Topic: Rubella (German measles)
Description
For most people, rubella is a mild illness caused by the rubella virus. However, rubella can cause serious birth defects if infection occurs during pregnancy. Up to 20% of pregnant women will miscarry if they are infected with rubella. If miscarriage does not occur, there is a risk of the infant being born with congenital rubella syndrome (CRS). CRS occurs in up to 90% of infants born to women who are infected with rubella during the first trimester of pregnancy. Infection after the 15th week of pregnancy carries a 10%-20% risk of defects in the infant. From the 20th week of pregnancy defects are rare following rubella infection. The most common defects to occur are deafness, cataracts and other vision problems, inflammation of the brain, heart defects, liver disease, bone disease and growth retardation.
There have been 43 cases of rubella notified in Queensland since 2005. However, as not all cases get symptoms or are notified, the actual number is likely to have been higher. Since the introduction of an effective vaccine, rubella mainly occurs in young unimmunised children, or in adolescents and young adults who have received less than two doses of the vaccine.
Symptoms
Up to 50% of people infected with rubella, and particularly children, show few or no symptoms. Adults may have a fever, headache, loss of appetite and feel generally unwell from around five days before the onset of a generalised rash. Other symptoms of rubella may include arthritis or painful joints, swollen lymph glands (especially at the back of the neck), cough, runny nose and conjunctivitis. Inflammation of the brain (encephalitis) is a rare complication, occurring more frequently in adults than in children.
The rash is the most common symptom of rubella and usually lasts 3 to 5 days. If fever is present, the fever usually settles on the first day of the rash.
Transmission
Rubella is highly contagious. It is spread by droplets from the nose and throat through coughing or sneezing, or by direct contact with infectious people.
The usual time between contact with the virus and the development of the illness is 14-17 days, although sometimes it can take longer.
A person is infectious from seven days before the onset of the rash until at least four days after the rash appears. Infants with CRS shed large quantities of virus in body secretions for up to one year and can therefore transmit rubella to susceptible people caring for them.
Treatment
Symptoms of the rubella virus can generally be treated with rest, plenty of fluids, and paracetamol to reduce fever or pain. Your local doctor can provide you with advice.
If a pregnant woman at 20 weeks gestation or less has been in contact with the rubella virus, she should consult her doctor for blood tests and counselling.
Control
People with rubella should stay away from childcare, school or work until fully recovered and until at least four days after the rash appears. It is very important that they stay away from crowded areas such as shopping centres, and also keep away from pregnant women while they are infectious.
Health Outcome
Prevention
Rubella can be prevented with vaccination. While rubella is generally a mild disease, vaccination is important to prevent the virus from being spread to pregnant women and their unborn babies. The rubella vaccination is offered as part of a combined measles, mumps and rubella (MMR) vaccine and is recommended for all children at 12 months of age and again at four years of age.
The MMR vaccine is also recommended for adults who are not immune or don't have a documented history of vaccination. It is particularly important for women of childbearing age who are not immune. These women should avoid becoming pregnant for 28 days after vaccination. They should have a blood test two months after vaccination to make sure they have become immune. A second dose of the vaccine can be given if necessary and the woman is not pregnant. Women found not to be immune while pregnant should be vaccinated after delivery.
Vaccination is also recommended for the following groups:
- males born during or after 1966 who do not have a record of having two rubella vaccinations
- healthcare staff and people working with children born during or since 1966 who have no record of receiving the vaccine or who are not immune on blood tests.
Help and Assistance
For further information please contact your local doctor, community health centre or nearest public health unit.
References
Heymann, D., ed. 2008. Control of Communicable Diseases Manual, 18th edition. Washington, DC: American Public Health Association, pp 529-534.
National Health and Medical Research Council, 2008. The Australian Immunisation Handbook (9th Ed.) Canberra: National Capital Printing.
Related Content
Rubella and immunisation fact sheet
Last Updated: 24th November, 2010
Date Valid to: 24th November, 2011
