Family doctor

Overview:

• Rubella is caused by a virus and is sometimes known as "German measles"
• It is generally a mild illness but is serious in pregnancy and can cause birth defects
• The incubation period is between two and three weeks
• The illness starts with mild fever and swollen glands with a rash a few days later
• There is no cure and rest is the best treatment
• Most people recover within one week
• Women of childbearing age should be immunised against rubella
• Rubella vaccine is routinely given to infants aged between 12 and 15 months

What is it?

Rubella is also known as German measles and is different from English measles in which the illness lasts longer.

Rubella is mostly a mild childhood illness. However, it is serious if contracted during pregnancy.

Rubella can cause birth defects and miscarriage. Children infected in the womb may be born with abnormal eyes, heart, brain, and have liver, spleen, hearing, and bone marrow problems. It is particularly dangerous in the first 3 months of pregnancy.

The disease is usually very mild - one quarter of those affected have no symptoms. It lasts about one week and is spread by sneezing and coughing.

The incubation period for rubella is between two and three weeks, with an average of 18 days. People are contagious one week before the rash appears and up to one week after it.

Before a vaccine was available in 1969 there were rubella epidemics every six to nine years, mainly affecting children, and infants born with congenital abnormalities.

It is now estimated about 10 percent of women of child bearing age are at risk of rubella infection.

What are the symptoms?

It begins with two to three days of mild fever and swollen glands found in the neck or behind the ears.

A scattered rash of small pink or light red spots appears on the second or third day. It begins on the face and spreads down the rest of the body. The rash doesn't itch and lasts about three days. Most children recover within one week but adults may take longer to feel better.

Some people may experience other symptoms such as red eyes, a blocked or runny nose, swollen lymph glands and aching joints.

In rare cases the disease causes inflammation of the brain.

It is important to get medical advice and make an accurate diagnosis, as other conditions (such as meningitis) may also start as fever with a rash.

What can be done to help?

Rest is the best treatment. There is no cure for rubella.

Paracetamol may help relieve symptoms, and drink lots of fluid.

Do not give aspirin to a child with a viral infection because this has been linked to Reye's syndrome, a very rare but potentially fatal illness which can cause brain swelling and liver damage.

How can it be prevented?

A vaccine is available to prevent rubella and is generally given to children aged 12 to 15 months. However, immunisation rates are still too low in many countries.

Women are tested for immunity against the virus in early pregnancy. This should be repeated for each pregnancy. Women planning pregnancy should check whether they are immune before trying to conceive (a simple blood test can tell).

Women without immunity who are not pregnant should be vaccinated against the virus. A woman should not get pregnant for three months after immunisation because it's been suggested the vaccine itself could cause birth defects.

Stay home if you are diagnosed with rubella and stay away from anyone in the early stages of pregnancy.

Telephone the doctor before visiting to ensure there are no pregnant patients in the waiting room.

Future trends

Increasing immunisation rates with the measles, mumps and rubella (MMR) vaccine is the key to preventing outbreaks in the future.

Getting help

Your doctor can offer advice on diagnosis, and vaccination for rubella.