Rubella is a viral infection characterized by fever, headache, swollen lymph nodes, aching joints, and a distinctive red rash. Although it is sometimes called German measles or three-day measles, it is not caused by the same virus that causes measles. Rubella is generally mild in children and more severe but not life-threatening in adults. However, if a pregnant woman is infected with rubella, it can cause serious problems for the unborn child. In the United States, most children receive the measles-mumps-rubella (MMR) vaccine, and therefore the disease has become uncommon. In March 2005, health officials announced that rubella has been eliminated from the United States. However, it is still important for Americans to vaccinate their children, and women who are pregnant or might get pregnant still need to be sure they are immune, because the disease exists elsewhere. According to the Centers for Disease Control and Prevention (CDC), nine rubella cases were reported in the United States in 2004, and all of them originated in other countries.
Rubella is predominantly a childhood disease, although it also occurs among adolescents and adults. It has a 14- to 21-day incubation period and a 1- to 5-day preliminary phase in children. The preliminary phase may be minimal or absent in adolescents and adults. Tender swelling of the glands in the back of the head, the neck and behind the ears is characteristic. The typical rash appears days after onset of these symptoms.
The rubella rash is similar to that of measles, but it is usually less extensive and disappears more quickly. It begins on the face and neck and quickly spreads to the trunk and the extremities. At the onset of the eruption, a flush similar to that of scarlet fever may appear, particularly on the face. The rash usually lasts about three days. It may disappear before this time, and rarely there is no rash at all. A slight fever usually occurs with the rash. Other symptoms such as headache, loss of appetite, sore throat and general malaise, are more common in adults and teenagers than in children.
After-effects of rubella are rare among children, although there have been cases of joint pain (arthralgia), sleeping sickness and blood clotting problems. Adult women who contract rubella are often left with chronic joint pains. Encephalitis is a rare complication that has occurred during extensive outbreaks of rubella among young adults serving in the armed services. Transient pain in the testes is also a frequent complaint in adult males with rubella.
Congenital rubella syndrome is the name applied to the disease that affects the unborn child when a pregnant woman becomes infected with rubella. This is most dangerous to the fetus during the first six months of pregnancy. Congenital rubella syndrome can lead to miscarriage, stillbirth, and birth defects that include cataracts, deafness, mental retardation, and cardiac anomalies.
Rubella is caused by a virus and is spread by airborne droplet clusters or by close contact with an infected person. A patient can transmit the disease from 1 week before onset of the rash until 1 week after it fades. Congenitally infected infants are potentially infectious for a few months after birth. Rubella is apparently less contagious than measles, and many persons are not infected during childhood. As a result, 10% to 15% of young adult women are susceptible if they have not been vaccinated against the disorder. Many cases are misdiagnosed or go unnoticed.
Before the rubella vaccine was developed, epidemics occurred at regular intervals during the spring. Major epidemics occur at about 6- to 9-year intervals. Once a person has been infected by rubella, immunity appears to be lifelong.
Rubella affects males and females in equal numbers. During 1964 and 1965, according to the CDC, a rubella epidemic in the United States caused an estimated 12.5 million cases of rubella and 20,000 cases of congenital rubella syndrome, which led to more than 11,600 babies born deaf, 11,250 fetal deaths, 2,100 neonatal deaths, 3,580 babies born blind, and 1,800 babies born mentally retarded. Since 1969, the rubella virus has been included in the measles, mumps, and rubella (MMR) vaccine routinely given to babies and young children.
Since the rubella rash is so much like rashes caused by other viruses, the definitive diagnosis is made on the basis of blood tests for the presence of the virus.
There is no specific treatment for rubella, so prevention (through vaccination) is important. Women of childbearing age who are not immune should be immunized. Conception should be prevented afterward until the overseeing physician says that it is safe. Women who become pregnant and have not had rubella or been immunized, or are not certain whether they have, should contact their physicians promptly.
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