RUBELLA

DEFINITION

Rubella (pronounced roo-BELL-uh) is a highly contagious (catching) viral disease also known as German measles. It is spread through contact with discharges from the nose and throat of an infected person. The symptoms of the disease include swollen glands, joint pain, low fever, and a fine red rash. While relatively mild in most instances, Rubella can have serious complications for pregnant women and may cause a miscarriage (prematurely ended pregnancy) or severe birth defects in the infected woman's child.

DESCRIPTION

Rubella was once a common childhood disease. However, an effective vaccine (pronounced vak-SEEN) against the disease was invented in 1969. A vaccine is a material that causes the body's immune system to build up resistance to a particular disease. Over the next three decades the number of rubella cases dropped more than 99.6 percent. In 1996 only 229 cases of the disease were reported in the United States and public health officials hoped to eliminate the disease completely within a few years.

The virus that causes rubella is spread when an infected person coughs or sneezes, sending droplets of water containing the virus into the air. If these droplets come to rest on another person, the virus may enter the healthy person's body, causing that person to develop the disease.

Rubella has an incubation period of about twelve to twenty-three days. The incubation period is the time after a person is infected before the symptoms of the disease first appear. An infected person is contagious (can spread the disease) during a period of about seven days before the symptoms appear until four days after they appear.

Rubella is usually considered a childhood disease but people of any age can catch it if they have not been vaccinated. People who have been vaccinated are protected against the disease forever.

Rubella poses the greatest danger to pregnant women and their fetuses. Women who develop the disease during the first trimester (three months) of their pregnancy face a serious risk. The virus passes from an infected woman's body into the body of the fetus. The virus may cause a serious infection that can cause birth defects or even kill the fetus.

This risk is considered very low in the United States because most women in this country were vaccinated against rubella when they were children. However, in some parts of the world countries do not have the money or the medical facilities to vaccinate all children. Many girls still grow up unprotected against the disease and the risk it poses if they become pregnant.

CAUSES

Rubella is caused by a virus called Rubivirus.

SYMPTOMS

The first sign of rubella is a fine red rash on the face. The rash spreads across the whole body within twenty-four hours and lasts about three days. Because of this fact, rubella is sometimes called the three-day measles (see measles entry).

Other symptoms include swollen glands and a low fever. There may also be pain or swelling in the joints. Interestingly, some patients show no symptoms of the disease at all. Symptoms usually disappear after about three days. Some joint pain may remain for a week or two. Most people recover with no complications.

The one exception is pregnant women. If these women get rubella during the first three months of pregnancy, the health of their fetus is threatened. Birth defects occur in about half of all women who get rubella in the first month of pregnancy. The rate of birth defects drops to 20 percent in the second month and 10 percent in the third month.

Some birth defects caused by rubella include:

• Eye defects, such as cataracts (see cataract entry), glaucoma (see glaucoma entry), and blindness
• Deafness
• Heart defects
• Mental retardation (see mental retardation entry)

The risk of birth defects drops dramatically after the first trimester. After the twentieth week of pregnancy, there are rarely any complications caused by rubella.

DIAGNOSIS

The symptoms of rubella are similar to those of other diseases. A positive diagnosis can be made only with a blood test. The blood test is designed to look for antibodies to the rubella virus. An antibody is a chemical produced by the body's immune system to fight off infections. Each antibody is designed to attack a specific virus or bacterium. If antibodies to the Rubivirus are present, the person has been infected with the virus.

TREATMENT

There is no treatment for rubella. The disease runs its course in a short time. Bed rest and fluids may help the body heal itself. Painkillers, such as aspirin or acetaminophen, can be used to reduce any discomfort and fever. Aspirin should not be given to children because of the risk of Reye's syndrome (see Reye's syndrome entry).

Alternative Treatment

A number of alternative treatments have been suggested in order to make patients comfortable during the period they have rubella. These treatments include ginger tea or clove tea, which some people believe make the disease run its course faster. Other herbs suggested for the treatment of rubella symptoms include peppermint, cicada, witch hazel, and eyebright. Homeopathic practitioners may recommend Belladonna, Pulsatilla, or Phytolacca.

Rubella rash. (Reproduced by permission of

Custom Medical Stock Photo

)

Rubella virus particles, magnified 300,000 times. (© 1994. Reproduced by permission of

Custom Medical Stock Photo

.)

PROGNOSIS

The vast majority of patients recover completely from rubella with no further complications. The greatest threat is to pregnant women in their first trimester (roughly the first three months of pregnancy). Fetuses carried by these women are at risk of being miscarried, stillborn, delivered with a low birth weight, or of developing birth defects.

PREVENTION

Vaccination is a safe and certain way to prevent rubella. Most school systems today require that children be vaccinated for rubella before entering school. The rubella vaccine is given in conjunction with vaccines for measles and mumps. The combined vaccine is known as the MMR vaccine. Children receive their first dose of MMR vaccine at the age of twelve to fifteen months and receive a second dose at between the ages of four and six years.

Women who intend to have children should be tested for the Rubivirus antibody. If they lack the antibody, they should be vaccinated against the disease. However, they should not be vaccinated after they have become pregnant.

FOR MORE INFORMATION

Books

Silverstein, Alvin, Virginia Silverstein, and Robert Silverstein. Measles and Rubella. Hillside, NJ: Enslow Publishers, Inc., 1997.

Organizations

March of Dimes Resource Center. 1275 Mamaroneck Ave., White Plains, NY 10605. (888) 663–4637. http://www.modimes.org.

National Organization of Rare Disorders. PO Box 8923, New Fairfield, CT 01812. (800) 999–6673. http://www.rarediseases.org.