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Rubella

Commonly called German measles, rubella is an acute, mildly contagious viral disease that produces a distinctive rash and lymphadenopathy.

Rubella is worldwide in distribution. It flourishes during spring. Since the introduction of live attenuated vaccine in 1969, there have been no epidemics, and limited outbreaks have been reported in schools and workplaces. It occurs most commonly among children ages 5 to 9, adolescents, and young adults.

The incubation period is 18 days with a duration of 12 to 23 days. The disease is self-limiting and the prognosis is excellent, except for congenital rubella, which can have disastrous consequences.

Causes

Congenital rubella is caused by the destructive action of the rubella virus on the fetus at a critical time in development. The most critical time is the first trimester. After the fourth month, the mother's rubella infection is less likely to harm the developing fetus.

Symptoms and Signs

Rubella is usually a mild illness, with a slight fever, swelling of the lymph glands, and a rash that lasts for three days. Children may sometimes have no symptoms, but adults may have temporary swelling and pain in the joints, a low-grade fever, headache, weakness, runny nose, and red eyes.

Diagnostic tests

Clinical signs and symptoms usually are sufficient to make a diagnosis, so laboratory tests seldom are done. Cell cultures of the throat, blood, urine, and cerebrospinal fluid, along with convalescent serum that shows a fourfold increase in antibody titers, confirm the diagnosis. Rubella-specific immunoglobulin M (IgM) antibody also can be determined by laboratory testing.

Congenital rubella can be diagnosed by determining the presence of rubella-specific IgM antibody in cord blood.

Treatment

Because the rubella rash is self-limiting and only mildly pruritic, it doesn't require topical or systemic medication. Treatment consists of antipyretics and analgesics for fever and joint pain. Bed rest isn't necessary, but the patient should be isolated until the rash disappears.

Immunization with the live rubella virus vaccine (RA 27/3), the only rubella vaccine available in the United States, is necessary for prevention. The vaccine should be given with measles and mumps vaccines at age 15 months and a second dose during childhood.

Prevention

Vaccination prior to pregnancy can prevent congenital rubella. Pregnant women who are not immune to rubella should avoid contact with persons who have carry the virus.

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