Rubella

What is Rubella?

Rubella, also known as German measles, is a mild viral infection that usually affects children and young adults who have not been vaccinated or had the disease before. The infection often starts with a slight fever, feeling unwell, and swollen lymph nodes, followed by a short-lived rash all over the body.

For people who aren’t pregnant, rubella is usually a self-contained infection that resolves itself. However, if a pregnant woman gets rubella, particularly during the first 10 weeks of pregnancy, it can lead to miscarriage, the fetus dying in the womb, or severe birth defects. These birth defects are collectively referred to as congenital rubella syndrome (CRS).

Since the introduction of a vaccine for rubella in 1969, the number of rubella infections has dropped greatly in many countries. In fact, the disease has been effectively eliminated from the United States. Despite this progress, rubella remains a public health concern and a major cause of long-term disability worldwide.

What Causes Rubella?

The Rubella virus is the only virus in the specific category (or ‘genus’) known as Rubivirus, which is part of a newly classified family of viruses called Matonaviridae. This virus is built from single-stranded RNA (which is a type of genetic material) and is surrounded by an envelope. The Rubella virus produces two non-structural proteins (p90 and p150) and three structural proteins, known as glycoprotein (E1 and E2) and the capsid protein (CP).

In simpler terms, the E1 protein helps the virus to enter cells within your body and triggers your immune system to respond and fight the virus. This often causes a health condition prevalent in human populations known as “Rubella.”

Lastly, it’s good to know that the Rubella virus isn’t very strong and can be killed by high temperatures (over 56°C), exposure to ultraviolet light, and extremes in pH levels (pH levels lower than 6.8 or higher than 8.1). This means the virus can be killed with these common germ-fighting methods.

Risk Factors and Frequency for Rubella

Rubella used to be most common in children aged 5 to 9 years, especially during late winter and early spring. However, after the introduction of vaccination in the United States, the number of rubella cases has significantly dropped, although a few cases are occasionally reported among people coming from countries where rubella is still a common disease.

Rubella affects both boys and girls equally. However, among adults, more women are affected than men. Also, since the creation of the rubella vaccine, rubella tends to occur more often among older adolescents and young adults. People most at risk for rubella include those who haven’t gotten their vaccines, those who travel to places where rubella is common, those living with someone who has rubella, and those who have a weakened immune system.

In countries where rubella is still common, about 1.3 out of every 100,000 people typically get the disease.

Signs and Symptoms of Rubella

Postnatal rubella infection, meaning infection with rubella after birth, doesn’t show symptoms in roughly 25% to 50% of people, particularly young children. When signs do show, they typically start 14 to 21 days after exposure. Symptoms may include a mild fever, fatigue, loss of appetite, headaches, a sore throat, and swollen lymph nodes. These swollen lymph nodes often appear behind the ears, at the base of the skull, and on the front of the neck. A child may begin to develop a rash of tiny pink spots and bumps that starts on the face and quickly spreads to the body and limbs. Sometimes, the rash may look like scarlet fever or show signs of bleeding under the skin. This rash usually lasts for three days and disappears in the same order in which it appeared. Around 20% of patients also display tiny red or purple spots on the soft, back part of the roof of their mouth.

When rubella infection happens during the formation of an embryo, it can result in a condition known as congenital rubella syndrome (CRS). This can lead to a combination of birth defects – most commonly cataracts, heart defects, and hearing loss. A baby with CRS might also be underweight at birth, have low platelet count with signs of bleeding, break down their red blood cells too fast, and show unusual enlargement of the liver, spleen, and inflammation of membranes around the brain and spinal cord. These signs usually resolve over time. Other symptoms of CRS can include eye diseases, heart abnormalities, delayed motor skills, and a smaller than normal head size.

In those with CRS, hearing loss is the most commonly seen symptom and sometimes may be the only sign. If a child survives the newborn period, they may have severe disabilities including visual and hearing impairments and also face a higher risk of developmental disorders like autism. Some late appearing health problems connected to CRS include, abnormalities in hormone function, circulatory system, and nervous system.

Testing for Rubella

Diagnosing Rubella, also known as German Measles, can be challenging because the symptoms can be mild and not specific to the disease. Because of this, doctors often perform blood tests to confirm the diagnosis.

The most common test looks for rubella-specific IgM antibodies in your blood using a method called an enzyme immunoassay. If these antibodies are present, usually detectable about 4 days after a rash appears, it’s a good sign that you may have been recently infected with Rubella. Furthermore, if the blood test determines that there’s been a large increase in different antibodies known as rubella-specific IgG titers, it can show that a Rubella infection or reinfection has occurred. In some cases, a specific low avidity IgG can also confirm a recent primary Rubella infection.

For pregnant women who may have been exposed to Rubella, doctors recommend testing their blood for rubella-specific IgG antibodies as soon as possible. If these antibodies are present, it usually means that the woman is likely immune to Rubella and can be reassured. If no antibodies are found, doctors typically wait 3 weeks and then repeat the blood test, this time testing for both rubella-specific IgG and IgM. Doing so will help ensure that any silent or symptomless Rubella infection is caught.

Before birth, doctors can diagnose a congenital Rubella infection (an infection passed from mother to baby) in several ways. One way is by identifying specific IgM antibodies in the baby’s blood. alternatively, the presence of Rubella’s genetic material (RNA) can be detected in amniotic fluid, fetal blood, or taken from a small sample of the placenta known as a chorionic villus biopsy. This is done using a technique called reverse transcription-polymerase chain reaction (RT-PCR). Once the baby is born, doctors can usually diagnose congenital Rubella by finding rubella-specific IgM in the baby’s blood for the first 6 months of life, or by seeing the presence or an increase in rubella-specific IgG after 6 to 12 months. They can also detect the viral genome in samples taken from the baby’s nose and throat, urine, and oral fluid via RT-PCR to give hard evidence of a congenital Rubella infection.

Treatment Options for Rubella

If you get rubella, which is also known as German Measles, after you’re born and you’re not pregnant, the treatment is normally pretty simple. It usually involves taking over-the-counter drugs like Tylenol to help with symptoms like fever, muscle and joint pain or swelling.

If you’re pregnant, on the other hand, the way doctors manage the illness will depend on how far along you are in your pregnancy. If you get rubella before 18 weeks into the pregnancy, there’s a high risk that the virus could harm the fetus and cause malformations. So, doctors may advise considering pregnancy termination depending on local ethical and legal rules.

If you get rubella after 18 weeks into your pregnancy, there’s less risk to the fetus. Doctors may suggest continuing the pregnancy, while keeping a close eye on the baby’s development with ultrasound scans. After the baby’s birth, doctors will manage the infant’s care based on their specific needs.

Children who are born with congenital rubella syndrome will need therapy that matches their specific symptoms and supports the affected body parts. This might involve care from many different kinds of doctors, including pediatricians, eye doctors, heart doctors, audiology (ear) doctors, and neurodevelopmental specialists. These children will need to be checked regularly for a long time to see if any problems show up later.

What else can Rubella be?

Rubella has symptoms similar to several other medical conditions, which could result in confusion during diagnosis. These conditions include both infections featuring similar kinds of rashes and non-infectious causes.

Here are some of the conditions that may resemble Rubella:

• Other infections such as measles, human herpesvirus 6 and 7, infectious mononucleosis, cytomegalovirus, various arboviruses (like Zika virus, West Nile fever, Ross River fever, and Chikungunya virus), enteroviruses, scarlet fever, and mycoplasma infection.
• Non-infectious causes like Kawasaki disease, drug eruption, and contact dermatitis.

It is essential to differentiate these conditions from Rubella to provide the right treatment.

What to expect with Rubella

Getting infected with rubella after birth is usually not severe, tends to clear up on its own, and has a good recovery outlook. However, the situation is less positive for children born with rubella, or congenital rubella syndrome. The outcomes for these children greatly depends on how severe the infection is and how many of their organs are affected. Babies with complications like low platelet count (thrombocytopenia), lung inflammation (interstitial pneumonia), enlargement of the liver and spleen (hepatosplenomegaly), and high blood pressure in the lungs (pulmonary hypertension), face a higher risk of dying.

Also, children born with rubella are at risk of long-term health issues such as blindness, heart failure, developmental problems, and a shortened life span.

Possible Complications When Diagnosed with Rubella

The most common problem that can occur when someone gets rubella, or German measles, is joint pain and swelling, especially in teenage and adult women. This can affect up to 70% of these patients and is usually noticed in places like the wrists, fingers, knees, and ankles. Rubella can also cause other less common, but severe health problems, such as low platelet count, a form of anemia where the body destroys its own red blood cells, heart inflammation, liver inflammation, testicle inflammation, eye diseases, Guillain-Barré syndrome, and a type of brain inflammation that occurs after infection.

Women who get infected with rubella during pregnancy can have other complications like miscarriage, stillbirth, premature labor, slowed growth of the baby in the womb, and a group of birth defects known as congenital rubella syndrome. The risk of these complications is highest if a woman catches the infection within the first 12 weeks of pregnancy.

Common Complications:

• Pain and swelling in multiple joints
• Low platelets in the blood
• Red blood cell destruction leading to anemia
• Heart inflammation
• Liver inflammation
• Testicle inflammation
• Eye diseases (retinopathy and uveitis)
• Guillain-Barré syndrome
• Post-infection brain inflammation
• Complications in pregnancy, including miscarriage, stillbirth, premature labor, slow fetal growth, and congenital rubella syndrome

Preventing Rubella

It’s important for parents to understand the critical role of getting routine vaccinations for their infants and young children. Vaccinations help their bodies build up a defense against various diseases. Also, women who are capable of having children need to be aware of their vaccination status before becoming pregnant. All of this ensures that future generations are protected from potential health threats.