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Three-Day Measles / Rubella

Definition:
Rubella is sometimes called German measles or three-day (3-day) measles. Rubella is not the same as measles (rubeola). These conditions share some characteristics, but they're caused by different viruses.

Rubella and measles are both contagious viral infections best known by the distinctive red rash that may appear on the skin of those who contract either illness. However, rubella is neither as infectious nor usually as severe as measles, which is why rubella is also called three-day measles. There is one important exception: If a pregnant woman contracts rubella, especially during her first trimester, the virus can cause death or serious birth defects in the developing fetus.

The measles-mumps-rubella (MMR) vaccine, usually given to children in the United States twice before they reach school age, is highly effective in preventing the illness. Rubella outbreaks once were common in the United States. Today, because of widespread use of the vaccine, the Centers for Disease Control and Prevention has declared rubella eliminated in the United States, but cautions parents to make sure their children are vaccinated.

Causes
:
The cause of rubella is a virus that's passed from person to person. It can spread when an infected person coughs or sneezes, or it can spread by direct contact with an infected person's respiratory secretions, such as mucus. It can also be transmitted from a pregnant woman to her unborn child. A person with rubella is contagious from one week before the onset of the rash until about one to two weeks after the rash disappears.

Rubella is rare in the United States because most children receive a vaccination against the infection at an early age. However, cases of rubella do occur, mostly in unvaccinated foreign-born adults.

The disease is still common in many parts of the world, although more than half of all countries now use a rubella vaccine. The prevalence of rubella in some other countries is something to consider before going abroad, especially if you're pregnant.

When to seek medical advice:
Contact your doctor if you think you or your child may have been exposed to rubella or has some of the symptoms that might indicate rubella.

If you're contemplating getting pregnant, check your vaccination record to make sure you've received your MMR inoculations. It's best for women to be protected against rubella before pregnancy.

If you're pregnant, you'll likely undergo a routine screening for immunity to rubella. But if you've never received the vaccine and think you might have been exposed to rubella, contact your doctor immediately. A blood test might confirm that you're already immune and unlikely to develop rubella.

Symptoms:
Often the signs and symptoms of rubella are so mild that they're difficult to notice, especially in children. If signs and symptoms do occur, they generally appear between two and three weeks after exposure to the virus. They typically last about two to three days and may include :
  • Mild fever of 102 F or lower
  • Headache
  • Stuffy or runny nose
  • Inflamed, red eyes
  • Enlarged, tender lymph nodes at the base of the skull, the back of the neck and behind the ears
  • A fine, pink rash that begins on the face and quickly spreads to the trunk and then the arms and legs, before disappearing in the same sequence
  • Aching joints, especially in young women

Dignosis:
The rubella rash can look like many other viral rashes. So doctors usually confirm rubella with the help of laboratory tests. You may have a virus culture or a blood test, which can detect the presence of different types of rubella antibodies in your blood. These antibodies indicate whether you've had a recent or past infection or a rubella vaccine.

Complication:
Rubella is a mild infection. Once you've had the disease, you're usually permanently immune. About 70 percent of adult women with rubella experience arthritis in the fingers, wrists and knees, which generally lasts for about one month. In rare cases, rubella can cause an ear infection (otitis media) or inflammation of the brain (encephalitis).

However, if you're pregnant when you contract rubella, the consequences for your unborn child may be severe. Up to 85 percent of infants born to mothers who had rubella during the first 11 weeks of pregnancy develop congenital rubella syndrome. This can cause one or more problems, including growth retardation, cataracts, deafness, congenital heart defects and defects in other organs. The highest risk to the fetus is during the first trimester, but exposure later in pregnancy also is dangerous.

Fortunately, an average of fewer than 10 babies are born with congenital rubella syndrome in the United States each year. Rubella occurs most frequently in adults who never received vaccinations because they came from other countries where the MMR vaccine isn't widely used.

Treatment:
No treatment will shorten the course of rubella infection, and symptoms are so mild that treatment usually isn't necessary. However, doctors often recommend isolation from others — especially pregnant women — during the infectious period.

If you contract rubella while you're pregnant, discuss the risks to your baby with your doctor. If you wish to continue your pregnancy, you may be given antibodies called hyperimmune globulin that can fight off the infection. This can reduce your symptoms but doesn't eliminate the possibility of your baby developing congenital rubella syndrome.

Support of an infant born with congenital rubella syndrome varies depending on the extent of the infant's problems. Children with multiple complications may require early treatment from a team of specialists.

Prevention:
The rubella vaccine is usually given as a combined measles-mumps-rubella inoculation, which contains the safest and most effective form of each vaccine. Doctors recommend that children receive the MMR vaccine between 12 and 15 months of age, and again between 4 and 6 years of age — before entering school. It's particularly important that girls receive the vaccine to prevent rubella during future pregnancies.

Usually babies are protected from rubella for six to eight months after birth because of the immunity passed on from their mothers. If a child requires protection from rubella before 12 months of age — for example, for certain foreign travel — the vaccine can be given as early as 6 months of age. But children who are vaccinated early still need to be vaccinated at the recommended ages later.

Do you need the MMR vaccine?
You don't need a vaccine if you:
  • Had two doses of the MMR vaccine after 12 months of age or one dose of the MMR vaccine plus a second dose of measles vaccine
  • Have blood tests that prove you're immune to measles, mumps and rubella
  • Are a man who was born before 1957
  • Are a woman who was born before 1957 and you don't plan to have any more children, you already had the rubella vaccine or you have a positive rubella test
You should get a vaccine if you don't fit the criteria listed above and you:
  • Are a nonpregnant woman of childbearing age
  • Attend college, trade school or postsecondary school
  • Work in a hospital, medical facility, child care center or school
  • Plan to travel overseas or take a cruise

The vaccine is not recommended for :

  • Pregnant women or women who plan to get pregnant within the next four weeks
  • People who have had a life-threatening allergic reaction to gelatin or the antibiotic neomycin
If you have cancer, a blood disorder or another disease that affects your immune system, talk to your doctor before getting an MMR vaccine.

Side effects of the vaccine
Most people experience no side effects from the vaccine. About 15 percent of people develop a fever between seven and 12 days after the vaccination, and about 5 percent of people develop a mild rash. Some teens and adult women experience temporary joint pain or stiffness after receiving the vaccine. Fewer than one out of a million doses causes a serious allergic reaction.

In recent years, some news reports have raised concerns about a connection between the MMR vaccine and autism. However, extensive reports from the American Academy of Pediatrics, the Institute of Medicine, and the Centers for Disease Control and Prevention (CDC) conclude that there is no scientifically proven link between the MMR vaccine and autism. In addition, there is no scientific benefit to separating the vaccines. These organizations note that autism is often identified in toddlers between the ages of 18 months and 30 months, which happens to be about the time children are given their first MMR vaccine. But this coincidence in timing shouldn't be mistaken for a cause-and-effect relationship.
 
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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