Rubella

Rubella, also called German measles, is a viral illness that is spread from person to person by breathing in droplets of respiratory secretions exhaled by an infected person. It also may be spread by touching the nose or mouth after a person’s hands have been in contact with secretions (such as saliva) of an infected person.

Rubella and congenital rubella syndrome, a condition that affects newborn infants when the mother transfers rubella to the baby, became nationally reportable diseases in 1966. Prior to this, epidemics were occurring every six to nine years. Following vaccine licensure in 1969, no further large epidemics have occurred, and the number of U.S. cases has dropped annually from 58 per 100,000 in the pre-vaccine era to 0.5 per 100,000 by 1983. Since 1994, the disease has occurred predominately among persons 20 to 39 years old; most of these persons were born outside the U.S. in areas where rubella vaccine is not routinely given. The decrease in rubella cases has paralleled s increased efforts to vaccinate susceptible adolescents and young adults, especially women.

Outbreaks continue to occur among groups of susceptible persons who congregate in locations that increase their exposure, such as workplaces, and among persons with religious and philosophic exemption to vaccination. Several recent outbreaks have occurred among Hispanic persons. In fact, in 1996, two-thirds of reported cases were among Hispanics.

Symptoms of rubella include an acute onset of rash (small, fine pink spots) that starts on the face and spreads to the torso, then to the arms and legs, with low-grade fever, swollen lymph nodes or conjunctivitis. Many (25 percent to 50 percent) cases are asymptomatic, especially in children, but adults may experience symptoms for one to five days. Incubation is normally 16-18 days, but can be 12 -23 days. Persons with rubella are infectious from seven days before rash onset to seven days after rash onset.

Rubella can be especially dangerous to pregnant women, who may transfer infection to the baby, resulting in abortions, miscarriages, stillbirths and severe birth defects. The most common congenital defects are cataracts and other eye defects, heart defects, sensorineural deafness, mental retardation and other immunodeficiencies.

The disease is most contagious when the rash is erupting. In schools and other educational institutions, exclusion of persons without valid evidence of immunity and persons exempted from rubella vaccination because of medical, religious or other reasons should be enforced and continue until two weeks after the onset of rash of the last reported case in the outbreak setting. In medical settings, mandatory exclusion and vaccination of adults should be practiced.

Treatment includes bed rest, lots of fluids and medicine for fever, headache or joint pain. Antibiotics neither cure nor prevent rubella. There are no antiviral drugs for treating rubella.

The best prevention against rubella is immunization.The rubella vaccine is part of the MMR (measles, mumps, rubella) vaccine administered to children beginning at 12 months of age. Susceptible hospital personnel, volunteers, trainees, nurses, physicians and all persons who are not immune should be vaccinated against rubella. Women who are pregnant or intend to become pregnant within three months, however, should not receive rubella vaccine.

Acquired immunity after illness is permanent.