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What is Rubella?
Rubella - commonly known as German measles or
3-day measles - is an infection that primarily affects the skin
and lymph nodes. It is caused by the rubella virus (not the same
virus that causes measles), which is usually transmitted by secretions
from the nose or throat. It can also pass through a pregnant woman's
bloodstream to infect her unborn child. As this is a generally
mild disease in children, the primary medical danger of rubella
is the infection of pregnant women, which may cause congenital
rubella syndrome in developing babies.
Before a vaccine against rubella became available in 1969, rubella epidemics occurred every 6 to 9 years. Children ages 5 to 9 were primarily affected, and many cases of congenital rubella occurred as well. Now, due to immunization of younger children and teens, there are fewer cases of congenital rubella.
Most rubella infections today appear in young, unimmunized adults rather than children. In fact, experts estimate that 10% of young adults are currently susceptible to rubella, which could pose a danger to any children they might have someday.
Signs and Symptoms
Rubella infection may begin with 1 or 2 days of mild fever (99 to 100 degrees Fahrenheit, or 37.2 to 37.8 degrees Celsius) and swollen, tender lymph nodes, usually in the back of the neck or behind the ears. On the second or third day, a rash appears that begins on the face and spreads downward. As it spreads down the body, it usually clears on the face. This rash is often the first sign of illness that a parent notices.
The rubella rash can look like many other viral rashes. It appears as either pink or light red spots, which may merge to form evenly colored patches. The rash can itch and lasts up to 3 days. As the rash passes, the affected skin occasionally sheds in very fine flakes.
Other symptoms of rubella, which are more common in teens and adults, may include: headache; loss of appetite; mild conjunctivitis (inflammation of the lining of the eyelids and eyeballs); a stuffy or runny nose; swollen lymph nodes in other parts of the body; and pain and swelling in the joints (especially in young women). Many people with rubella have few or no symptoms at all.
When rubella occurs in a pregnant woman, it may cause congenital rubella syndrome, with potentially devastating consequences for the developing fetus. Children who are infected with rubella before birth are at risk for growth retardation; mental retardation; malformations of the heart and eyes; deafness; and liver, spleen, and bone marrow problems.
The rubella virus passes from person to person through tiny drops of fluid from the nose and throat. People who have rubella are most contagious from 1 week before to 1 week after the rash appears. Someone who is infected but has no symptoms can still spread the virus.
Infants who have congenital rubella syndrome can shed the virus in urine and fluid from the nose and throat for a year or more and may pass the virus to people who have not been immunized.
Rubella can be prevented by a rubella vaccine. Widespread immunization against rubella is critical to controlling the spread of the disease, thereby preventing birth defects caused by congenital rubella syndrome.
The vaccine is usually given to children at 12 to 15 months of age as part of the scheduled measles-mumps-rubella (MMR) immunization. A second dose of MMR is generally given at 4 to 6 years of age, but should be given no later than 11 to 12 years of age. As is the case with all immunization schedules, there are important exceptions and special circumstances. Your child's doctor will have the most current information.
The rubella vaccine should not be given to pregnant women or to a woman who may become pregnant within 1 month of receiving the vaccine. If you are thinking about becoming pregnant, make sure that you are immune to rubella through a blood test or proof of immunization. If not, you should receive the vaccine at least 1 month before you become pregnant.
Pregnant women who are not immune should avoid anyone who has the illness and should be vaccinated after delivery so that they will be immune during any future pregnancies.
The incubation period for rubella is 14 to 23 days, with an average incubation period of 16 to 18 days.
The rubella rash typically lasts 3 days. Lymph nodes may remain swollen for a week or more, and joint pain can last for more than 2 weeks. Children who have rubella usually recover in 1 week, but adults may take longer.
Rubella cannot be treated with antibiotics because antibiotics do not work against viral infections.
Any pregnant woman who has been exposed to rubella should contact her obstetrician immediately.
Rubella is usually a mild illness, especially in children and typically requires little special care at home. Monitor your child's temperature, and call your child's doctor if the fever climbs too high.
To relieve minor discomfort, you can give your child acetaminophen or ibuprofen. Avoid giving aspirin to a child who has a viral illness because the use of aspirin in such cases has been associated with the development of Reye syndrome, which can lead to liver failure and death.
When to Call Your Child's Doctor
Call your child's doctor if your child develops a fever of 102 degrees Fahrenheit (38.9 degrees Celsius) or above (in a child younger than 6 months, call for a fever above 100.4 degrees Fahrenheit, or 38 degrees Celsius), or if your child appears to be getting sicker than the mild course of symptoms described above.