Rubella

Rubella

National Organization for Rare Disorders, Inc.

Important

It is possible that the main title of the report Rubella is not the name you expected. Please check the synonyms listing to find the alternate name(s) and disorder subdivision(s) covered by this report.

Synonyms

  • German Measles
  • Three-Day Measles

Disorder Subdivisions

  • None

General Discussion

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.

Symptoms

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.

Causes

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.

Affected Populations

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.

Standard Therapies

Diagnosis

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.



Treatment

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.

Investigational Therapies

Information on current clinical trials is posted on the Internet at www.clinicaltrials.gov. All studies receiving U.S. government funding, and some supported by private industry, are posted on this government web site.



For information about clinical trials being conducted at the NIH Clinical Center in Bethesda, MD, contact the NIH Patient Recruitment Office:



Tollfree: (800) 411-1222

TTY: (866) 411-1010

Email: prpl@cc.nih.gov



For information about clinical trials sponsored by private sources, contact:

www.centerwatch.com

References

TEXTBOOKS

Beers MH, Berkow R, eds. The Merck Manual, 17th ed. Whitehouse Station, NJ: Merck Research Laboratories; 1999:2327-29; 2185-86.



Berkow R, ed. The Merck Manual-Home Edition.2nd ed. Whitehouse Station, NJ: Merck Research Laboratories; 2003:1580-82.



Bennett JC, Plum F, eds. Cecil Textbook of Medicine. 20th ed. W.B. Saunders Co., Philadelphia, PA; 1996:1761-62.



Behrman RE, Kliegman RM, Arvin AM, eds. Nelson Textbook of Pediatrics. 15th ed. W.B. Saunder Company. Philadelphia, PA; 1996:871-73.



REVIEW ARTICLES

Chez MG, Chin K, Hung PC. Immunizations, immunology, and autism. Semin Pediatr Neurol. 2004;11:214-17.



Song BJ, Katial RK. Update on the side effects from common vaccines. Curr Allergy Asthma Rep. 2004;4:447-53.



Levitt C, Shaw E, Wong S, et al. Systematic review of the literature on postpartum care: selected contraception methods, postpartum Papanicolaou test, and rubella immunization. Birth. 2004;31:203-12.



Atreya CD, Mohan KV, Kulkarni S. Rubella virus and birth defects: molecular insights into the viral teratogenesis at the cellular level. Birth Defects Res A Clin Mol Teratol. 2004;70:431-37.



Fitzpatrick M. MMR: risk, choice, chance. Br Med Bull. 2004;69:143-53.



Banatvala JE, Brown DW. Rubella. Lancet. 2004;363:1127-37.



Bedford H. Measles, mumps and rubella - safety of the combined combined vaccine. Nurs Times. 2004;100:74-75.



FROM THE INTERNET

Ratner A. Medical Encyclopedia: Rubella. MedlinePlus. Update Date: 9/26/2003. 3pp.

www.nlm.nih.gov/medlineplus/ency/article/001574.htm



FAQs about MMR Vaccine & Autism. CDC. National Immunization Program. Last reviewed on May 19, 2004. 10pp.

www.cdc.gov/nip/vacsafe/concerns/autism/autism_mmr.htm



Rubella. CDC. nd. pp. 145-158

www.cdc.gov/nip/publications/pink/rubella.pdf



Rubella. MayoClinic.com. June 16, 2004. 5pp.

www.mayoclinic.com/invoke.cfm?id=DS00332



Rubella. JAMA Patient Page: Rubella. January 23/30, 2002. 3pp.

www.medem.com/MedLB/article_detaillb_for_printer.cfm?



Facts About Rubella For Adults. National Coalition for Adult Immunization. July, 2002. 2pp.

www.nfid.org/factsheets/rubellaadult.html

Resources

Centers for Disease Control and Prevention

1600 Clifton Road NE

Atlanta, GA 30333

Tel: (404)639-3534

Tel: (800)232-4636

TDD: (888)232-6348

Email: cdcinfo@cdc.gov

Internet: http://www.cdc.gov/



NIH/National Institute of Allergy and Infectious Diseases

Office of Communications and Government Relations

6610 Rockledge Drive, MSC 6612

Bethesda, MD 20892-6612

Tel: (301)496-5717

Fax: (301)402-3573

Tel: (866)284-4107

TDD: (800)877-8339

Email: ocpostoffice@niaid.nih.gov

Internet: http://www.niaid.nih.gov/



Genetic and Rare Diseases (GARD) Information Center

PO Box 8126

Gaithersburg, MD 20898-8126

Tel: (301)251-4925

Fax: (301)251-4911

Tel: (888)205-2311

TDD: (888)205-3223

Internet: http://rarediseases.info.nih.gov/GARD/



For a Complete Report

This is an abstract of a report from the National Organization for Rare Disorders, Inc.® (NORD). Cigna members can access the complete report by logging into myCigna.com. For non-Cigna members, a copy of the complete report can be obtained for a small fee by visiting the NORD website. The complete report contains additional information including symptoms, causes, affected population, related disorders, standard and investigational treatments (if available), and references from medical literature. For a full-text version of this topic, see http://www.rarediseases.org/search/rdblist.html.

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