. Only about half of the world's population had been immunized against rubella as of 2008. Most recent outbreaks in the United States have been among Hispanics, many of whom were born in countries without rubella vaccination programs.

SEE ALSO Developmental disability; Glaucoma; Measles

WORDS TO KNOW

Congenital rubella syndrome (CRS): A group of birth defects that may affect a baby born to a mother who had rubella during the first three months of pregnancy.

Lymph node: Part of the lymphatic system, the lymph nodes trap foreign particles and are important to defend the body from disease.

For more information

BOOKS

Beers, Mark H. Merck Manual of Medical Information, 2nd home ed. White-house Station, NJ: Merck and Co., 2003.

Litin, Scott C., ed. Mayo Clinic Family Health Book, 3rd ed. New York: HarperResource, 2003.

PERIODICALS

Steinhauer, Jennifer. “Rising Public Health Risk Seen as More Parents Reject Vaccines.” New York Times, March 21, 2008. Available online at http://query.nytimes.com/gst/fullpage.html?res=9E0CEFDA1330F932A15750C0A96E9C8B63&sec=&spon=&pagewanted=all (accessed May 12, 2008). This is a news article about the rising rate of rubella and other preventable diseases among children whose parents refuse to have them vaccinated.

WEB SITES

Centers for Disease Control and Prevention (CDC). Rubella Disease In-Short (German Measles). Available online at http://www.cdc.gov/vaccines/vpd-vac/rubella/in-short-adult.htm (updated January 16, 2007; accessed May 12, 2008).

March of Dimes. Rubella (German Measles). Available online at http://www.marchofdimes.com/pnhec/188_673.asp (accessed May 12, 2008). This is a brief description of the effects of rubella on an unborn child and advice about immunization.

Mayo Clinic. Rubella. Available online at http://www.mayoclinic.com/health/rubella/DS00332 (updated July 9, 2007; accessed May 12, 2008).

National Network for Immunization Information (NNII). Vaccine Information: Rubella. Available online at http://www.immunizationinfo.org/vaccineInfo/vaccine_detail.cfv?id=24 (updated September 25, 2006; accessed May 12, 2008).