Rubella

Rubella is a contagious infection caused by the rubella virus. It mostly affects children and young adults. Symptoms usually appear 2 to 3 weeks after exposure to the virus. The symptoms include rash, fever, nausea, and conjunctivitis. The rashes which occur in majority of cases, usually start on the face and neck, before progressing down the body. They can last from 1 to 3 days. The most infectious period is usually 1–5 days after the appearance of the rash.

Other names #

Also known as German measles, Three-day measles and Epidemic roseola

Causes #

• Contaminated droplets that are spread through the air while coughing, sneezing, talking, or coming in direct contact with infected nasal or throat secretions. The virus remains contagious in the air for up to two hours.

• Sharing food, drinks, and utensils with someone who has rubella.

• Kissing someone with rubella.

• Shaking hands or hugging someone having rubella.

• Pregnant women can pass on to their babies during the pregnancy, delivery, or while breastfeeding.

Symptoms #

In children, the symptoms of the disease include:

• Rashes

• Mild fever

• Nausea

• Mild conjunctivitis

• Lymphadenopathy (swollen lymph glands) behind the ears and in the neck

• Runny nose

• General discomfort

• Cough

Congenital rubella #

When a woman is infected with the rubella virus early in pregnancy (especially in the first trimester), she has a 90% chance of passing the virus to her baby. Pregnant women getting rubella have a high chance of miscarriage, premature delivery or fetal death. Also, their babies can have birth defects such as:

• Heart problems

• Intellectual disabilities

• Loss of hearing or eyesight

• Liver or spleen damage

• Microcephaly (baby’s head is much smaller than normal)

• Central nervous system sequelae like mental and motor delay, autism

• Thrombocytopenia with purpura/petechiae (blueberry muffin syndrome)

• Intrauterine growth retardation

• Meningoencephalitis

Diagnosis #

Clinical evaluation #

• Healthcare providers should consider rubella in patients a pink or red-spotted rash which is often the first sign of infection. These spots are especially helpful because they appear early.

• If the child has recently traveled or is unvaccinated, rubella is even more likely.

• Sometimes, other diseases can be complicated with rubella, but rubella rashes are easy to differentiate from other rashes.

• The rash starts on the face and spreads to the rest of the body.

Lab tests #

Laboratory confirmation is important after the clinical evaluation is done by the doctor.

IgM antibody: Detection of rubella-specific IgM antibody in serum. The antibody is usually present soon after the rashes appear. The level of antibodies is highest during the 14th day and is not present after the 30th day.

IgG antibody: A four-fold or greater increase in measles virus-specific IgG antibody levels is seen between acute and convalescent-phase serum specimens.

Cell culture: Rubella can also be diagnosed by isolation of the virus in cell culture from respiratory secretions, nasopharyngeal or conjunctival swabs, blood, or urine.

Biopsy: Direct detection of giant cells in the respiratory secretions, urine, or tissue obtained by biopsy provides another method of diagnosis.

Real-time polymerase chain reaction (RT-PCR): Rubella RNA by RT-PCR is a common method for confirming rubella. Serum samples as well as the throat swab are used for sample collection. RT-PCR is now a common assay that can detect 3 to 10 copies of rubella virus RNA. This test can sometimes be necessary since many specimens have small amounts of rubella RNA.

Urine sample: A urine sample can also contain the virus. Collecting urine samples can increase the chances of detecting the rubella virus.

Treatment #

Controlling fever and relieving pain #

Paracetamol and ibuprofen can be taken to control fever and the pain caused by the fever. Liquid infant paracetamol can be used for young children.

Drinking plenty of fluids #

If your child is having a high temperature drink a lot of fluids to eliminate the risk of dehydration.

Treating sore eyes #

Cleaning your child’s eyelids and closing curtains or dimming lights can help in soothing the eyes.

Treating cold-like symptoms #

If your child has cold-like symptoms then make them sit in a hot bathroom or make them drink warm liquids containing honey to relax the airway and soothe a cough.

Dealing with other illnesses #

Medical care is necessary to avoid serious complications because of the rubella virus. Some serious problems are:

• Shortness of breath

• Convulsions

• Sharp chest pain

Role of immunoglobulins #

• Immunoglobulins do not prevent rubella virus infection after exposure and therefore are not recommended as a routine treatment.

• However, administration of immunoglobulins can be considered only when a pregnant woman who has had exposure to a person with rubella will not consider termination of pregnancy under any circumstances.

• In such cases, administration of immunoglobulins within 72 hours of rubella exposure may reduce, but not eliminate the risk of rubella infection.