RUBELLA

Introduction

The disease is caused by a virus that is spread through the air or by close contact. It can also be transmitted to a fetus by a mother with an active infection. The disease is usually mild and may even go unnoticed. Children may have few symptoms, but adults may experience a prodrome (warning symptom) of a fever, headache, malaise, runny nose, and inflamed eyes that lasts from 1 to 5 days before the rash appears.

A person can transmit the disease from 1 week before the onset of the rash until 1 week after the rash disappears. The disease is not as contagious as rubeola (measles), therefore many people are not infected during childhood. Lifelong immunity to the disease follows infection. Epidemics may occur at about 6- to 9-year intervals. The risk factors are the unimmunized individuals. Only 1,400 cases were reported in the U.S. in 1991.

The disease is potentially serious because of the ability to produce defects in a developing fetus if the mother is infected during early pregnancy. As many as 10 to 15% of women in their childbearing years are susceptible to infection. Congenital rubella syndrome occurs in 25% or more of infants born to women who acquired rubella during the first trimester of pregnancy. Defects are rare if the infection occurs after the 20th week of pregnancy. One or more defects may occur in an infected fetus and include deafness, cataracts, microcephaly, mental retardation, congenital heart defects, and other defects. A miscarriage or stillbirth may occur.

Prevention

Live rubella virus vaccine is routinely recommended for all children. It is routinely given at 15 months of age, but is sometimes given earlier during epidemics. A second vaccination is required in some locations between the ages of 4 to 6 or 11 to 12. MMR immunization (vaccine) 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 3 months 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.

Symptoms

• low-grade fever (102ºF or lower)
• headache
• general discomfort or uneasiness (malaise)
• runny nose
• inflammation of the eyes (bloodshot eyes)
• rash with skin redness or inflammation
• cloudy cornea

Note: There may be no symptoms

Treatment

There is no treatment for this disease. Paracetamol can be given to reduce fever. The treatment of congenital rubella syndrome is for the defects that may be present.

Prognosis

Rubella is usually a mild, self-limiting infection with an excellent probable outcome. Up to 25% of infants born to mothers infected during early pregnancy will develop congenital rubella syndrome associated with a poor probable outcome.