Rubella or German measles is a contagious viral infection of the respiratory tract accompanied by a characteristic skin rash. Although the red rash is common between German measles (rubella) and measles (rubeola), the causative viruses and the progression of these diseases are very different. Due to the active immunization program with the measles-mumps-rubella (MMR) vaccine, rubella is declared as eliminated from U.S. by the Center for Disease Control and Prevention (CDC). However, the disease is prevalent in other countries and among immigrants to developed nations who were not vaccinated in childhood.
The key symptom of rubella is the pink rash which typically lasts for three days and hence the name three day measles. In children, this is the first symptom. It starts at the hairline, then on the face and later spreads downwards towards the body trunk and the limbs. The rash then, heals in the same order.
In adults, the symptoms manifest 2 to 3 weeks after contracting the virus, the time known as the incubation period of the virus. The rash is preceded by signs of a nose and throat infection such as mild fever, running nose, phlegm, malaise, muscle pain and headache. Inflammation, another key feature of rubella, causes blood red eyes and swollen lymph nodes at the neck, armpits and behind the ears. Some patients experience ongoing joint pains even after the infection resolves.
German measles (rubella) is caused by the rubella virus. Droplets dispersed during coughing and sneezing are the primary mode of disease transmission. An infected person is contagious from the “running nose” phase till two weeks after the disappearance of the rash. The patient should be quarantined to avoid transmission to other members in the household, especially pregnant women.
The reason for this isolation from pregnant women is because the infection in the gestating mother can cause a viral transmission to the developing fetus through blood, resulting in congenital rubella. Urine and nasal secretions from the newborn, then serves as a means of infection for a non-vaccinated person.
Individuals whose immunity is weakened such as cancer patients on radiation therapy and those on corticosteroid medications are at high risk of contracting a rubella infection.
Diagnosis of rubella is done by testing nasal and throat swabs for the presence of virus, as it lodges in the upper respiratory system. A blood test may reveal the presence of antibodies against the rubella virus. This is an important part of the various tests that women take before conceiving.
The MMR vaccine is administered at the age of 12 to 15 months and is followed by a booster dose when children are 4 to 6 years old. This has been very effective in conferring immunity against rubella as well as the mumps and measles viruses.
There is no treatment for rubella. The immune system mounts a response against the rubella virus which provides life-long immunity against the disease. However, patients may be given antipyretics (to reduce fever) and anti-inflammatory medications to provide symptomatic relief.
Pregnant women affected by rubella are given shots of hyperimmune globulin antibodies which reduces the infection severity in the mother. It must be noted that these injections do not eliminate the possibility of congenital rubella in the newborn.